Tag Archives: skin health


Just How Beneficial Is ‘Good’ Bacteria to the Body?

It’s quite well known that the good bacteria of our internal microbiome help to support the health of the digestive system. However, recent research has highlighted other areas where using specific good bacteria could support other areas of health and wellbeing. This includes intimate health, skin health, mood and memory.

Good bacteria for mood and memory

In the last decade, it has been revealed that the brain and the gut are in constant communication with each other. This has led to a field of research known as ‘psychobiotics’, investigating the link between the gut flora and the development of psychological problems (1).

Specific bacteria shown to be helpful for mood and memory
  • Studies have indicated that probiotic treatment can induce behavioural and psychological changes, including improved memory and reduced anxiety (2). The strains with the most consistent research include Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus and Bifidobacteria bifidum.
  • In a study on chronic fatigue syndrome, supplementation with L. casei was linked to a significant decrease in anxiety symptoms (3).
  • L. rhamnosus has been shown to reduce stress induced anxiety and depression (4).
  • A study providing L. acidophilus, L. casei and B. bifidus (2 billion of each) over 8 weeks: The patients who had received the probiotic combination had significantly decreased total scores on the Beck Depression Inventory. In addition, they had significant decreases in systemic inflammation (2,5).

Good bacteria for intimate health

Vaginal infections affect 300 million women worldwide:

  • 75% of women will suffer thrush at least once in their lives and over 5% will suffer recurrent episodes more than 4 times a year.
  • Bacterial Vaginosis (BV) is actually the most common cause of vaginal infections in women of childbearing age, affecting up to 84% women. BV in some women may also produce irritation and discomfort. Left untreated BV can lead to infertility and premature labour.

Treatment for BV (antibiotics) can lead to the overgrowth of candida, resulting in thrush. Likewise, treatments for thrush can lead to dysbiosis in the vaginal flora, resulting in a change in vaginal pH leading to BV. Therefore, a product which can address both issues, without the need for a woman to know which infection she has and offering prevention as well as treatment of both, will help to break the vicious cycle many women find themselves in.

Specific bacteria researched for intimate health

A combination of Lactobacillus rhamnosus, Lactobacillus plantarum and Bifidobateria animalis subsp. lactis has been extensively researched for their role in the maintenance of vaginal pH and control of bacteria and yeasts, and has been shown to be effective against both thrush and BV infections.

In a trial carried out using L. rhamnosus, L. plantarum and B. animalis subsp. lactis the women who were using the supplement reported effective relief from:

  • Itching
  • Burning
  • Discharge
  • Dryness (6)

Good bacteria to support skin health

The link between skin health and the health of the gut is not new. Researchers as far back as 1930 suspected a link between gut health and skin health – modern research though, has confirmed the importance of this relationship.

This means that good bacteria could be very helpful in reducing the severity of all manner of skin complaints.

Did you know?
    • 40% of those people who suffer with inflammatory bowel diseases, also struggle with some form of skin disorder.
    • Unbalanced gut flora is 10 times more common in those people who are suffering with acne rosacea.
    • Many skin conditions including acne rosacea, psoriasis and dermatitis have now been shown to be linked to increased levels of unfriendly bacteria in the gut.
Specific good bacteria researched for benefits in skin health

A combination of Lactobacillus plantarum, Lactobacillus reuteri and Lactobacillus rhamnosus, has been extensively trialled for its action on skin health. This specific combination has been found to inhibit the following pathogens: (7)

  • Staphyloccocus aureas – responsible for skin infections, pimples, impetigo, boils, abscesses and cellulitis. The combination of bacteria can inhibit this pathogen within 24 hours.
  • Pseudomonas aeruginosa – responsible for inflammation, sepsis, skin infections and dermatitis. The bacteria are strongly effective in reducing this pathogen within just 3 hours and they maintain their inhibitory effect for over 24 hours.
  • Propionibacterium acnes – responsible for skin discomforts such as acne vulgaris and oily skin. The bacterial combination has been shown to have the ability to inhibit this bacteria within 48 hours with a continued reduction over 7 days.
  • Staphylococcus epidermis – an opportunistic pathogen responsible for unbalanced skin microbiota and the worsening of skin conditions. The 3 strains reduced levels of this pathogen within 3 hours.

Written by Jenny Logan, Natures Aid Technical Training Manager

1. The best probiotics for mood: Psychobioitcs May enhance the Gut-Brain Connection. Kathleen Jade, UHN Daily, Apr. 2017.
2. The effects of probiotics on depressive symptoms in humans: a systematic review. Caroline J K Wallace Ann Gen Psychiatry 2017
3. A randomised, double blind, placebo controlled, pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. A Venket Roo et al, Gut Pathog, 2009
4. Ingestion of Lactobacillus strain regulates emotional behaviour and central GABA receptor expression in a mouse, via the Vegas nerve; Javier A Bravo et al, Proc Natl Acad Sci USA, 2011
5. Nutrition 2015 Sept 28 pii 50899-9007
6. Intimique FS – Efficacy Dossier – Principum Division – Rev 01/01/2017
7. Synbalance ProBeauty Shield – Efficacy Dossier Rev 01 2017

Sensitive Skin

Living Nature: Looking After Sensitive Skin

How to Look After Sensitive Skin

Sensitive skin is thought to affect millions of people worldwide. A recent report by the American Academy of Dermatology indicated at least 50% of the US population experience some kind of skin sensitivity, with increasing concern over this situation.

Here in the UK, incidences of skin sensitivity are also widely reported as being on the rise, with sensitive skin now viewed as a common skin condition. It’s also more likely to affect women than men, with about 50% of women and 30% of men suffering from sensitive skin. So what exactly is sensitive skin and why do people suffer from it?

What is Sensitive Skin?

Sensitive skin is described as skin that has reduced tolerance to cosmetics or personal care products. This is an everyday term rather than a medical diagnosis and is characterised by reactiveness, redness or blotchy appearance, burning, tight or dry sensation, blushing or permanent flushing, eczema, dermatitis, psoriasis or rosacea.

It should be noted that allergic skin is different from sensitive skin. Allergic skin will react immediately to a specific ingredient, whereas sensitive skin may simply show a little irritation or redness. This can build up over time or come and go depending on lifestyle and other factors.

Why is Skin Sensitive?

Skin sensitivity can be caused by numerous factors, including genetic predisposition, diet (for instance a lack of essential fatty acids), hormonal fluctuations, smoking, medication, excessive shaving, compromised immunity, the use of irritant skincare products or ingredients, or other products such as washing detergents, fabric softeners, fabrics, etc. that come into contact with the skin.

Skin that is constantly exposed to the elements, air conditioning or heaters can also become sensitive due to dehydration, moisture loss or sun exposure.

Living Nature Certified Natural Sensitive Skin Range
Living Nature Certified Natural                  Sensitive Skin Range

Caring for Sensitive Skin

Our skin reflects our inner health as well as the care we give it, so it’s important to look after your skin from the inside and the outside.

From the inside:

  • Drink lots of water to help flush away toxins and rehydrate
  • Avoid excess caffeine and alcohol as both are very dehydrating
  • Eat lots of nutrient rich vegetables, especially green, leafy vegetables and Omega 3 and 6 essential fatty acids
  • Manage stress levels as stress can compromise the immune system and make skin more sensitive
  • Avoid smoking as it damages collagen and elastin fibre, contributing to wrinkles and decreased circulation, making skin dull and lifeless

From the outside:

  • Cleanse and moisturise morning and night to help keep skin clean, clear and nourished
  • Always remove makeup before going to sleep to allow the skin to breathe and renew
  • Minimise the risk of sun damage by wearing a large hat or protective clothing
Living Nature Gentle Makeup Remover
Living Nature Gentle Makeup           Remover

What to Use

As stated above, skin sensitivity and allergic reactions can be caused by the synthetic and chemical ingredients used in many popular skincare and makeup brands. Often it’s difficult to isolate the exact ingredient that’s causing the sensitivity, especially since we are estimated to place 168 different chemicals on our skin each and every day!

However, here are some of the main culprits to avoid:

  • Parabens – an estimated 70% of makeup as well as skincare and other cosmetic products contain parabens . They prevent spoilage and inhibit bacterial and fungal growth. These synthetic ingredients have been directly linked to incidences of skin irritation and dermatitis.
  • Methylisothiazolinone (MI) and Methylchloroisothiazolinone/Methylisothiazolinone (MCI/MI) – there is concern these chemical preservatives are causing an ‘epidemic’ of contact dermatitis. Both are found in moist tissue wipes, cleansers, shower gels, deodorants and shaving foams, as well as household products such as washing up liquid.
  • Sodium Lauryl Sulphate (SLS) and Sodium Laureth Sulphate (SLES) – these cleansing and foaming agents have been linked to incidences of irritation of the skin and eyes. Many mainstream cleansing products contain SLS and/or SLES, such as shampoos, shower gels, soaps and facial cleansers.
  • Oxybenzone – this chemical sunscreen agent is used in some foundations and is a known skin irritant.

Anyone with sensitive or reactive skin should also avoid products containing the following:

  • Harsh surfactants
  • Petrochemicals
  • Silicones
  • Mineral oils
  • Artificial fragrances
  • Grain alcohols
  • Chemical sun protection filters
  • Irradiated or genetically modified ingredients

What to Use on Sensitive Skin?

For reassurance, opt for certified natural and organic skincare products using only natural preservatives, fragrances and ingredients. They are gentle and safe to use on sensitive skin and work in harmony with skin’s natural processes, so they are good for the beauty and health of your skin and body.

Those with extreme sensitivity or those suffering from eczema, psoriasis, rosacea and other allergies, should also take extra precaution by using natural skincare products that are fragrance-free. This is because some natural fragrances can irritate those with severe sensitivity. Those experiencing sensitivity around the eyes should also opt for fragrance-free skincare products and cosmetics.

Living Nature Firming Eye Cream
Living Nature Firming Eye Cream

Look out for these key features and benefits when sourcing a natural and organic skincare and cosmetics range that’s suitable for your sensitive skin:

  • Certified by a recognised certification body such as BDIH Germany, Soil Association, Eco-Cert and Cosmos amongst others
  • Clinically proven to be non-irritating
  • Dermal tested
  • Hypoallergenic
  • No added fragrance or allergens
Living Nature Mascara
              Living Nature Mascara

Spiezia Organics Facial Ritual

A five step guide to feeling fabulous!

Follow these five simple steps to achieve beautiful healthy skin the natural way. These 100% organic products, made only from natural ingredients are a joy to use and will last for ages – a little of each product goes a long way.


Spiezia facial cleanser Gently massage a pea size amount in circular movements onto the face. Start around the mouth and jaw line and work up over the forehead to the scalp line. Leave to absorb into the skin for 2-3 minutes. This is a good time to put the kettle on and have an organic tea!


Spiezia Floral Skin Toner Shake the bottle to blend the essential oils and floral waters. Apply toner to some cotton wool and gently remove the facial cleanser using upward sweeping motions. Alternatively, apply to a damp muslin flannel and press over the face for a revitalising effect.


Spiezia Rose & Vanilla Face Oil For a lighter treatment. Pour a very small amount of oil into your hand and allow to warm. Clasp the fingers together under the chin and draw the fingers outwards to the angle of the jaw bone. Stroke up the face towards the forehead to apply. Then, using a series of light circular movements with the finger tips, gently massage into the skin, beginning at the base of the neck and finishing at the forehead. Allow the oil to completely absorb into the skin before applying make-up.


Spiezia Intensive Moisturiser For a deeper, hydrating treatment. Take a pea sized amount and warm between the fingers. Clasp the fingers together under the chin and draw the fingers outwards to the angle of the jaw bone. Stroke up the face towards the forehead. Then, using a series of light circular movements with the finger tips, gently massage into the skin, beginning at the base of the neck and finishing at the forehead. Allow the moisturiser to completely soak into the skin before applying make-up.


Spiezia Rose & Chamomile Face Scrub Apply a small amount to the fingertips and, working from the neck up, slowly circle the fingertips all over the face to encourage gentle exfoliation for a minute or two. Softly brush the residue away with finger tips or gently remove with a warm damp cloth.


Probiotics – What are they and do you need them?

Probiotics, or ‘friendly bacteria’, are live microorganisms, which when consumed in adequate amounts, are thought to confer health benefits on the human body. Taking a daily probiotic supplement could not only help with your digestion, but could also spark off other feel-good factors, such as good skin health, immunity and wellbeing.

Probiotics are key to the digestive system. They help the body to produce digestive enzymes (such as lactase) which breakdown certain food substances (in this case, lactose, found in dairy products.) This is why topping up your levels of probiotics on a daily basis can help with food intolerances.

Probiotics support the digestive system, and various research has shown that these microorganisms can help to encourage bowel regularity, and discourage digestive disorders or conditions such as diarrhoea (1,2), bloating (3) , or constipation(4,5).

High Quality Probiotic
A High Quality Probiotic such as OptiBac For Daily Wellbeing EXTRA Strength can help line the gut wall with good bacteria to fend off pathogens.

Probiotics are thought to support the immune system thanks to the ‘barrier effect’. A high quality probiotic is tested for its ability to bind to cells on the gut wall lining. When you supplement with plenty of probiotics they begin to coat your gut wall, taking up space on this lining. This means that when pathogens (harmful microorganisms) enter the body, they reach the gut and have fewer points on the gut wall upon which they can adhere. It’s effectively a competition for space, between the good guys and the bad! The more good guys (probiotics) you have lining your gut wall, the fewer bad guys (pathogens) you should have in turn. This is known as the barrier effect; taking a daily probiotic can support this process.

Probiotics also improve the absorption of vitamins and minerals into the bloodstream. After all there’s no use taking lots of vitamins if your body is not absorbing them. This improved vitamin uptake provides essential support for the immune system, and what’s more, means that a probiotic nicely complements any other daily supplements you may take.

Skin health
Probiotics are also thought to help support healthy skin, as often acne or spots are caused by bad bacteria, or toxins in the body. Supporting your gut with friendly bacteria means that the body will digest foods more efficiently (producing fewer toxins in the first place) and what’s more, probiotics help to displace toxins or bad bacteria in the gut (through various mechanisms, including the barrier effect mentioned above.) Probiotics have even been shown to help with atopic allergies such as eczema (6). Supporting your gut health from the inside should hopefully see you benefiting on the outside too.

Frequency of Use
Some specific probiotics can be effectively taken as a ‘one-off’ treatment, for example Saccharomyces boulardii to support gut health in those suffering from diarrhoea. However if you’re taking probiotics for general support to your digestion, immunity, energy & skin, best to take them every day for at least a few months; giving your gut time to top up its friendly bacteria levels. Many people safely and happily take probiotics on an ongoing basis for years.



1. McFarland, L.V. & Bernasconi, P. (1993) Saccharomyces boulardii: A Review of an Innovative Biotherapeutic Agent. Microbial Ecology in Health and Disease; Vol. 6 pp. 157-171.
2. Hochter, W. et al (1990) Saccharomyces boulardii in acute adult diarrhea. Efficacy and tolerance of treatment. Munchener Medizinische Wochenschrift; Vol. 132 (12) pp. 188-192
3. Paineau, D. (2007) Regular consumption of short-chain fructo-oligosachharides improves digestive comfort with minor functional bowel disorders. Br. J. Nutr. Aug 13:1-8 [Epub ahead of print]
4. Matsumoto, M. et al. (2001) Effect of Yoghurt with Bifidobacterium lactis Bb-12® in Improving Fecal Microflora and Defecation of Healthy Volunteers. Journal of Intestinal Microbiology; 14(2): pp. 97-102
5. Pitkala, K.H et al. (2007) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. Journal of Nutritional Health and Aging; 11(4): pp.305-311.
6. Isolauri, E., et al., Probiotics in the management of atopic eczema. Clin Exp Allergy, 2000. 30(11): p. 1604-10.


Echium Seed Oil – Beauty from Within

Composed of several types of tissue, and functioning to protect the body from the everyday environmental barrage of abuse, the skin serves as our largest organ. The outer layer, known as the epidermis, is made up of a fibrous protein called keratin and numerous types of fat, including various omega-3 and omega-6 polyunsaturated fatty acids. Some of which are important for skin health and others not so. Though ‘biologically dead’ the epidermis remains active, with its fatty acid composition playing a key role in the health and appearance of the skin’s surface.

The skin lacks important enzymes to reconstruct omega-3 and omega-6 fats from food, so our skin’s makeup is a direct reflection of our diet. This may be good news if you eat plenty of oily fish, nuts, seeds and avocados and avoid refined carbohydrates and vegetable oils. If your plate typically resembles Western diet patterns, your skin will likely contain an abundance of omega-6 fats such as linoleic acid (LA) and arachidonic acid (AA) – the latter being linked directly with inflammation and inflammatory-based skin conditions such as psoriasis and eczema.

Igennus Echiomega
Igennus Echiomega is made from echium seed oil and is suitable for vegetarians and vegans.

Echium seed oil is a natural plant oil renowned for its unique profile of skin-supporting fatty acids. Especially rich in a rare form of omega-3 called stearidonic acid (SDA), as well as anti-inflammatory omega-6 GLA and omega-9, it provides the skin with an ideal balance of fats to regenerate cells and reduce inflammation.

Well known for its anti-ageing potential, echium seed oil is a popular ingredient in many skin creams and beauty products but only recently has it become available in supplement form to nourish the skin from within. Oral supplementation offers enhanced benefits over topical products (though a combination of both would offer synergistic benefits) due to more efficient absorption, enabling the beneficial fatty acids to be incorporated directly into skin cells to target inflammation beneath the skin’s surface.

Each Igennus Echiomega capsule provides 500mg echium seed oil, with just two capsules daily providing ideal levels for skincare. Offered in a capsule shell derived from seaweed, Echiomega is suitable for vegetarians and vegans.

Written by Dr Nina Bailey from Igennus Healthcare Nutrition


Healthy skin the light therapy way

The health of our skin is often the first thing people notice when we speak to them.  It can tell the tales of the past whether it be sun damage or pigmentation from enjoying just that little bit too much sunshine, or wrinkles and age spots just because of the inevitable ageing process.  It can also display some of the more confidence-sapping conditions such as rosacea, eczema or acne.  Like it or not, we can often be judged on our appearances and the health of our skin and if it isn’t looking or feeling its best it can make us feel insecure.

Skin Light Therapy
Of late, more people are turning to light therapy to help their skin regain its natural balance.

There are all sorts of lotions, potions and treatments out there to help improve the appearance of our skin, some more natural than others.  Many people don’t fancy botox or collagen injections in search of eternal youth or want to take high strength prescription medicines to dry out their acne vulgaris.  Often these prescriptions have negative side effects sometimes associated with these treatments, such as digestive complaints or further skin inflammation.  Of late, more people are turning to light therapy to help their skin regain its natural balance and help improve the appearance of wrinkles, spider veins, acne and roseacea the natural way.  Light therapy is the exposure to specific wavelengths of light for a specific amount of time in order to treat a particular disorder, problem or concern.

Daylight is a vital ingredient for our existence and since time began humans have responded to their natural environments.  We feel happier in sunny months and our skin is often healthier when the sun is out for longer with more natural daylight available.  Light lamps emitting red and/or blue wavelengths are often used for those with skin concerns such as acne vulgaris, p.acnes, rosacea, spider veins, wrinkles or inflammation.  Blue wavelengths are used for anti-bacterial treatment, while red wavelengths are best for reducing inflammation, pigmentation and fine lines.

Britebox Dermaclear
Models such as the Britebox dermaclear now combine both red & blue wavelengths in order to reduce both bacteria and inflammation.

Blue wavelengths are primarily used for the treatment of acne and to reduce bacteria, however many models such as the Britebox dermaclear now combine both red & blue wavelengths in order to reduce both bacteria and inflammation and for better, faster results.  Infrared and red wavelengths are primarily used for skin pigmentation, wrinkles and fine lines, roseacea, spider veins and age spots.

Treatment times vary between models and can range from 3 minutes to 30 minutes per day with results being seen from anything between 24 hours and 8 weeks – depending on severity of the skin concern.

View our Skin Health Light Therapy Comparison chart here

We have many other blog posts on supporting the health of the skin written by Ani Richardson RNutri. For further reading, see her posts here.

Written by Katie Guest


*Extracts taken from bodykind’s Light Therapy Knowledge Base


Healthy skin spotlight – Our top 5 supplements for skin health

This blog post looks at some of the key nutritional supplements for supporting and maintaining healthy skin.  Follow our top five tips and your skin will be looking healthy and radiant all through natural choices and healthy diet without the need for beauty products that contain harmful chemicals.

Natural skin care
Support your skin care through nutrition and a healthy diet (1)

1. Fish Oils

Fish oils are essential fatty acids which means that they are not made by the body and have to be consumed (either eaten or supplemented) in order to provide the body with their fantastic benefits.  Fatty acids have been recognised for their ability to improve the skin through their anti-inflammatory activity which may also reduce the development of eczema psoriasis, acne and rashes.  They can also help to firm the skin and potentially reduce lines and wrinkles.  Read more about the power of fish oils for skin health in previous blog posts here.  Overall a top skin care provider!

2. Antioxidants:

Oxidative damage from free radicals (unstable molecules) is the primary cause of premature skin aging as they can interfere with DNA and breakdown collagen which contributes to the formation of those dreaded wrinkles.  Antioxidants have been found to help prevent this damage and protect the body from their harmful effects.  Antioxidants, such as alpha tocopherol, beta carotene, lycopene, and lutein, have also been identified to protect against UV damage (photoaging) which causes the most harm to the skin (3).

3. Multivitamin

Eating a diet rich in vegetables, fruits and wholegrains helps to provide the body with vitamins, minerals, fibre and other essential components to help the body to function optimally and keep the skin in its best condition.  Adding a multivitamin (which are natural nutrients that are essentially consumed as the body can not produce them itself) to this regime can offer a great boost to your body’s balance of health and support the health and appearance of the largest organ in your body, your skin.  Again multivitamins that include the antioxidant vitamins A, C, E are great skin supporters, and also B3, D and K have also been identified as protecting against the biggest skin ager, photoaging (4).

Higher Nature Aeterna Gold
Having a healthy diet with lots of vitamins and antioxidants such as vitamin C, can help to encourage collagen production

4. Collagen

As we age, our collagen stores steadily decrease which reduces the elasticity in our skin and causes lines and wrinkles, so supplementing collagen may help to limit these effects.  Also having a healthy diet with lots of vitamins and antioxidants such as vitamin C, can help to encourage collagen production and its use within the body, which may assist in keeping the skin bright and youthful.

5. Probiotics

Probiotics are non digestible foods that can promote health by stimulating the activity of beneficial bacteria in the gut.  They have been found to assist with the absorption of nutrients in the digestive tract which then allows the nutrients to fully benefit the skin.  Additionally, probiotics have also been recognised for stimulating the microflora of the skin and protecting the skin through the immune system (6).  Therefore these friendly bacteria are perfect little protectors of youthful skin so make sure you include them in your daily routine.

A top tip for supplementing would be to include probiotics with your supplements to ensure that your digestive system is optimal and you are absorbing the necessary nutrients from the supplements you are taking.

P.S. You may also wish to consider using light therapy as an alternative to help keep skin beautiful, as they have been found to kill the bacteria that causes acne and also to reduce the inflammation in the skin caused by acne.  They do this through the combination of wavelengths which also assist facial lesions, scars and many other conditions.  They have also shown to be very effective at brightening the skin tone (7,8).  Therefore they may be worth considering if you are suffering from a skin complaint.

Written by Lauren Foster


(1) Image courtesy of  photostock.

(2)De Spirit s et al. (2009) Intervention with flaxseed and borage oil supplements modulates skin condition in women. British Journal of Nutrition, 101:440-445.

(3) Evans, J.A. & Johnson, E.J. (2010) The Role of Phytonutrients in Skin Health. Nutrients, 2, 903-928.

(4) Zussman, J., Ahdout, J. and Kim, J. (2010) Vitamins and photoaging: Do scientific data support their use? American Academy of Dermatology, Vol. 63, No. 3.

(5) Zouboulis, C.C., Makrantonaki, E. (2011) Clinical aspects and molecular diagnostics of skin aging. Clinics in Dermatology, 29, 3–14.

(6) Krutmann, J. (2009) Pre- and probiotics for human skin. Journal of Dermatological Science 54, 1–5.

(7) Babilas, B. (2010) Light-assisted therapy in dermatology: The use of intense pulsed light (IPL). Medical Laser Application, Vol. 25, 61–69.

(8) Lee, S.Y., You, C.E. & Park, M.Y. (2007) Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV. Lasers in Surgery and Medicine, 39:180–188.