Abnormal brain responses to social fairness in depression: an fMRI study using the Ultimatum Game.

BACKGROUND: Depression is a prevalent disorder that significantly affects the social functioning and interpersonal relationships of individuals. This highlights the need for investigation of the neural mechanisms underlying these social difficulties. Investigation of social exchanges has traditionally been challenging as such interactions are difficult to quantify. Recently, however, neuroeconomic approaches that combine multiplayer behavioural economic paradigms and neuroimaging have provided a framework to operationalize and quantify the study of social interactions and the associated neural substrates. METHOD: We investigated brain activation using functional magnetic resonance imaging (fMRI) in unmedicated depressed participants (n = 25) and matched healthy controls (n = 25). During scanning, participants played a behavioural economic paradigm, the Ultimatum Game (UG). In this task, participants accept or reject monetary offers from other players. RESULTS: In comparison to controls, depressed participants reported decreased levels of happiness in response to 'fair' offers. With increasing fairness of offers, controls activated the nucleus accumbens and the dorsal caudate, regions that have been reported to process social information and responses to rewards. By contrast, participants with depression failed to activate these regions with increasing fairness, with the lack of nucleus accumbens activation correlating with increased anhedonia symptoms. Depressed participants also showed a diminished response to increasing unfairness of offers in the medial occipital lobe. CONCLUSIONS: Our findings suggest that depressed individuals differ from healthy controls in the neural substrates involved with processing social information. In depression, the nucleus accumbens and dorsal caudate may underlie abnormalities in processing information linked to the fairness and rewarding aspects of other people's decisions.

Human myiasis in western Jamaica: five years after the implementation of a screwworm eradication programme

OBJECTIVE: To determine the distribution of cases of human myiasis admitted to the Cornwall Regional Hospital (CRH), Jamaica, between 1999 and 2003, following the inception of the National Screwworm Eradication Programme (NSEP) in 1998, and the risk factors associated with the condition. METHOD: A total of 144 cases of myiasis were retrieved from the database of the department of Medical Records at the CRH for the years 1999 to 2003. A data extraction form was devised to review the circumstances of each case. The data were analyzed using EpiInfo version 6. RESULTS: Of 144 cases, 54.9% were female and 45.1% male. The largest groups were < 10 years, 52.8% [76/144 (M-21, F-55)] and 60years and over, 18.8% [27/144 (M-16, F-I)] (p < 0.001). Case distribution for the years 1999-2003 showed 16, 39, 31, 30, and 28 cases respectively. Three-quarters (74.6%) of all cases affected the scalp/head one-fifth (20.3%) affected the lower limbs. Ninety-six per cent of those < 10 years had scalp/head myiasis (p < 0.001; OR = 23.29; CI: 6.14 < OR < 104.11). Two-thirds (66.6%) of those 60 years and over had lower limb myiasis (p < 0.001; OR = 19.09; CI: 6.20 < OR < 61.12). Mean duration of treatment was 3.5 days (SD = 1.4 days) and 69.7% required hospitalization for seven or more days. There was no difference in duration of treatment for myiasis or in length of hospitalization in relation to method used to eliminate maggots. Risk factors identified included Tinea capitis for myiasis of the scalp/head (p < 0.001) and diabetes mellitus for lower limb myiasis (p < 0.001; OR = 14.48; CI: 2.37 < OR < 133.25). CONCLUSION: Human myiasis remains a public health issue in western Jamaica with no significant decreasing trend in the number of cases admitted to the CRH since 1999. It is recommended that this zoonosis become a Class 1 notifiable disease to the Ministries of Health and Agriculture because of the existing NSEP.

Human myiasis in western Jamaica: five years after the implementation of a screwworm eradication programme.

OBJECTIVE: To determine the distribution of cases of human myiasis admitted to the Cornwall Regional Hospital (CRH), Jamaica, between 1999 and 2003, following the inception of the National Screwworm Eradication Programme (NSEP) in 1998, and the risk factors associated with the condition. METHOD: A total of 144 cases of myiasis were retrieved from the database of the department of Medical Records at the CRH for the years 1999 to 2003. A data extraction form was devised to review the circumstances of each case. The data were analyzed using EpiInfo version 6. RESULTS: Of 144 cases, 54.9% were female and 45.1% male. The largest groups were < 10 years, 52.8% [76/144 (M-21, F-55)] and 60years and over, 18.8% [27/144 (M-16, F-I)] (p < 0.001). Case distribution for the years 1999-2003 showed 16, 39, 31, 30, and 28 cases respectively. Three-quarters (74.6%) of all cases affected the scalp/head one-fifth (20.3%) affected the lower limbs. Ninety-six per cent of those < 10 years had scalp/head myiasis (p < 0.001; OR = 23.29; CI: 6.14 < OR < 104.11). Two-thirds (66.6%) of those 60 years and over had lower limb myiasis (p < 0.001; OR = 19.09; CI: 6.20 < OR < 61.12). Mean duration of treatment was 3.5 days (SD = 1.4 days) and 69.7% required hospitalization for seven or more days. There was no difference in duration of treatment for myiasis or in length of hospitalization in relation to method used to eliminate maggots. Risk factors identified included Tinea capitis for myiasis of the scalp/head (p < 0.001) and diabetes mellitus for lower limb myiasis (p < 0.001; OR = 14.48; CI: 2.37 < OR < 133.25). CONCLUSION: Human myiasis remains a public health issue in western Jamaica with no significant decreasing trend in the number of cases admitted to the CRH since 1999. It is recommended that this zoonosis become a Class 1 notifiable disease to the Ministries of Health and Agriculture because of the existing NSEP.

Influence of the perimenopause on cardiovascular risk factors and symptoms of middle-aged healthy women.

OBJECTIVE: To determine the changes in cardiovascular risk factors and psychological and physical symptoms that occur during the perimenopause. DESIGN: Cohort study of 541 healthy middle-aged premenopausal women followed up through the menopause. SETTING: General community. PARTICIPANTS: After a baseline evaluation taken at study entry, 152 women ceased menstruating for 3 months (not due to surgery) and were not using hormone replacement therapy, and were reevaluated in a similar protocol (perimenopausal examination); 105 of the 152 were evaluated a third time when they had ceased menstruating for 12 months and were not using hormone replacement therapy (postmenopausal examination). One hundred nine premenopausal women who were repeatedly tested constituted a comparison group. MAIN OUTCOME MEASURES: Levels of lipids and lipoproteins, triglycerides, fasting glucose and insulin, blood pressure, weight, height, and standardized measures of psychological symptoms. RESULTS: Women who became perimenopausal showed increased levels of cardiovascular risk factors, which were similar in magnitude to those experienced by the comparison group of premenopausal women. Perimenopausal women reported a greater number of symptoms, especially hot flashes, cold sweats, joint pain, aches in the skull and/or neck, and being forgetful; reports of hot flashes at the perimenopausal examination were associated with low concentrations of serum estrogens. Menopausal status was not associated with depressive symptoms. Perimenopausal women who became postmenopausal showed a decline in the level of high-density lipoprotein-2-cholesterol (means, 0.53 to 0.43 mmol/L [20.6 to 16.7 mg/dL]) and a gradual increase in the level of low-density lipoprotein cholesterol (means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereas symptom reporting declined. CONCLUSIONS: During mid-life, women experience adverse changes in cardiovascular risk factors and a temporary increase in total number of reported symptoms, with no change in depression. Preventive efforts to reduce the menopause-induced increase in cardiovascular risk factors should begin early in the menopausal transition.

Environmental and familial contributions to insulin levels and change in insulin levels in middle-aged women.

OBJECTIVE: To examine familial and environmental variables associated with elevated insulin levels and changes in insulin levels in healthy, premenopausal women. METHODS: A population-based sample of 518 women (aged 42 to 50 years) completed baseline assessments of weight, cardiovascular risk factors, exercise behaviors, and glucose and insulin levels (fasting and 2 hours after a glucose load); 495 of the women were reevaluated after 3 years. RESULTS: Plasma insulin levels were related to weight, activity level, race, body fat distribution, and weight gain since age 20 years. Parental history of either diabetes or hypertension was also related to elevated insulin levels, independent of body mass index, with the highest insulin levels occurring in those women with a parental history of both diseases. Increases in plasma insulin levels over the years of follow-up were related to weight gain. CONCLUSIONS: This study suggests that importance of using family history to identify women who may have elevated insulin levels and of intervening to prevent weight gain during middle age.

Influence of age, sex, and family on Type A and hostile attitudes and behaviors.

We describe the influence of age, sex, and family on Type A and hostility indices that have been related to rates of coronary heart disease (CHD). The sample consisted of 120 girls and 95 boys (ages 6 to 18 years) and 141 women and 120 men (ages 31 to 62 years) from 142 families residing in an upper middle class community. Results showed little familial aggregation of Type A and hostility. Adults had higher Structured Interview (SI) Potential for Hostility ratings than did children, whereas children had higher Minnesota Multiphasic Personality Inventory (MMPI)-derived Hostility scores and SI Anger-In ratings than did adults. Male adults and male children had higher SI Potential for Hostility ratings and MMPI-derived Hostility scores than did their female counterparts. The heightened hostility of males may account, in part, for their heightened risk of CHD relative to females'.

Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors.

Waist to hip ratio (WHR) was measured in 487 middle-aged women participating in the Healthy Women Study. Upper body fat distribution was found to be associated with numerous behaviors that affect cardiovascular risk, including smoking, low exercise levels, weight gain during adulthood, and higher caloric intake. Moreover, WHR was also associated with higher levels of anger, anxiety, and depression and lower levels of perceived social support. Women with upper body fat obesity had higher systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, and apolipoprotein B and lower levels of high density lipoprotein (HDL) and the HDL subfractions 2 and 3. These associations remained significant after adjusting for body mass index. Among 108 women who had repeat measurements of WHR, changes in WHR over a 3-year period were significantly correlated with changes in activity and with decreases in HDL2. Thus, WHR appears to be an integral component of the cardiovascular risk profile. WHR is related to those behaviors and psychosocial attributes that influence cardiovascular risk.

Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women.

A long-standing hypothesis is that feelings of anger and anxiety increase the risk for essential hypertension. Most studies examining this hypothesis have been cross-sectional in design or undertaken with men only. We tested this hypothesis along with determination of the other behavioral and biological predictors of increases in systolic (SBP) and diastolic (DBP) blood pressure from baseline to a follow-up examination 3 years later in a prospective study of 468 middle-aged women whose blood pressure at the baseline examination was less than 140/90 mmHg. Analyses showed that increases in the Spielberger Trait Anger Scale between the baseline and 3-year follow-up examination, as well as Framingham Tension scores (a measure of anxiety) at baseline, independently predicted an increase in SBP (P less than 0.01). Other factors that independently predicted an increase in SBP were baseline fasting insulin, parental history of hypertension and increases in body mass index and in alcohol intake across the 3 years of follow-up. Increases in the Spielberger Trait Anger Scores independently predicted increases in DBP (P less than 0.02), as did black race, increases in body mass index and hematocrit and decreases in potassium intake. Although menopausal status and hormone replacement therapy were unrelated to changes in blood pressure, postmenopausal women on hormone replacement therapy did show significant increases in DBP in the univariate analysis. Anxiety at baseline, along with parental history of hypertension, baseline fasting insulin and baseline body mass index, predicted a later onset of hypertension, i.e. on pharmacologic treatment for hypertension, in the univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Weight gain at the time of menopause.

We studied prospectively the weight change and the effect of weight change on changes in coronary heart disease risk factors in a population-based sample of 485 middle-aged women. All women were studied first in 1983 to 1984, when they were premenopausal and aged 42 to 50 years, and then restudied in 1987. Women gained an average of 2.25 +/- 4.19 kg during this 3-year period; 20% of women gained 4.5 kg or more, and only 3% lost 4.5 kg or more. There were no significant differences in weight gain of women who remained premenopausal and those who had a natural menopause (+2.07 kg vs +1.35 kg). Weight gain was significantly associated with increases in blood pressure and levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting insulin. Weight gain is thus a common occurrence for women at the time of menopause and is related to the changes in coronary heart disease risk factors observed during this period. Efforts to lose weight or to prevent weight gain may help to mitigate the worsening in coronary heart disease risk factors in middle-aged women.

Cigarette smoking and oral contraceptive use influence women's lipid, lipoprotein, and cardiovascular responses during stress.

Investigated the effects of behavioral stress and smoking cigarettes on the lipid, lipoprotein, neuroendocrine, and cardiovascular responses of female smokers who either used or did not use oral contraceptives (OC). Thirty-five healthy female smokers (20 of whom used OC) relaxed, smoked, or sham smoked and then prepared, delivered, and reviewed a speech presented in front of a video camera. Results show that behavioral stress increased total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglyceride, and free fatty acid levels, with significant increases in cholesterol, LDL-C, and free fatty acids apparent only among women who smoked during the session. In addition, OC users exhibited larger increases in triglyceride and blood pressure responses during stress than did nonusers whether or not they smoked during the protocol. Possible physiological mechanisms for each of the effects, as well as implications of the findings for understanding epidemiological associations among OC use, smoking, and coronary heart disease in women are discussed.

PIP: 35 females smokers, of whom 20 had taken combined oral contraceptives for 6 months or more, participated in a study of the effect of smoking and social stress on cardiovascular response, catecholamines and lipoproteins. The stress consisted of giving a 4-minute videotaped extemporaneous speech, after smoking 1 cigarette or sham-smoking. Testing was done in the luteal phase or on Days 15-22 of a pill cycle, after an overnight fast without smoking. Neither smoking nor stress affected catecholamines. Blood pressures and heart rate increased significantly during speech preparation, delivery and review in all subjects; and during inhalation in smoking women. Oral contraceptive users had higher baseline levels of total cholesterol and triglycerides, and their cholesterol and triglycerides increased more than did nonusers during the speech, triglycerides significantly so. Pill users also had higher systolic and diastolic blood pressure increases during delivery of the speech than did nonusers. This study corroborates previous reports that smoking increases cardiovascular responses additively to stress, and is the first report higher increases in triglycerides and cholesterol during stress in pill users.

Stability of overt type A behaviors in children: results from a two- and five-year longitudinal study.

The stability of Type A behaviors in children was evaluated in a 2- and 5-year longitudinal study. Type A behaviors were rated by the children's classroom teachers using the Matthews Youth Test for Health (MYTH). MYTH ratings were obtained annually for 3 years on children from 3 inner-city parochial schools (initial N = 317) and for 6 years on children from 3 suburban public schools (initial N = 434). Participants were predominantly Caucasian and in grades K, 2, 4, and 6 when the project began in 1979. Correlations for total Type A scores for the 2-year follow-up period were .38 and .45 in the suburban and urban samples, respectively, collapsing across grade and sex. There were no significant differences in the magnitude of correlations between the samples or between sex or grade subgroups within each sample. The correlation for total Type A score for the 5-year follow-up period was .39 in the suburban sample, and no differences in the magnitude of the correlations between sex or grade subgroups were found. The stability of children's Type A behaviors across 2 and 5 years compares favorably to the stability of other cardiovascular risk factors in children.