Pacific ethnic groups and frequent hospital presentation: A fair target?

In New Zealand, Pacific health figures are traditionally presented for all Pacific ethnic groups combined. Use of EDs and urgent care clinics is high compared with Maori and non-Maori, non-Pacific (nMnP) use. By controlling for proximity to the hospital and socioeconomic status, we demonstrate greater variation between Pacific ethnic groups than between Pacific and nMnP, or between Maori and nMnP groups. We discuss the significance of subpopulation variation in use of urgent care services.

Evangelical Doctors Belief and Practice: A Case Study of the Wellington Christian Medical Fellowship, New Zealand 1971-1980.

This paper presents a critical analysis of the proceedings of the Wellington Christian Medical Fellowship (CMF) during the 1970s. Formation of the CMF, contemporaneous and historical influences, new traditions, and key events are discussed as they arise in the narrative of the case study. Interaction between cultural and religious influences on medical practice is a recurring theme relevant to other bicultural or multicultural nations with significant health inequalities.

Hunger does not motivate reward in women remitted from anorexia nervosa.

BACKGROUND: Hunger enhances sensitivity to reward, yet individuals with anorexia nervosa (AN) are not motivated to eat when starved. This study investigated brain response to rewards during hunger and satiated states to examine whether diminished response to reward could underlie food restriction in AN. METHODS: Using a delay discounting monetary decision task known to discriminate brain regions contributing to processing of immediate rewards and cognitive control important for decision making regarding future rewards, we compared 23 women remitted from AN (RAN group; to reduce the confounding effects of starvation) with 17 healthy comparison women (CW group). Monetary rewards were used because the rewarding value of food may be confounded by anxiety in AN. RESULTS: Interactions of Group (RAN, CW) × Visit (hunger, satiety) revealed that, for the CW group, hunger significantly increased activation in reward salience circuitry (ventral striatum, dorsal caudate, anterior cingulate cortex) during processing of immediate reward, whereas satiety increased activation in cognitive control circuitry (ventrolateral prefrontal cortex, insula) during decision making. In contrast, brain response in reward and cognitive neurocircuitry did not differ during hunger and satiety in the RAN group. A main effect of group revealed elevated response in the middle frontal gyrus for the RAN group compared with the CW group. CONCLUSIONS: Women remitted from AN failed to increase activation of reward valuation circuitry when hungry and showed elevated response in cognitive control circuitry independent of metabolic state. Decreased sensitivity to the motivational drive of hunger may explain the ability of individuals with AN to restrict food when emaciated. Difficulties in valuating emotional salience may contribute to inabilities to appreciate the risks inherent in this disorder.

Altered BOLD response during inhibitory and error processing in adolescents with anorexia nervosa.

BACKGROUND: Individuals with anorexia nervosa (AN) are often cognitively rigid and behaviorally over-controlled. We previously showed that adult females recovered from AN relative to healthy comparison females had less prefrontal activation during an inhibition task, which suggested a functional brain correlate of altered inhibitory processing in individuals recovered from AN. However, the degree to which these functional brain alterations are related to disease state and whether error processing is altered in AN individuals is unknown. METHODOLOGY/PRINCIPAL FINDINGS: In the current study, ill adolescent AN females (n = 11) and matched healthy comparison adolescents (CA) with no history of an eating disorder (n = 12) performed a validated stop signal task (SST) during functional magnetic resonance imaging (fMRI) to explore differences in error and inhibitory processing. The groups did not differ on sociodemographic variables or on SST performance. During inhibitory processing, a significant group x difficulty (hard, easy) interaction was detected in the right dorsal anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), and left posterior cingulate cortex (PCC), which was characterized by less activation in AN compared to CA participants during hard trials. During error processing, a significant group x accuracy (successful inhibit, failed inhibit) interaction in bilateral MFG and right PCC was observed, which was characterized by less activation in AN compared to CA participants during error (i.e., failed inhibit) trials. CONCLUSION/SIGNIFICANCE: Consistent with our prior findings in recovered AN, ill AN adolescents, relative to CA, showed less inhibition-related activation within the dorsal ACC, MFG and PCC as inhibitory demand increased. In addition, ill AN adolescents, relative to CA, also showed reduced activation to errors in the bilateral MFG and left PCC. These findings suggest that altered prefrontal and cingulate activation during inhibitory and error processing may represent a behavioral characteristic in AN that is independent of the state of recovery.

Greater anterior insula activation during anticipation of food images in women recovered from anorexia nervosa versus controls.

Individuals with anorexia nervosa (AN) restrict food consumption and become severely emaciated. Eating food, even thinking of eating food, is often associated with heightened anxiety. However, food cue anticipation in AN is poorly understood. Fourteen women recovered from AN and 12 matched healthy control women performed an anticipation task viewing images of food and object images during functional magnetic resonance imaging. Comparing anticipation of food versus object images between control women and recovered AN groups showed significant interaction only in the right ventral anterior insula, with greater activation in recovered AN anticipating food images. These data support the hypothesis of a disconnect between anticipating and experiencing food stimuli in recovered AN. Insula activation positively correlated with pleasantness ratings of palatable foods in control women, while no such relationship existed in recovered AN, which is further evidence of altered interoceptive function. Finally, these findings raise the possibility that enhanced anterior insula anticipatory response to food cues in recovered AN could contribute to exaggerated sensitivity and anxiety related to food and eating.

The ingestion of different dietary proteins by humans induces large changes in the plasma tryptophan ratio, a predictor of brain tryptophan uptake and serotonin synthesis.

BACKGROUND & AIMS: The ingestion by rats of different proteins causes large differences in the plasma ratio of tryptophan to other large neutral amino acids, which predicts brain tryptophan uptake and serotonin synthesis. We evaluated in humans whether ingesting these proteins also produces large excursions in the tryptophan ratio. METHODS: Fasting males (n = 6) ingested V-8 Juice containing 40 g of α-lactalbumin, gluten, zein or starch. Blood was drawn before and at 30 min intervals after ingestion for 4 h; tryptophan and other large neutral amino acids were quantitated. RESULTS: Pre-meal plasma tryptophan was ~50 nmol/ml; the tryptophan ratio was ~0.010. α-Lactalbumin increased plasma tryptophan (3-fold) and the tryptophan ratio (50%); starch did not change either tryptophan variable, while gluten caused a modest (25%) and zein a large reduction (50%) in plasma tryptophan. Gluten and zein reduced the tryptophan ratio. The maximal difference in the tryptophan ratio occurred between α-lactalbumin and zein and was large (~3-fold). CONCLUSION: Since the plasma tryptophan ratio predicts brain tryptophan uptake and serotonin synthesis in rats, the differences in the ratio produced in humans by these proteins may modify serotonin synthesis, and perhaps elicit serotonin-linked changes in behavior.