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RA Individuals From Lower GDP Countries Keep Working Despite Worse Symptoms Than Richer Countries
Individuals diagnosed with rheumatoid arthritis (RA) in lower gross domestic product (GDP) countries (GDP below $11,000) are more likely to continue working despite higher disease activity and functional disability scores compared to their counterparts in higher GDP countries (GDP >$24,000) according to a new multinational study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.

NEJM Perspective Pieces Examine Physician Involvement In Health Reform, Congressional Progress On Reform
"Achieving Health Care Reform -- How Physicians Can Help," New England Journal of Medicine: In a perspective piece, Elliott Fisher, a professor of medicine and of community and family medicine at Dartmouth Medical School and associate director for Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice; Donald Berwick, a professor at the Harvard University School of Public Health Department of Health Policy and Management and president and CEO of the Institute for Healthcare Improvement; and Karen Davis, president of the Commonwealth Fund, call on physicians to "lead the change our country needs" on health reform. They suggest several areas for physicians to become involved, saying that physicians should "first help to create a shared vision that could overcome doctrinal divides" and that they also must "recognize that achieving savings sufficient to cover the cost of expanded coverage need not impose a hardship on patients or providers." Finally, physicians also must help with a health reform deal that "all stakeholders can support," the authors say (Fisher et al., NEJM, 5/21).
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NHS Healthcare Science Research Projects Awarded Over ÷£1 Million
First Chief Scientific Officer (CSO) Research Fellowships announced
Endocrinology

Brain Emotion Circuit Sparks As Teen Girls Size Up Peers

What is going on in teenagers" brains as their drive for peer approval begins to eclipse their family affiliations? Brain scans of teens sizing each other up reveal an emotion circuit activating more in girls as they grow older, but not in boys. The study by Daniel Pine, M.D., of the National Institute of Mental Health (NIMH), part of National Institutes of Health, and colleagues, shows how emotion circuitry diverges in the male and female brain during a developmental stage in which girls are at increased risk for developing mood and anxiety disorders. "During this time of heightened sensitivity to interpersonal stress and peers" perceptions, girls are becoming increasingly preoccupied with how individual peers view them, while boys tend to become more focused on their status within group pecking orders," explained Pine. "However, in the study, the prospect of interacting with peers activated brain circuitry involved in approaching others, rather than circuitry responsible for withdrawal and fear, which is associated with anxiety and depression." Pine, Amanda Guyer, Ph.D., Eric Nelson, Ph.D., and colleagues at NIMH and Georgia State University, report on one of the first studies to reveal the workings of the teen brain in a simulated real-world social interaction, in the July, 2009 issue of the journal Child Development. Thirty-four psychiatrically healthy males and females, aged 9 to 17, were ostensibly participating in a study of teenagers" communications via Internet chat rooms. They were told that after an fMRI (functional magnetic resonance imaging) scan, which visualizes brain activity, they would chat online with another teen from a collaborating study site. Each participant was asked to rate his or her interest in communicating with each of 40 teens presented on a computer screen, so they could be matched with a high interest participant. Two weeks later, the teens viewed the same faces while in an fMRI scanner. But this time they were asked to instead rate how interested they surmised each of the other prospective chatters would be in interacting with them. Only after they exited the scanner did they learn that, in fact, the faces were of actors, not study participants, and that there would be no Internet chat. The scenario was intended to keep the teens engaged -- maintain a high level of anticipation/motivation -- during the tasks. This helped to ensure that the scanner would detect contrasts in brain circuit responses to high interest versus low interest peers. Although the faces were selected by the researchers for their happy expressions, their attractiveness was random, so that they appeared to be a mix of typical peers encountered by teens. As expected, the teen participants deemed the same faces they initially chose as high interest to be the peers most interested in interacting with them. Older participants tended to choose more faces of the opposite sex than younger ones. When they appraised anticipated interest from peers of high interest compared with low interest, older females showed more brain activity than younger females in circuitry that processes social emotion. "This developmental shift suggested a change in socio-emotional calculus from avoidance to approach," noted Pine. The circuit is made up of the nucleus accumbens (reward and motivation), hypothalamus (hormonal activation), hippocampus (social memory) and insula (visceral/subjective feelings). By contrast, males showed little change in the activity of most of these circuit areas with age, except for a decrease in activation of the insula. This may reflect a waning of interpersonal emotional ties over time in teenage males, as they shift their interest to groups, suggest Pine and colleagues. "In females, absence of activation in areas associated with mood and anxiety disorders, such as the amygdala, suggests that emotional responses to peers may be driven more by a brain network related to approach than to one related to fear and withdrawal," said Pine. "This reflects resilience to psychosocial stress among healthy female adolescents during this vulnerable period." Reference: Probing the neural correlates of anticipated peer evaluation in adolescence. Guyer AE, McClure-Tone EB, Shiffrin ND, Pine DS, Nelson EE. July 2009, Child Development. Jules Asher NIH/National Institute of Mental Health


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