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1.  Sleep deprivation amplifies reactivity of brain reward networks, biasing the appraisal of positive emotional experiences 
Appropriate interpretation of pleasurable, rewarding experiences favors decisions that enhance survival. Conversely, dysfunctional affective brain processing can lead to life-threatening risk behaviors (e.g. addiction) and emotion imbalance (e.g. mood disorders). The state of sleep deprivation continues to be associated with maladaptive emotional regulation, leading to exaggerated neural and behavioral reactivity to negative, aversive experiences. However, such detrimental consequences are paradoxically aligned with the perplexing antidepressant benefit of sleep deprivation, elevating mood in a proportion of patients with major depression. Nevertheless, it remains unknown how sleep loss alters the dynamics of brain and behavioral reactivity to rewarding, positive emotional experiences. Using fMRI, here we demonstrate that sleep deprivation amplifies reactivity throughout human mesolimbic reward brain networks in response to pleasure-evoking stimuli. In addition, this amplified reactivity was associated with enhanced connectivity in early primary visual processing pathways and extended limbic regions, yet with a reduction in coupling with medial- and orbito-frontal regions. These neural changes were accompanied by a biased increase in the number of emotional stimuli judged as pleasant in the sleep-deprived group, the extent of which exclusively correlated with activity in mesolimbic regions. Together, these data support a view that sleep deprivation is not only associated with enhanced reactivity towards negative stimuli, but imposes a bi-directional nature of affective imbalance, associated with amplified reward-relevant reactivity towards pleasure-evoking stimuli also. Such findings may offer a neural foundation on which to consider interactions between sleep loss and emotional reactivity in a variety of clinical mood disorders.
PMCID: PMC3086142  PMID: 21430147
Sleep Deprivation; Positive Emotion; Reward; Brain Reactivity
2.  Experience of Pleasure and Emotional Expression in Individuals with Schizotypal Personality Features 
PLoS ONE  2012;7(5):e34147.
Difficulties in feeling pleasure and expressing emotions are one of the key features of schizophrenia spectrum conditions, and are significant contributors to constricted interpersonal interactions. The current study examined the experience of pleasure and emotional expression in college students who demonstrated high and low levels of schizotypal personality disorder (SPD) traits on self-report questionnaires. One hundred and seventeen subjects with SPD traits and 116 comparison controls were recruited to participate. Cluster analyses conducted in the SPD group identified negative SPD and positive SPD subgroups. The negative SPD group exhibited deficient emotional expression and anticipatory pleasure, but showed intact consummatory pleasure. The positive SPD group reported significantly greater levels of anticipatory, consummatory and total pleasure compared to the control group. Both SPD groups reported significantly more problems in everyday memory and greater levels of depressive and anxiety-related symptoms.
PMCID: PMC3353966  PMID: 22615731
3.  Us versus Them: Social Identity Shapes Neural Responses to Intergroup Competition and Harm 
Psychological science  2011;22(3):10.1177/0956797610397667.
Intergroup competition makes social identity salient, which affects how people respond to competitors’ hardships. The failures of a fellow group member are painful, while those of a rival group member may give pleasure—a feeling that may motivate harming rivals. The present study examines whether valuation-related neural responses to rival groups’ failures correlate with likelihood of harming individuals associated with those rivals. Avid fans of the Red Sox and Yankees teams viewed baseball plays while undergoing fMRI. Subjectively negative outcomes (favored-failure, rival-success) activated anterior cingulate cortex and insula, while positive outcomes (favored-success, rival-failure—even against a third team) activated ventral striatum. The ventral striatum effect, associated with subjective pleasure, also correlated with self-reported likelihood of aggressing against a fan of the rival team (controlling for general aggression). Outcomes of social group competition can directly affect primary reward-processing neural systems, with implications for intergroup harm.
PMCID: PMC3833634  PMID: 21270447
4.  Pleasurable Emotional Response to Music: A Case of Neurodegenerative Generalized Auditory Agnosia 
Neurocase  2009;15(3):248-259.
Recent functional neuroimaging studies implicate the network of mesolimbic structures known to be active in reward processing as the neural substrate of pleasure associated with listening to music. Psychoacoustic and lesion studies suggest that there is a widely distributed cortical network involved in processing discreet musical variables. Here we present the case of a young man with auditory agnosia as the consequence of cortical neurodegeneration who continues to experience pleasure when exposed to music. In a series of musical tasks the subject was unable to accurately identify any of the perceptual components of music beyond simple pitch discrimination, including musical variables know to impact the perception of affect. The subject subsequently misidentified the musical character of personally familiar tunes presented experimentally, but continued to report the activity of “listening” to specific musical genres was an emotionally rewarding experience. The implications of this case for the evolving understanding of music perception, music misperception, music memory, and music-associated emotion are discussed.
PMCID: PMC2829118  PMID: 19253088
5.  Relief as a Reward: Hedonic and Neural Responses to Safety from Pain 
PLoS ONE  2011;6(4):e17870.
Relief fits the definition of a reward. Unlike other reward types the pleasantness of relief depends on the violation of a negative expectation, yet this has not been investigated using neuroimaging approaches. We hypothesized that the degree of negative expectation depends on state (dread) and trait (pessimism) sensitivity. Of the brain regions that are involved in mediating pleasure, the nucleus accumbens also signals unexpected reward and positive prediction error. We hypothesized that accumbens activity reflects the level of negative expectation and subsequent pleasant relief. Using fMRI and two purpose-made tasks, we compared hedonic and BOLD responses to relief with responses during an appetitive reward task in 18 healthy volunteers. We expected some similarities in task responses, reflecting common neural substrates implicated across reward types. However, we also hypothesized that relief responses would differ from appetitive rewards in the nucleus accumbens, since only relief pleasantness depends on negative expectations. The results confirmed these hypotheses. Relief and appetitive reward task activity converged in the ventromedial prefrontal cortex, which also correlated with appetitive reward pleasantness ratings. In contrast, dread and pessimism scores correlated with relief but not with appetitive reward hedonics. Moreover, only relief pleasantness covaried with accumbens activation. Importantly, the accumbens signal appeared to specifically reflect individual differences in anticipation of the adverse event (dread, pessimism) but was uncorrelated to appetitive reward hedonics. In conclusion, relief differs from appetitive rewards due to its reliance on negative expectations, the violation of which is reflected in relief-related accumbens activation.
PMCID: PMC3072382  PMID: 21490964
6.  Independent and Combined Influence of Homeownership, Occupation, Education, Income and Community Poverty on Physical Health in Persons with Arthritis 
Arthritis care & research  2011;63(5):643-653.
To examine the independent and combined influence of individual and community-level socioeconomic (SES) measures with physical health status outcomes in people with self-reported arthritis.
From 2004-2005, 968 participants completed a telephone survey assessing health status, chronic conditions, community characteristics, and socio-demographic variables. Individual-level SES measures: homeownership, occupation [professional, or not], educational attainment (< high school (HS), HS degree, and > HS), income (<15, 15-45, >$45K) and community poverty: 2000 U.S. Census block-group “% of individuals living below the poverty line” (low, medium, high) were used. Outcomes were physical functioning (MOS SF-12v2 PCS), functional disability (HAQ) and the CDC HRQOL Healthy Days physical and limited activity days and were analyzed via multivariable regressions.
When entered separately, all individual-level SES variables were significantly (p<0.01) associated with poorer PCS, HAQ, and CDC HRQOL scores. A higher magnitude of effect was seen for household income, specifically <$15,000 in final models with all 4 individual SES measures and community poverty. The magnitude of effect for education is reduced and marginally significant for PCS and number of physically unhealthy days. No effects were seen for occupation, homeownership, and community poverty.
Findings confirm that after adjusting for important covariates, lower individual and community-level SES are associated with poorer physical health outcomes, while household income is the strongest predictor (as measured by both significance and effect) of poorer health status in final models. Studies not having participant-reported income available should make use of other SES measures as they do independently predict physical health.
PMCID: PMC3091982  PMID: 21225675
Socioeconomic Status; Health Status
7.  Noise nuisance and health inequalities in Belgium: a population study 
Archives of Public Health  2009;67(2):52-61.
Lower socioeconomic groups are more likely to live in contaminated environments. This may partly explain socioeconomic health inequalities.
Does noise nuisance contribute to socio-economic inequalities in subjective health?
This research is based on the last Belgian census data carried out in 2001. We work on a 10% sample of the Belgian population. The data are processed through bivariate and multivariate analyses. We model poor subjective health in relation to exposure to noise nuisance and several socio-economic variables.
The risk of poor subjective health increases with noise nuisance and is higher in lower socio-economic groups. Noise nuisance does contribute to health inequalities, particularly regarding type of housing and activity. These relations are stronger in urban areas.
Noise nuisance affects the subjective health status and contributes to health inequalities, particularly in urban areas. This suggests that public policies, particularly those related to environmental planning, should be driven also by environmental equity considerations.
PMCID: PMC3463011
Health inequalities; noise nuisance; socio-economic factors; subjective health; urban health
8.  Poverty, social exclusion and dental caries of 12-year-old children: a cross-sectional study in Lima, Peru 
BMC Oral Health  2009;9:16.
Socioeconomic differences in oral health have been reported in many countries. Poverty and social exclusion are two commonly used indicators of socioeconomic position in Latin America. The aim of this study was to explore the associations of poverty and social exclusion with dental caries experience in 12-year-old children.
Ninety families, with a child aged 12 years, were selected from 11 underserved communities in Lima (Peru), using a two-stage cluster sampling. Head of households were interviewed with regard to indicators of poverty and social exclusion and their children were clinically examined for dental caries. The associations of poverty and social exclusion with dental caries prevalence were tested in binary logistic regression models.
Among children in the sample, 84.5% lived in poor households and 30.0% in socially excluded families. Out of all the children, 83.3% had dental caries. Poverty and social exclusion were significantly associated with dental caries in the unadjusted models (p = 0.013 and 0.047 respectively). In the adjusted model, poverty remained significantly related to dental caries (p = 0.008), but the association between social exclusion and dental caries was no longer significant (p = 0.077). Children living in poor households were 2.25 times more likely to have dental caries (95% confidence interval: 1.24; 4.09), compared to those living in non-poor households.
There was support for an association between poverty and dental caries, but not for an association between social exclusion and dental caries in these children. Some potential explanations for these findings are discussed.
PMCID: PMC2713218  PMID: 19583867
9.  Anhedonia Associated With Stimulant Use and Dependence in a Population-Based Sample of American Adults 
Prior research suggests an association between anhedonia—diminished interest or pleasure in rewarding activities—and stimulant use in selected samples. However, it is unclear whether this association generalizes to the overall population and is consistent across stimulant drug types (amphetamine vs. cocaine) and outcome characteristics (any lifetime use vs. dependence). Questions also remain as to whether the anhedonia–stimulant relationship is unique from covariance with depressed mood, psychiatric disorders, and nonstimulant substance use. The current study addressed these questions by examining anhedonia–stimulant relationships in a cross-sectional population-based sample of 43,093 American adults. Results indicated that lifetime anhedonia and depressed mood each were positively associated with lifetime stimulant use and lifetime dependence among those who reported stimulant use. Anhedonia–stimulant relationships were consistent across amphetamine- and cocaine-related outcomes and distinct from covariance with depressed mood, which exhibited no association over and above the effect of anhedonia. After adjusting for demographic, psychiatric, and nonstimulant substance use characteristics, anhedonia–stimulant associations remained significant, although effect sizes were partially attenuated. Lifetime anhedonia was also more prevalent among respondents who initiated use but did not eventually progress to dependence in comparison with individuals who never once used a stimulant drug. Anhedonia appears to be uniquely associated with lifetime use of cocaine and amphetamines and lifetime progression from use to dependence in the American population. Albeit cross-sectional in nature, these findings add further support to the generalizability and specificity of the anhedonia–stimulant relationship. Future research utilizing longitudinal and experimental designs are warranted to clarify the underpinnings of this association.
PMCID: PMC3307593  PMID: 21186931
anhedonia; stimulant dependence; amphetamine; cocaine; depressed mood
10.  The Pleasure Principle: The Effect of Perceived Pleasure Loss Associated with Condoms on Unprotected Anal Intercourse Among Immigrant Latino Men Who Have Sex with Men 
AIDS Patient Care and STDs  2012;26(7):430-435.
Sexual pleasure has been identified as an important consideration in decision-making surrounding condom use. We examined the impact of perceived pleasure loss associated with condom use on recent history of insertive and receptive unprotected anal intercourse (UAI) among Latino men who have sex with men (MSM) living in the United States. A total of 482 Dominican, Colombian, and Brazilian immigrant MSM were surveyed regarding sexual attitudes and practices via computer-assisted self-interviewing technology with audio enhancement (ACASI). Participants rated the pleasure they derived from protected and unprotected anal intercourse in each position (insertive and receptive) and also reported their HIV status, relationship status, and recent sexual history. Men who had engaged in both positions, with and without condoms (n=268), perceived a greater pleasure loss associated with condoms during anal intercourse in the insertive versus receptive position. Logistic regression analyses controlling for HIV status, relationship status, and age revealed that men who perceived greater pleasure loss from condoms were more likely to have engaged in UAI over the past 3 months (n[insertive]=297; n[receptive]=284). Findings indicate that the pleasure loss associated with condoms may be a key deterrent for their use in either sex position among Latino MSM. Therefore, pleasure needs to be prioritized in the development of condoms and other sexual safety measures as well as in the promotion of their use.
PMCID: PMC3389381  PMID: 22663165
11.  Hemodynamic Scaling of fMRI-BOLD signal: Validation of low frequency spectral amplitude as a Scalability Factor 
Magnetic resonance imaging  2007;25(10):1358-1369.
fMRI-BOLD signal representing neural activity may be optimized by discriminating MR signal components related to neural activity and those related to intrinsic properties of the cortical vasculature. The objective of this study was to diminish the hemodynamic change independent of neural activity to obtain a scaled fMRI-BOLD response using two factors namely the low frequency spectral amplitude (LFSA) and breath hold amplitude (BHA). Ten subjects (22-38 years of age) were scanned during various task conditions; (a) rest while breathing room air; (b) bilateral finger-tapping breathing room air; (c) rest during a partial inspirational breath hold; and (d) rest during moderate hypercapnia (breathing 5% CO2, 20% O2, and 75% N2). In all subjects who breathed 5% CO2, regions with significant BOLD response during breath hold correlated significantly with the percent signal increase during 5% CO2 inhalation. Finger tapping-induced responses in the motor cortex were diminished to a similar extent after scaling using either the LFSA or the BHA. Inter and intra-subject variation in the amplitude of the BOLD signal response reduced after hemodynamic scaling using LFSA or BHA. The results validate the hemodynamic amplitude scaling using the LFSA with earlier established BHA. LFSA free from motor task contamination can be used to calibrate the fMRI-BOLD response in lieu of BHA or hypercapnia to minimize intra and inter subject variation arising from vascular anatomy and vasodilative capacity.
PMCID: PMC2701471  PMID: 17482411
fMRI; breath hold; BOLD; CBF; scaling; hypercapnia; low frequency; spectral amplitude
12.  Hedonic Deficits in Parkinson’s Disease: Is Consummatory Anhedonia Specific? 
Background: Anhedonia, the lowered ability to experience pleasure, is one of the non-motor symptoms of Parkinson’s disease (PD) that is underdiagnosed and consequently undertreated. Few studies have investigated anhedonia in PD by taking into account the influence of socio-demographic variables and versus a control group composed of patients with a pure motor neurologic disease other than PD. The aim of this study was to investigate hedonic deficits in patients with PD compared to a control group of patients with non-Parkinson motor neurologic disease (OND), matched for age, gender, level of education, and inpatient/outpatient status. Distinctions between anticipatory and consummatory anhedonia and between endogenomorphic and non-endogenomorphic depression were taken into account.
Methods: The study population comprised 49 PD patients and 40 subjects with OND. Anhedonia was rated by using the anticipatory [Temporal Experience Pleasure Scale (TEPS)-ANT] and consummatory (TEPS-CONS) subscales of the TEPS and two subscales extracted from the revised Physical Anhedonia Scale (PAS), measuring physical anticipatory (PAS-ANT) and physical consummatory (PAS-CONS) anhedonias. The Snaith–Hamilton Pleasure Scale (SHAPS) and the Beck Depression Inventory-II (BDI-II) were also used together with a subscale extracted from the BDI-II (ENDO-BDI-II) for the diagnosis of endogenomorphic depression. Statistical analyses were performed on the whole group and on the PD group.
Results: As hypothesized, several anhedonia scores varied with age and gender in the whole population or in the PD group. On univariate or multivariate analyses, only PAS-CONS was specific for PD and only SHAPS scores differed between depression subtypes in the whole population or the PD group.
Conclusion: This study suggests that physical consummatory anhedonia could be specific to PD subjects.
PMCID: PMC3948001  PMID: 24653714
anhedonia; depression; dopamine; Parkinson’s disease
13.  Neighborhood Socioeconomic Status, Depression, and Health Status in the Look AHEAD (Action for Health in Diabetes) Study 
BMC Public Health  2011;11:349.
Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression.
Individual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (% living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES.
Overall, the % living in poverty in the participants' neighborhoods varied, mean = 11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (β-coefficient [β] = -1.90 units, 95% CI: -3.40,-0.039), mental health (β = -2.92 units, -4.31,-1.53) and global health (β = -2.77 units, -4.21,-1.33) composite scores.
In this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.
PMCID: PMC3111582  PMID: 22182286
14.  Prevalence and outcome of partial remissionin depression 
The goal of treatment of major depression should be full remission. Many patients, however, fail to achieve or maintain symptom-free status. Residual depressive symptoms are common, even where there has been a robust response to antidepressant therapy. In clinical studies, approximately one-third of patients achieve a full remission, one-third experience a response and one-third are nonresponders. Partial remission is characterized by the presence of poorly defined residual symptoms. These symptoms typically include depressed mood, psychic anxiety, sleep disturbance, fatigue and diminished interest or pleasure. It is currently unclear which factors predict partial remission. However, it is clear that residual symptoms are powerful predictors of relapse, with relapse rates 3–6 times higher in patients with residual symptoms than in those who experience full remission. Residual symptoms are also associated with more medical and psychiatric visits, increased public assistance, disability benefits, thoughts of and attempts at suicide and chronicity. The risk of stroke and coronary events is also higher in patients with residual depressive symptoms. The substantial proportion of patients who achieve only partial remission has traditionally been neglected in antidepressant trials. Given that residual symptoms may relate, in part, to an incompatibility between patient and treatment, further research is needed to predict a better match. These symptoms are a clinically relevant state of illness, and the correct choice of initial antidepressant treatment should offer the greatest chance of achieving full remission.
PMCID: PMC161658  PMID: 12174733
antidepressive agents; behavioral symptoms; cognitive therapy; depressive disorder; drug therapy; psychiatric status rating scales; psychotherapy; recurrence; remission induction; treatment outcome
15.  The Role of the Anterior Cingulate Cortex in Women’s Sexual Decision Making 
Neuroscience letters  2008;449(1):42-47.
Women’s sexual decision making is a complex process balancing the potential rewards of conception and pleasure against the risks of possible low paternal care or sexually transmitted infection. Although neural processes underlying social decision making are suggested to overlap with those involved in economic decision making, the neural systems associated with women’s sexual decision making are unknown. Using fMRI, we measured the brain activation of 12 women while they viewed photos of men’s faces. Face stimuli were accompanied by information regarding each man’s potential risk as a sexual partner, indicated by a written description of the man’s number of previous sexual partners and frequency of condom use. Participants were asked to evaluate how likely they would be to have sex with the man depicted. Women reported that they would be more likely to have sex with low compared to high risk men. Stimuli depicting low risk men also elicited stronger activation in the anterior cingulate cortex (ACC), midbrain, and intraparietal sulcus, possibly reflecting an influence of sexual risk on women’s attraction, arousal, and attention during their sexual decision making. Activation in the ACC was positively correlated with women’s subjective evaluations of sex likelihood and response times during their evaluations of high, but not low, risk men. These findings provide evidence that neural systems involved in sexual decision making in women overlap with those described previously to underlie nonsexual decision making.
PMCID: PMC2614659  PMID: 18992789
mate choice; decision making; anterior cingulated; risk
16.  Neural Correlates of Visual Aesthetics – Beauty as the Coalescence of Stimulus and Internal State 
PLoS ONE  2012;7(2):e31248.
How do external stimuli and our internal state coalesce to create the distinctive aesthetic pleasures that give vibrance to human experience? Neuroaesthetics has so far focused on the neural correlates of observing beautiful stimuli compared to neutral or ugly stimuli, or on neural correlates of judging for beauty as opposed to other judgments. Our group questioned whether this approach is sufficient. In our view, a brain region that assesses beauty should show beauty-level-dependent activation during the beauty judgment task, but not during other, unrelated tasks. We therefore performed an fMRI experiment in which subjects judged visual textures for beauty, naturalness and roughness. Our focus was on finding brain activation related to the rated beauty level of the stimuli, which would take place exclusively during the beauty judgment. An initial whole-brain analysis did not reveal such interactions, yet a number of the regions showing main effects of the judgment task or the beauty level of stimuli were selectively sensitive to beauty level during the beauty task. Of the regions that were more active during beauty judgments than roughness judgments, the frontomedian cortex and the amygdala demonstrated the hypothesized interaction effect, while the posterior cingulate cortex did not. The latter region, which only showed a task effect, may play a supporting role in beauty assessments, such as attending to one's internal state rather than the external world. Most of the regions showing interaction effects of judgment and beauty level correspond to regions that have previously been implicated in aesthetics using different stimulus classes, but based on either task or beauty effects alone. The fact that we have now shown that task-stimulus interactions are also present during the aesthetic judgment of visual textures implies that these areas form a network that is specifically devoted to aesthetic assessment, irrespective of the stimulus type.
PMCID: PMC3285156  PMID: 22384006
17.  Violence as a source of pleasure or displeasure is associated with specific functional connectivity with the nucleus accumbens 
The appraisal of violent stimuli is dependent on the social context and the perceiver's individual characteristics. To identify the specific neural circuits involved in the perception of violent videos, forty-nine male participants were scanned with functional MRI while watching video-clips depicting Mixed Martial Arts (MMA) and Capoeira as a baseline. Prior to scanning, a self-report measure of pleasure or displeasure when watching MMA was collected. Watching MMA was associated with activation of the anterior insula (AI), brainstem, ventral tegmental area (VTA), striatum, medial, and lateral prefrontal cortex, orbitofrontal cortex, somatosensory cortex, and supramarginal gyrus. While this pattern of brain activation was not related to participants' reported experience of pleasure or displeasure, pleasurable ratings of MMA predicted increased functional connectivity (FC) seeded in the nucleus accumbens (NAcc) (a structure known to be responsive to anticipating both positive and negative outcomes) with the subgenual anterior cingulate cortex (ACC) and anterior insular cortex (AIC) (regions involved in positive feelings and visceral somatic representations). Displeasure ratings of MMA were related to increased FC with regions of the prefrontal cortex and superior parietal lobule, structures implicated in cognitive control and executive attention. These data suggest that functional connectivity is an effective approach to investigate the relationship between subjective feelings of pleasure and pain of neural structures known to respond to both the anticipation of positive and negative outcomes.
PMCID: PMC3741555  PMID: 23964226
violence; emotion; pleasure; functional connectivity; nucleus accumbens; insular cortex; orbitalfrontal cortex; reward
18.  Major depressive disorder is characterized by greater reward network activation to monetary than pleasant image rewards 
Psychiatry research  2011;194(3):263-270.
Anhedonia, the loss of interest or pleasure in normally rewarding activities, is a hallmark feature of unipolar Major Depressive Disorder (MDD). A growing body of literature has identified frontostriatal dysfunction during reward anticipation and outcomes in MDD. However, no study to date has directly compared responses to different types of rewards such as pleasant images and monetary rewards in MDD. To investigate the neural responses to monetary and pleasant image rewards in MDD, a modified Monetary Incentive Delay task was used during fMRI scanning to assess neural responses during anticipation and receipt of monetary and pleasant image rewards. Participants included nine adults with MDD and thirteen affectively healthy controls. The MDD group showed lower activation than controls when anticipating monetary rewards in right orbitofrontal cortex and subcallosal cortex, and when anticipating pleasant image rewards in paracingulate and supplementary motor cortex. The MDD group had relatively greater activation in right putamen when anticipating monetary versus pleasant image rewards, relative to the control group. Results suggest reduced reward network activation in MDD when anticipating rewards, as well as relatively greater hypoactivation to pleasant image than monetary rewards.
PMCID: PMC3225489  PMID: 22079658
Major Depressive Disorder; Reward; Anhedonia; Anticipation; Magnetic Resonance Imaging
19.  Health and social cohesion: why care about income inequality? 
BMJ : British Medical Journal  1997;314(7086):1037-1040.
Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income-in addition to the absolute standard of living enjoyed by the poor-is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.
PMCID: PMC2126438  PMID: 9112854
20.  Inequities in under-five child malnutrition in South Africa 
To assess and quantify the magnitude of inequalities in under-five child malnutrition, particularly those ascribable to socio-economic status and to consider the policy implications of these findings.
Data on 3765 under-five children were derived from the Living Standards and Development Survey. Household income, proxied by per capita household expenditure, was used as the main indicator of socio-economic status. Socio-economic inequality in malnutrition (stunting, underweight and wasting) was measured using the illness concentration index. The concentration index was calculated for the whole sample, as well as for different population groups, areas of residence (rural, urban and metropolitan) and for each province.
Stunting was found to be the most prevalent form of malnutrition in South Africa. Consistent with expectation, the rate of stunting is observed to be the highest in the Eastern Cape and the Northern Province – provinces with the highest concentration of poverty. There are considerable pro-rich inequalities in the distribution of stunting and underweight. However, wasting does not manifest gradients related to socio-economic position. Among White children, no inequities are observed in all three forms of malnutrition. The highest pro-rich inequalities in stunting and underweight are found among Coloured children and metropolitan areas. There is a tendency for high pro-rich concentration indices in those provinces with relatively lower rates of stunting and underweight (Gauteng and the Western Cape).
There are significant differences in under-five child malnutrition (stunting and underweight) that favour the richest of society. These are unnecessary, avoidable and unjust. It is demonstrated that addressing such socio-economic gradients in ill-health, which perpetuate inequalities in the future adult population requires a sound evidence base. Reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution. Furthermore, addressing problems of stunting and underweight, which are found to be responsive to improvements in household income status, requires initiatives that transcend the medical arena.
PMCID: PMC201028  PMID: 14514357
inequity; under-five child malnutrition; socio-economic status; concentration index; South Africa
21.  Breast Cancer and Socioeconomic Status in Austria 
Breast Care  2009;4(4):263-267.
With 28% of all cancers, breast cancer is the most common cancer in the Austrian female population (also worldwide), and incidence has shown a development similar to that in most of the Western European countries. Several studies reveal a higher incidence of breast cancer in women of higher socioeconomic status (SES) compared to women of lower SES. Later age of first childbearing, low total parity, significantly greater use of hormone replacement therapy, and a greater use of mammography screening by women of higher SES are possible explanations for these trends. Socioeconomic inequalities have a strong influence on the subjective perception of health, but also on objective indicators of the health situation. The health behavior of the Austrian population is, of course, determined by social factors. People with a higher socioeconomic status not only live longer than people with a lower SES, they also have a healthier lifestyle and they better assess their own health status. These inequalities can also be observed in significant differences in life expectancy between university graduates and low-educated people (6.2 years for men and 2.6 years for women).
PMCID: PMC2941657  PMID: 21049072
Breast cancer; Socioeconomic status; Austria
22.  The Rewarding Aspects of Music Listening Are Related to Degree of Emotional Arousal 
PLoS ONE  2009;4(10):e7487.
Listening to music is amongst the most rewarding experiences for humans. Music has no functional resemblance to other rewarding stimuli, and has no demonstrated biological value, yet individuals continue listening to music for pleasure. It has been suggested that the pleasurable aspects of music listening are related to a change in emotional arousal, although this link has not been directly investigated. In this study, using methods of high temporal sensitivity we investigated whether there is a systematic relationship between dynamic increases in pleasure states and physiological indicators of emotional arousal, including changes in heart rate, respiration, electrodermal activity, body temperature, and blood volume pulse.
Twenty-six participants listened to self-selected intensely pleasurable music and “neutral” music that was individually selected for them based on low pleasure ratings they provided on other participants' music. The “chills” phenomenon was used to index intensely pleasurable responses to music. During music listening, continuous real-time recordings of subjective pleasure states and simultaneous recordings of sympathetic nervous system activity, an objective measure of emotional arousal, were obtained.
Principal Findings
Results revealed a strong positive correlation between ratings of pleasure and emotional arousal. Importantly, a dissociation was revealed as individuals who did not experience pleasure also showed no significant increases in emotional arousal.
These results have broader implications by demonstrating that strongly felt emotions could be rewarding in themselves in the absence of a physically tangible reward or a specific functional goal.
PMCID: PMC2759002  PMID: 19834599
23.  Pleasure in decision-making situations 
BMC Psychiatry  2002;2:7.
This study explores the role of pleasure in decision making.
In Experiment 1, 12 subjects were presented with a questionnaire containing 46 items taken from the literature. Twenty-three items described a situation where a decision should be made and ended with a suggested solution. The other items served as filler items. The subjects were requested not to make a decision but to rate the pleasure or displeasure they experienced when reading the situation described in the item. The subjects' ratings were then compared to the decisions on the same situations made by the other subjects of the studies published by other workers. The ratings of pleasure/displeasure given by our subjects correlated significantly with the choices published by other authors. This result satisfies a necessary condition for pleasure to be the key of the decision making process in theoretical situations. In Experiment 2, a new group of 12 subjects rated their experience of pleasure/displeasure when reading various versions of 50 situations taken from daily life where an ethical decision had to be made (Questionnaire I) including 200 items. This was followed by a multiple-choice test with the 50 situations (Questionnaire II) using the same 200 items and offering the various behaviors. Subjects tended to choose ethical and unethical responses corresponding to their highest pleasure rating within each problem. In all cases the subjects' behavior was higher than chance level, and thus, followed the trend to maximize pleasure. In Experiment 3, 12 subjects reading 50 mathematical short problems followed by correct and incorrect versions of the answer to the problem (Questionnaire III), including 200 items. This was followed by a multiple-choice mathematical test with the 50 problems (Questionnaire IV) using the same 200 items and offering the correct and incorrect answers. In questionnaire IV, subjects tended to choose correct as well as incorrect responses corresponding to their highest hedonic rating within each problem. In all cases the subjects' behavior was higher than chance level, and thus, followed the trend to maximize pleasure.
The results of the three experiments support the hypothesis according to which decisions are made in the hedonic dimension of conscious experience.
PMCID: PMC116425  PMID: 12036434
24.  Malnutrition and the disproportional burden on the poor: the case of Ghana 
Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups.
This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey.
The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population.
Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition.
PMCID: PMC2245943  PMID: 18045499
25.  Expressed racial identity and hypertension in a telephone survey sample from Toronto and Vancouver, Canada: do socioeconomic status, perceived discrimination and psychosocial stress explain the relatively high risk of hypertension for Black Canadians? 
Canadian research on racial health inequalities that foregrounds socially constructed racial identities and social factors which can explain consequent racial health inequalities is rare. This paper adopts a social typology of salient racial identities in contemporary Canada, empirically documents consequent racial inequalities in hypertension in an original survey dataset from Toronto and Vancouver, Canada, and then attempts to explain the inequalities in hypertension with information on socioeconomic status, perceived experiences with institutionalized and interpersonal discrimination, and psychosocial stress.
Telephone interviews were conducted in 2009 with 706 randomly selected adults living in the City of Toronto and 838 randomly selected adults living in the Vancouver Census Metropolitan Area. Bivariate analyses and logistic regression modeling were used to examine relationships between racial identity, hypertension, socio-demographic factors, socioeconomic status, perceived discrimination and psychosocial stress.
The Black Canadians in the sample were the most likely to report major and routine discriminatory experiences and were the least educated and the poorest. Black respondents were significantly more likely than Asian, South Asian and White respondents to report hypertension controlling for age, immigrant status and city of residence. Of the explanatory factors examined in this study, only educational attainment explained some of the relative risk of hypertension for Black respondents. Most of the risk remained unexplained in the models.
Consistent with previous Canadian research, socioeconomic status explained a small portion of the relatively high risk of hypertension documented for the Black respondents. Perceived experiences of discrimination both major and routine and self-reported psychosocial stress did not explain these racial inequalities in hypertension. Conducting subgroup analyses by gender, discerning between real and perceived experiences of discrimination and considering potentially moderating factors such as coping strategy and internalization of racial stereotypes are important issues to address in future Canadian racial inequalities research of this kind.
PMCID: PMC3520873  PMID: 23061401
Canada; Racial identity; Hypertension; Socioeconomic status; Perceived discrimination; Psychosocial stress

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