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The Development Of Mechanosensitivity
Researchers of the Max DelbrÃøck Center for Molecular Medicine (MDC) Berlin-Buch, Germany, have gained crucial insight into how mechanosensitivity arises. By measuring electrical impulses in the sensory neurons of mice, the neurobiologists and pain researchers Dr. Stefan G. Lechner and Professor Gary Lewin were able to directly elucidate, for the first time, the emergence of mechanosensitivity. At the same time they were able to show that neurons develop their sensitivity to touch and pain during different developmental phases but always coincidentally with the growth of the neuronal pathways. (EMBO Journal, 2009, doi:10.1038/emboj.2009.73).*
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Wall Street Journal Examines Patients' Confusion Over Coverage Of Preventive Exams
As employers increasingly offer no-cost preventive care as a means of controlling health costs, some people under such plans are being charged for services not deemed preventive by the insurer, the Wall Street Journal reports. According to Watson Wyatt Worldwide, 72% of large employers in 2009 cover 100% of preventive care -- such as physicals, colonoscopies or mammograms -- for employees, an increase from 55% of large companies in 2008. The Journal reports that the charges often result from billing errors or from a physician"s office being unaware of an insurer"s procedures. Charges that are the result of billing errors often can be reversed. However, others -- such as a test or treatment not being defined by the insurer as preventive -- force some patients to "wage a protracted battle" to get the charges reversed, according to the Journal. When unexpected charges appear on patients" bills, physicians and employers often receive complaints but they have little control over how insurers classify treatments. The Journal reports that patients can prevent being charged for preventive services by checking with their insurer before seeking care; asking for specific, covered screenings and treatments at physicians" offices; reviewing explanation of benefits forms supplied by insurers; asking supervisors at insurers to review disputed claims; and seeking help from employees in company human re departments (Wilde Mathews, Wall Street Journal, 5/21).
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Blogs Comment On 'Common Ground' Bill, Abortion Coverage In Health Reform Legislation, Other Topics
The following summarizes selected women"s health-related blog entries.~ "Democratic Bill Could Be a Preview of Obama"s Abortion Plan," Dan Gilgoff, U.S. News & World Report"s "God and Country": A recently introduced bill aimed at reducing the need for abortion is "big news because moderate to liberal faith-based advocates are urging the White House to adopt the bill ... as the core of its forthcoming "common ground" plan on abortion and reproductive health," Gilgoff writes. Some conservative religious groups, including the Southern Baptist Convention and the U.S. Conference of Catholic Bishops, "have warned the White House" that the bill is a "deal breaker" for them because of its support for comprehensive sex education and contraception, he writes. The White House "has refused to say which way it"s leaning," Gilgoff writes, adding the Obama administration could "buck" the groups that support the bill and "get behind" the Pregnant Women Support Act, "which is generally considered more robust on reducing demand for abortions and which leaves out contraceptive funding." However, he concludes, "that would be a pretty big surprise" (Gilgoff, "God and Country," U.S. News & World Report, 7/23).~ "New Report: Abortion Providers = American Human Rights Defenders, Now Under Increasing Attack," Jodi Jacobson, RH Reality Check: A new Center for Reproductive Rights report "calls on both the federal and state governments to address the growing threats against and stigmatization and abuse of abortion providers throughout the United States," Jacobson writes. The report "focuses on a key obstacle to the realization of women"s reproductive rights ... and recognizes their work as human rights defenders," she writes, adding that the U.S. has "historically been a leader both in creating and in encouraging accountability to human rights principles throughout the world." However, "[a]ccess to reproductive health care generally and abortion care specifically are basic human rights largely ignored within the context of U.S. domestic politics," Jacobson writes, noting that abortion access in the U.S. "has been increasingly limited due to the range of obstacles created through anti-choice advocacy." The report highlights several "types of rights violations [that] are most pervasive in limiting women"s choices and the rights of abortion providers," including "intimidation and harassment," "stigma" and "legal restrictions." The report makes a "series of recommendations for change at the state and local level for changes in policy and in law enforcement practices, as well as for the federal government, medical community and non-governmental organizations," Jacobson concludes, adding that the report "makes a special plea for the United Nations Special Rapporteur to document violations of women"s human rights in the United States" (Jacobson, RH Reality Check, 7/22).~ "Sixteen Governors Call on Congress To Include Medicaid Family Planning State Option in Health Reform," Jodi Jacobson, RH Reality Check: "Sixteen governors have written a letter to both Senate and House Leadership "expressing strong support for the Medicaid Family Planning State Option,"" which is included in President Obama"s fiscal year 2010 budget proposal, Jacobson writes. The governors wrote, "Many of our states have created family planning expansion programs, though we have done so with great difficulty," adding, "Since the early 1990s, 27 states have been granted federal waivers to expand their Medicaid family planning coverage. These demonstration projects have been unqualified successes, providing care to millions of women while saving states [millions] of dollars." Jacobson continues, "The current Medicaid waiver process, however, "puts unnecessary roadblocks in the way of our efforts to maintain and expand coverage for family planning services,"" according to the governors. She adds, "Passing this law as part of health care reform "would give us the needed flexibility to quickly and efficiently expand cove
Endocrinology

Processing In The Brain's Reward Pathways May Be Affected By Childhood Adversity

New research shows that childhood adversity is associated with diminished neural activity in brain regions implicated in the anticipation of possible rewards. Scientists at Harvard University used functional magnetic resonance imaging (fMRI) to monitor brain activity as participants played a game involving cues that predicted monetary rewards and penalties. "We found that, in comparison to community controls, young adults who had experienced childhood adversity showed weaker responses to reward-predicting cues in left hemisphere regions of the basal ganglia, a part of the brain that is important for orchestrating goal-directed actions," says Diego Pizzagalli, the John and Ruth Hazel Associate Professor of the Social Sciences in the Department of Psychology at Harvard. The research is published in the current issue of the journal Biological Psychiatry, and was conducted by Pizzagalli and Karlen Lyons-Ruth, associate professor of psychology at Harvard Medical School. The lead author is Daniel Dillon, a postdoctoral researcher working with Pizzagalli, and co-authors were Avram Holmes, Jeffrey Birk, and Nancy Brooks, all in the Department of Psychology in Harvard"s Faculty of Arts and Sciences. "In the group that had childhood adversity, two structures in the left basal ganglia were not responsive to reward cues, which differed from what we saw in the control group," says Dillon. "There weren"t any differences between the controls and maltreated participants in response to cues that predicted either penalties or no incentive outcomes. In other words, the group that had experienced childhood adversity only showed a weaker response to the reward cues." Participants also rated their experiences of positive and negative arousal in response to the cues while in the MRI scanner. Relative to controls, the participants who had experienced childhood adversity rated the reward cues as less positive, consistent with the weaker brain response to these cues. Most of the study participants did not currently meet criteria for any psychological disorder, but childhood adversity, such as emotional, physical, or sexual maltreatment, is known to increase the risk for psychopathology, particularly depression. Many previous studies have suggested that the link between childhood adversity and depression might be related to dysfunction in brain regions that are involved in regulating stress, which would contribute to the excessive sadness and negativity that characterizes depression. By contrast, according to the researchers, this study highlights another potential link: by weakening the brain"s response to rewards, childhood adversity may contribute to other important symptoms of depression, such as apathy, low motivation, and a reduced ability to experience pleasure. By identifying specific regions of the brain impacted in certain types of psychological disorders, the researchers hope to contribute to the development of more effective treatments for these disorders. "Eventually, we hope that this type of research will help fine-tune these interventions in much more personalized and hopefully effective ways," says Pizzagalli. The 13 maltreated individuals who participated in the study were young adults who had been followed since childhood as part of a study from the Cambridge Health Alliance, led by Lyons-Ruth. The participants had experienced childhood abuse that met state guidelines for maltreatment, but most were not currently experiencing any symptoms of depression, posttraumatic stress, or other disorders. Pizzagalli underlined the fact that while childhood adversity increases the risk for depression, it is not a one-to-one relationship: Other mitigating factors, such as genetics and social support, can counteract the risk. "This is a serious problem, and we are just starting to grasp what the potential neurobiological consequences will be," says Pizzagalli. "It"s not a direct pathway: Somebody who was exposed to early adversity will not necessarily develop depression. But an important first step to improving treatment is to try to understand what the changes in the brain might be, so that we can know how and when to intervene." The research was funded by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Society Scholars program and the Talley Fund. Amy Lavoie Harvard University


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