Youth Needs at Intake into Trauma‐Informed Group Homes and Response to Services: An Examination of Trauma Exposure,Symptoms, and Clinical Impression

Trauma‐informed care is recommended to improve the quality of group home services for youth. Youth exposure to trauma and associated symptoms are important factors involved in making the clinical impression that determines treatment services. This study considered three dimensions of trauma (exposure, symptoms, and clinical impression) to determine associations with behavioral incidents of youth in trauma‐informed group homes and how trauma was related to changes in psychopathology from intake to discharge. Archival records of youth (N = 1,096), age 9–18 (M = 15.7 years) who received services from January 2013 to December 2017, and departed the program were used. Statistical procedures included hierarchical linear modeling and analysis of covariance. Results indicated trauma symptoms predicted emotional problems and self‐injurious behavior. Youth in high‐ and low‐trauma groups both showed decreases in behavioral incidents and psychopathology, but clinical impression of trauma moderated the change in emotional problems from intake to discharge. Youth deemed by clinicians to have lower trauma (based on history of maltreatment and expression of trauma symptoms) had greater decrease in emotional problems from admission to discharge. Limitations and implications for further research on implementation and effectiveness of trauma‐informed models are discussed.     

Factor analysis and validation of a self-report measure of impaired fear inhibition

Difficulties with inhibiting fear have been associated with the emergence of anxiety problems and poor response to cognitive–behavioural treatment. Fear inhibition problems measured using experimental paradigms involving aversive stimuli may be inappropriate for vulnerable samples and may not capture fear inhibition problems evident in everyday life. We present the Fear Inhibition Questionnaire (FIQ), a self-report measure of fear inhibition abilities. We assess the FIQ’s factor structure across two cultures and how well it correlates with fear inhibition indices derived experimentally. Adolescent participants from Hong Kong and England completed the FIQ, with the English participants also completing a conditioning and extinction task to assess fear inhibition problems. Across both cultures, the FIQ showed a single factor structure and low FIQ scores, or worse fear inhibition problems, were associated with self-reports of heightened anxiety. Correlation of FIQ scores with experimental indices, whilst controlling for anxious symptoms, suggests that the FIQ represents a valid and unique measure of fear inhibition abilities. The FIQ might be used to assess more ecologically valid fear inhibition problems particularly amongst people who have or who are at risk of anxiety diagnoses.     

Influence of Attachment Style on Sexual Abuse Survivors' Posttraumatic Growth

This study investigated the directional relationship between adults' (N = 292) attachment styles and perceived impact of child sexual abuse with their experience of posttraumatic growth (PTG). Structural equation modeling results identified that attachment style served as a partial mediator between trauma and PTG scores, with the mediating effect contributing to 8% of the variance in the presence of PTG (p < .05; standardized coefficient = ?.31).     

Predictors of decision-making on the Iowa Gambling Task: independent effects of lifetime history of substance use disorders and performance on the Trail Making Test

Poor decision-making and executive function deficits are frequently observed in individuals with substance use disorders (SUDs), and executive deficits may contribute to poor decision-making in this population. This study examined the influence of lifetime history of an alcohol, cocaine, heroin, or polysubstance use disorder on decision-making as measured by the Iowa Gambling Task (IGT) after controlling for executive ability, demographic characteristics, and current substance use. Participants (131 with lifetime history of SUD and 37 controls) completed the IGT and two neuropsychological tests: the Trail Making Test and the Controlled Oral Word Association Test. Control participants performed significantly better than those with a lifetime SUD history on the IGT, but performance on the neuropsychological tests was comparable for the two groups. A lifetime SUD diagnosis was associated with performance on the IGT after controlling for covariates, and Trail Making Test performance was associated with IGT performance in both SUD and control participants.     

Attitudes related to child sexual abuse: scale construction and explorative study among psychologists

A Child Sexual Abuse Attitude and Belief Scale was constructed and then answered by 242 child psychologists. Four CSA related attitude and belief subscales were identified through confirmatory factor analysis: (1) The Disclosure subscale reflecting favouring a disclosure at any cost; (2) The Pro-Child subscale reflecting unconditional belief in children's reports; (3) The Intuition subscale reflecting favouring an intuitive approach to CSA investigations; and (4) The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to have stronger attitudes than male participants. The more training in interviewing children the participants had had, the more erroneous beliefs and stronger attitudes they had. Experience did not affect attitudes and beliefs.     

The Relation Between Childhood Proactive and Reactive Aggression and Substance Use Initiation

The current study examined whether proactive and reactive aggression were associated with the risk for initiation of substance use from fourth to ninth grade in a sample of 126 aggressive children (66% male). In addition, the study examined whether these functions of aggression increased risk for initiation via peer delinquency and peer rejection. Proactive aggression was marginally significantly directly associated with risk for initiation of alcohol use and indirectly associated with risk for initiation of marijuana and tobacco use through peer delinquency. Reactive aggression was associated with increased risk for initiation of tobacco and marijuana use through a complex chain that included both peer rejection and peer delinquency. However, high levels of reactive aggression that did not lead to peer rejection were negatively associated with risk for initiation of tobacco and marijuana use. Implications for intervention are discussed.

Personality and intimate partner aggression in dating relationships: the role of the "Big Five"

Although personality is shown to predict negative relationship experiences, few researchers have used a structural model of personality to study the ways that personality contributes to intimate partner aggression (IPA). This study investigates the five-factor model of personality and its associations with both the use and receipt of psychological, physical, and sexual IPA in 179 men and 301 women. Each of the five factors of personality was associated with at least one type of IPA perpetration or victimization. The dimensions of neuroticism and agreeableness were the strongest predictors of IPA particularly for women. Results are discussed in terms of why personality should be considered as a predictor for both the use and receipt of IPA, why sex differences emerged, and future research that should be conducted.     

急性冠脉综合征（ACS）使用他汀类药物越早越好

通过对急性冠脉综合征他汀治疗的循证医学证据分析,探讨他汀类药物治疗越早越好的依据,并分析血脂治疗达标现状,提高高危、极高危患者的血脂治疗达标率。汇总急性冠脉综合征的他汀治疗相关研究：MIRCAL、PROVEIT、ARMYDA等,以及他汀治疗对斑块的研究ES-TABLISH、GAIN等试验的研究结果,分析美国胆固醇教育计划中血脂目标,以及中国成人血脂异常防治指南中血脂目标值,结合目前临床血脂达标现状,用以确定高危、极高危患者使用他汀治疗的方案应越早越好。心内科以及其他科室的医生应该积极按照《指南》要求尽早使用他汀类药物。     

稳定性冠心病何时需要PCI

目前稳定性冠心病通行的治疗策略是药物治疗的同时常规作冠脉造影,如果病变严重,则尽可能地作介入治疗。但最近COURAGE试验结果的公布,证实介入治疗仅可以缓解症状,但不能改善预后。因此,我们要对PCI在稳定性冠心病中的作用和定位重新进行思考。     

腹腔肿块外科处理的临床决策

临床经常会面对诊断、来源、性质不清的腹腔内肿块。腹腔内肿块是临床常见的病症之一,大多需要外科手术。如何合理应对、妥善处置、科学决策是临床医师对本病诊治的要求和不懈追求。诊断的过程中,依靠详尽的病史、细致的体格检查、恰当的辅助检查,并进行综合的分析以及逻辑思维,做出正确的鉴别和诊断,以解决是否为腹腔内肿块;而后,尽快确定肿块的部位及性质,确定处理的方法和原则,制订详尽的手术方案和步骤。