Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Mild traumatic brain injury (mTBI) is a leading cause of injury among children, with approximately 15% of children experiencing a TBI prior to 15 years of age. Acutely, mTBI has been associated with a range of cognitive, physical, emotional and behavioural impairments. However, few studies have examined outcomes beyond five years post injury, long before the developmental process is complete and the full extent of any deficits may manifest. Our group had the unique opportunity to use data from a longitudinal birth cohort of 1265 children (Christchurch Health and Development Study) to examine the long term outcomes of early injury (0–5 years). Information about these children, including mTBI events, had been collected at birth, 4 months and at yearly intervals until age 16, and again at ages 18, 21 and 25 years. We found that even after statistical control for a wide range of child and family confounds, children who had been hospitalized for an mTBI had increased inattention/hyperactivity and conduct as rated by mothers and teachers over ages 7–13 years. Increased rates of psychiatric disorders were over 14–16 years for those injured in the preschool, including symptoms consistent with Attention Deficit/Hyperactivity Disorder (ADHD), Odds Ratio = 4.6, Conduct Disorder (CD), Odds Ratio = 5.6 and Substance Abuse (Odds Ratio = 9.1). Over ages 21–25 ongoing behaviour problems were assessed using self‐reported arrests, violent offenses and property offenses. Compared to non‐injured individuals, mTBI groups were more likely to be arrested, involved in property, and violent offences. We controlled for a wide range of factors and there was still clear evidence of ongoing problems for individuals who had experienced a mTBI compared to their non injured counterparts. These findings provide compelling evidence of long term psychosocial and psychiatric outcomes following mTBI.     

Timing of Stressful Life Events Affects Stability and Change of Neuroticism

Neuroticism is a predictor of many health problems. To study the determinants of within‐subject change in neuroticism, three hypotheses were tested: (i) subjects who experienced stressful life events (SLEs) show an increase in neuroticism; (ii) high baseline neuroticism moderated this effect; and (iii) recent SLEs had a greater impact on neuroticism than distant SLEs. Data came from the Finnish Twin Cohort. Neuroticism data were collected in 1975 and 1981 and SLEs data in 1981 (n = 21 085). By entering baseline neuroticism as a predictor for neuroticism at follow‐up, the outcome measure was change in neuroticism. Changes in neuroticism were predicted from SLE indices or their interaction with baseline neuroticism. Timing of SLEs was taken into account by distinguishing recent from distant SLEs. To control for confounding by shared genes and environments, both within‐twin pair and between‐twin pair effects were tested for monozygotic and dizygotic twin pairs separately. Neuroticism's six‐year stability was high (r = .58, p < .001). Exposure to SLEs modestly increased neuroticism (βs > .55, ps < .001), unconfounded by shared genes. This effect was not moderated by high baseline neuroticism. Recent SLEs (.09 < βs < .15) had more impact than distant SLEs (.03 < βs < .11; ps < .01). In conclusion, the findings strongly supported a model of environmentally driven SLEs causing dynamic fluctuations around a person's set point of neuroticism. Copyright © 2013 John Wiley & Sons, Ltd.     

Observed Variability and Values Matter: Toward a Better Understanding of Information Search and Decisions from Experience

The search for different options before making a consequential choice is a central aspect of many important decisions, such as mate selection or purchasing a house. Despite its importance, surprisingly little is known about how search and choice are affected by the observed and objective properties of the decision problem. Here, we analyze the effects of two key properties in a binary choice task: the options' observed and objective values, and the variability of payoffs. First, in a large public data set of a binary choice task, we investigate how the observed value and variability relate to decision‐makers' efforts and preferences during search. Furthermore, we test how these properties influence the chance of correctly identifying the objectively maximizing option, and how they affect choice. Second, we designed a novel experiment to systematically analyze the role of the objective difference between the options. We find that a larger objective difference between options increases the chance for correctly identifying the maximizing option, but it does not affect behavior during search and choice. Copyright © 2013 John Wiley & Sons, Ltd.     

新农合制度调整前后豫北地区腹膜透析患者透析质量的比较

腹膜透析是终末期肾脏病的有效替代治疗方法之一。2012年4月,河南省对包括慢性肾衰竭在内的六种疾病的新农合报销比例做出重大调整,腹透患者主要经济花费的透析液报销比例由原来的40％提高至80％。通过研究新农合制度调整前后豫北地区腹膜透析患者的临床资料,报告了制度调整后的患者透析充分性提高,贫血、营养状况较前好转,心血管疾病发生率下降,生存质量改善的现况,论证了老龄、糖尿病、营养不良、心血管疾病、透析不充分、较低的医疗保险支付比例是影响腹膜透析患者预后的重要因素,为腹膜透析患者的预后分析提供了理论依据。     

Client as expert: A Delphi poll of clients’ subjective experience of therapeutic alliance formation variables

This study extends prior research that identified client-derived variables believed to contribute to therapeutic alliance development. Forty-two clients participated in a three-round-modified Delphi poll in which the subjective importance of 74 client-derived, common alliance formation variables was rated using a six-point scale. Participants consensually identified 23 variables as highly important, five as moderately important and three as low in importance to the formation of a strong alliance. Variables related to validation and asking about parts of the client’s life other than the presenting concern were considered as most important by at least one-third of the sample. Limitations of the study are presented and implications for theory, measurement, practice and future research are briefly discussed.     

Extreme Outcomes Sway Risky Decisions from Experience

Whether buying stocks or playing the slots, people making real‐world risky decisions often rely on their experiences with the risks and rewards. These decisions, however, do not occur in isolation but are embedded in a rich context of other decisions, outcomes, and experiences. In this paper, we systematically evaluate how the local context of other rewarding outcomes alters risk preferences. Through a series of four experiments on decisions from experience, we provide evidence for an extreme‐outcome rule, whereby people overweight the most extreme outcomes (highest and lowest) in a given context. As a result, people should be more risk seeking for gains than losses, even with equally likely outcomes. Across the experiments, the decision context was varied so that the same outcomes served as the high extreme, low extreme, or neither. As predicted, people were more risk seeking for relative gains, but only when the risky option potentially led to the high‐extreme outcome. Similarly, people were more risk averse for relative losses, but only when the risky option potentially led to the low‐extreme outcome. We conclude that in risky decisions from experience, the biggest wins and the biggest losses seem to matter more than they should. Copyright © 2013 John Wiley & Sons, Ltd.     

On the Decision to Explore New Alternatives: The Coexistence of Under‐ and Over‐exploration

The decision whether to explore new alternatives or to choose from familiar ones is implicit in many of our daily activities. How is this decision made? When will deviation from optimal exploration be observed? The current paper examines exploration decisions in the context of a multi‐alternative “decisions from experience” task. In each trial, participants could choose a familiar option (the status quo) or a new alternative (risky exploration). The observed exploration rates were more sensitive to the frequent outcome from choosing new alternatives than to the average outcome. That is, the implicit decision whether to explore a new alternative reflects underweighting of rare events: Over‐exploration was documented in “Rare Disasters” environments, and insufficient exploration was evident in “Rare Treasures” environments. In addition, the results reveal a decrease in exploration of new alternatives over time even when it is always optimal and some exploration even when it is never reinforcing. These results can be captured with models that share a distinction between “data collection” and “outcome‐driven” decision modes. Under the data collection mode, the decision maker collects information about the environment, to be used in future choices. Under the outcome‐driven mode, the decision maker relies on small samples of previous experiences with familiar versus unfamiliar alternatives, before the selection of a specific alternative. The predictive value of a two‐parameter “explorative sampler” quantification of these assumptions is demonstrated. Copyright © 2013 John Wiley & Sons, Ltd.     

根据血压昼夜节律选择服药时间控制血压晨峰

根据血压昼夜节律,观察给药时间对血压晨峰的影响。256例原发性高血压患者,经24h动态血压监测分为超杓型（n＝49）、杓型（n＝127）和非杓型（n＝80）3组;各组再分为清晨服药组和晚上服药组。用药6周,比较用药前后血压昼夜节律及血压晨峰的变化,发现在改变血压昼夜节律及降低血压晨峰方面,超杓型组清晨服药优于晚上服药,非杓型组晚上服药优于清晨服药;杓型组清晨服药与晚上服药均能降低晨峰值,提示根据个体血压昼夜节律选择服药时间能更好地控制血压晨峰。     

Italian Adaptation and Confirmatory Factor Analysis of the Full and the Short Form of the Posttraumatic Growth Inventory

This study was designed to adapt and to assess the reliability and factor structure of an Italian translation of the full and short form of the Posttraumatic Growth Inventory. A sample of 1,244 Italian adults who had experienced a range of adverse life events participated in this study. Five models of the underlying structure of the Posttraumatic Growth Inventory were tested via confirmatory factor analyses. Analyses of both the short and full form of the PTGI provided support for the original correlated five-factor structure. Multigroup confirmatory factor analysis supported the invariance of the Posttraumatic Growth Inventory across gender.     

Relationship quality,divorce, and well-being: Findings from a three-year longitudinal study

Recent studies indicate that divorce sometimes is positive for subjective well-being, but we lack knowledge about the circumstances under which this is the case. Further, we lack knowledge about the possible different associations between divorce and life satisfaction (LS) vs. positive affect (PA). The current study is based on the Norwegian Mother and Child Cohort Study (MoBa). Change in LS and PA over a three-year period was examined in women who divorced and women who did not divorce (N > 37,000). Relationship quality and relationship status at follow-up were included in the models. The results indicated that divorce predicted higher LS and PA when initial relationship quality was poor. Furthermore, divorce predicted higher PA for women who, after divorce, reported being in a new romantic relationship. The associations between relationship quality and LS and PA were stronger among not-divorced than divorced women, indicating that relationship quality affects LS and PA.