Moral Hazard in Pediatrics

“Moral hazard” is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties.     

Counterfactual Evaluation of Outcomes in Social Risk Decision-Making Situations: The Cognitive Developmental Paradox Revisited

We report a study that examined the existence of a cognitive developmental paradox in the counterfactual evaluation of decision-making outcomes. According to this paradox adolescents and young adults could be able to apply counterfactual reasoning and, yet, their counterfactual evaluation of outcomes could be biased in a salient socio-emotional context. To this aim, we analyzed the impact of health and social feedback on the counterfactual evaluation of outcomes in a laboratory decision-making task involving short narratives with the presence of peers. Forty risky (e.g., taking or refusing a drug), forty neutral decisions (e.g., eating a hamburger or a hotdog), and emotions felt following positive or negative outcomes were examined in 256 early, mid- and late adolescents, and young adults, evenly distributed. Results showed that emotional ratings to negative outcomes (regret and disappointment) but not to positive outcomes (relief and elation) were attenuated when feedback was provided. Evidence of development of cognitive decision-making capacities did also exist, as the capacity to perform faster emotional ratings and to differentially allocate more resources to the elaboration of emotional ratings when no feedback information was available increased with age. Overall, we interpret these findings as challenging the traditional cognitive developmental assumption that development necessarily proceeds from lesser to greater capacities, reflecting the impact of socio-emotional processes that could bias the counterfactual evaluation of social decision-making outcomes.     

员工创新行为源于领导情感信任吗?风险倾向与组织行为授权的调节作用

领导情感信任会促进员工表现创新行为,但员工个体的风险倾向与组织行为授权可能对其具有调节作用。结果显示（1）领导情感信任能正向预测员工创新行为;（2）领导情感信任、组织行为授权与风险倾向对员工创新行为预测存在三维交互作用,相对于其他条件,组织行为授权和风险倾向均处于高水平条件下,领导情感信任与员工创新行为的正相关程度更为明显。探讨领导情感信任、组织行为授权、风险倾向与员工创新行为的关系可以为甄别影响员工创新行为的个体和环境因素提供理论指导,此外,也可为企业和直接领导如何增加员工创新行为提供借鉴。     

风险决策中的领域特异性

风险领域特异性指某特定领域内的风险决策和偏好可能会受到领域内特有的风险因素影响, 因而会导致领域特异性的行为。基于期望法则的风险决策理论认为, 风险倾向具有跨情境的稳定性。但近20年行为决策领域的证据表明, 风险倾向具有领域特异性, 其机制探索、测量工具和影响因素方面均取得了积极进展。从机制探索历程来看, 以往主流机制着重从风险−回报框架解构领域特异性的风险行为, 近年研究在丰富其机制检验证据的同时, 开始从进化、人格、动机等新的视角进行解读; 在测量工具层面, 领域特异性风险量表仍占主导地位, 并在多种文化、内容领域和群体间得到了进一步检验和扩展, 其他基于不同内容领域划分的风险领域特异性量表也具有较好的信效度; 在影响因素层面, 大量研究从遗传、环境、个体差异等角度探索了导致风险领域特异性的前因变量。未来研究方向应注重整合各风险内容领域, 在更加细化的风险领域检验现有理论, 并进一步探索个体层面的领域特异性规律。     

Neurobehavioral Changes in Adolescence

Adolescents across a variety of species exhibit age-specific behavioral characteristics that may have evolved to help them attain the necessary skills for independence. These adolescent-related characteristics, such as an increase in risk taking, may be promoted less by the hormonal changes of puberty than by developmental events occurring in brain. Among the prominent brain transformations of adolescence are alterations in the prefrontal cortex, limbic brain areas, and their dopamine input, systems that are sensitive to stressors and form part of the neural circuitry modulating the motivational value of drugs and other reinforcing stimuli. Such developmental transformations of the adolescent brain may predispose adolescents to behave in particular ways and make them particularly likely to initiate use of alcohol and other drugs.     

A Regional Study of Risk Factors for Drug Abuse and Delinquency: Sex and Racial Differences

Many juveniles are at high risk for delinquency and drug abuse by virtue of the characteristics of their neighborhoods, which are often economically impoverished, socially unstable, physically neglected, and rife with crime, drug use, and drug selling. However, a significant proportion of these youth do not engage in deviant behavior, while others participate to varying degrees. This study examined what factors discriminate between high-risk youth who do and who do not exhibit deviant behavior. Self-reported measures of several attitudes and behaviors known to correlate with drug abuse and delinquency were assessed in relation to reports of property offenses, person offenses, drug use, and drug selling. Additional analyses were conducted to distinguish between sex and racial groups to further qualify the relationships between deviant behaviors and attitudes. The most notable finding was that types of deviance that primarily involve material and monetary gain may be largely influenced by relationships with significant others, while deviance with potentially harmful consequences to both self and others are influenced largely by personal attitudes. Examination of individual variables showed that negative peer influences and positive attitudes toward fighting significantly increased the likelihood of reporting involvement in three of the four deviance measures, and that positive relationship with the father and prosocial values were inversely related to two of the behavioral deviance measures. There were very few differences in significant predictors of deviance for males versus females. Several self-reported attitudes and behaviors distinguished African Americans from Hispanics and Whites, even though Whites were reportedly responsible for a higher incidence of deviant behaviors.     

Women's bar‐related victimization: Refining and testing a conceptual model

A model of bar victimization is proposed that explores the relationships among a woman's exposure to the bar environment (i.e., frequency of going to bars), her intoxication in that setting (i.e., usual number of drinks), and such individual difference factors as her previous history of victimization (childhood sexual abuse, lifetime violence, and previous partner abuse) and personality characteristics (depression, social anxiety, sensation seeking, and hostility). Earlier findings from work in this area suggest that exposure to the bar environment increases a woman's risk for more severe aggression. The data being used to test the proposed model are from a survey of 198 women bar drinkers in western New York State. These women described bar‐related victimization that ranged from verbal aggression (e.g., threats) through severe physical and sexual violence (e.g., assault and rape). Younger age, history of victimization, greater negative affect, and more frequent drinking in bars were predictive of more severe bar‐related victimization during the past year. These findings are discussed in terms of women's risk for victimization in bars and needed areas of future research. Aggr. Behav. 25:349–364, 1999. © 1999 Wiley‐Liss, Inc.     

跨期选择和风险决策的认知神经机制

经济决策包含两个传统问题：跨期选择和风险决策。跨期选择分为冲动决策和自我控制,当冲动决策时,优先激活了与中脑多巴胺神经元相联系的旁边缘区域,包括伏隔核、眶额皮层中部和前额叶中部;自我控制即选择延迟决策时大脑双侧前额叶和后顶叶皮层神经活动增强。在风险和不确定性条件下,大脑皮层和杏仁核与风险决策联系密切。     

The development of executive function in early childhood is inversely related to change in body mass index: Evidence for an energetic tradeoff?

A well‐established literature demonstrates executive function (EF) deficits in obese children and adults relative to healthy weight comparisons. EF deficits in obesity are associated with overeating and impulsive consumption of high calorie foods leading to excess weight gain and to problems with metabolic regulation and low‐grade inflammation that detrimentally affect the structure and function of prefrontal cortex. Here, we test a complementary explanation for the relation between EF and body mass index (BMI) grounded in the energy demand of the developing brain. Recent work shows that the brain accounts for a lifetime peak of 66% of resting metabolic rate in childhood and that developmental changes in brain energetics and normative changes in body weight gain are closely inversely related. This finding suggests a trade‐off in early childhood between energy used to support brain development versus energy used to support physical growth and fat deposition. To test this theorized energetic trade‐off, we analyzed data from a large longitudinal sample (N = 1,292) and found that change in EF from age 3 to 5 years, as a proxy for brain development in energetically costly prefrontal cortex, is inversely related to change in BMI from age 2 to 5 years. Greater linear decline in BMI predicted greater linear increase in EF. We interpret this finding as tentative support for a brain–body energetic trade‐off in early childhood with implications for lifetime obesity risk.