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How does a great power ally's demonstration of toughness toward a common adversary influence the sense of security among its weaker ally's citizens? The literature on the effects of standing firm against adversaries has significantly evolved in recent years, but empirical evidence is scarce, especially at the mass level. By taking advantage of the unique opportunity of the 2019 North Korea–US Hanoi summit, we examine the conditions under which a powerful alliance partner's firm and uncompromising posture toward a common adversary reassures the citizens of a junior ally. Based on alliance literature, we hypothesize that a patron's hawkish policy reassures its protégé when the protégé fears abandonment more than entrapment and that the more a citizen of the protégé fears abandonment, the more reassuring the patron's hawkish policy is to the individual. Our analysis of online surveys conducted before and after the summit using a quota sample of the Japanese electorate shows that the level of threat perception is significantly lower in the post-summit sample than in the pre-summit one, especially among the respondents who fear abandonment by the US. We thus conclude that President Trump's decision not to compromise with North Korea on its nuclear programs alleviated Japanese citizens' concerns about US alliance commitments to Japan, improving their security perception. This study is significant in showing that a patron state's policy toward a common adversary can greatly influence the perception of its ally's citizens as well as its government. [ABSTRACT FROM AUTHOR]

L'anxiété centrée sur la santé (ACS) est un problème fréquent (jusqu'à 20 % des consultants en contexte de soins secondaires) responsable d'altération de la qualité de vie, d'invalidité, de complications somatiques et psychiatriques, et contribuant à des dépenses de santé élevées à l'échelle de la population. Il est probable, sinon formellement établi, que la prévalence de l'ACS soit en augmentation, et cela peut en partie être expliqué par la médicalisation croissante de la société en général, l'appétit des media pour les questions de santé, et l'usage incontrôlé d'Internet (pouvant conduire certains sujets vulnérables à la cyberchondrie). La pandémie de Covid-19 pourrait y avoir contribué, au moins par l'augmentation significative du niveau global de détresse psychique dans la population qu'elle a engendrée, bien que cela ne soit pas formellement démontré. Le diagnostic de l'ACS en est aisé, dès lors que son évaluation est considérée comme devant faire partie de toute consultation médicale. Certaines attitudes intuitives des médecins, comme la réassurance, s'avèrent iatrogènes face aux personnes ayant un niveau élevé d'ACS. Sa prise en charge peut en être facilitée par une acculturation des somaticiens aux conceptions cognitives de l'anxiété en général et de l'ACS en particulier. L'ACS s'avère traitable efficacement par certaines psychothérapies et en première place les thérapies comportementales et cognitives (TCC), mais la disponibilité de thérapeutes formés et accessibles à moindre coût fait cruellement défaut, particulièrement en France. Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France. [ABSTRACT FROM AUTHOR]

For the past several decades, US policy toward China has fundamentally limited the policy options toward Taiwan. For several historical and practical reasons, mistrust of the United States remains relatively strong among the Taiwanese public. Skepticism about US intentions oscillates between fears of being abandoned and being entrapped. As Washington policymakers continue to debate Taiwan policy through the lens of US-China relations, most of the discussion focuses on how to deter China from attacking Taiwan; few are articulating the importance of reassuring Taiwan. This article sheds light on the Taiwanese sentiment toward the United States, specifically the source of mistrust of the United States, which would significantly affect the efficacy of any US policy. The intricate history of the United States and Taiwan suggests that a new and effective US policy toward Taiwan should include both credible military deterrence of China and a clear reassurance for Taiwan. [ABSTRACT FROM AUTHOR]

This article argues that the conceptual basis for the Norwegian policy framed by 'deterrence and reassurance' towards the Soviet Union/Russia has consisted of two divergent 'balancing acts'. One is 'calibrated deterrence', where reassurance is the means to 'balance' the deterrent effect. The other is a 'balance' between two theoretically conflicting means of achieving security: calibrated deterrence, versus reassurance understood as efforts and means to achieve common security. The argument implies that reassurance balancing deterrence has represented different things according to its use. Clarifying these distinct dyads improves our theoretical understanding of how states conduct their deterrent policies. [ABSTRACT FROM AUTHOR]

Background: Almost 80% of individuals with functional dyspepsia experience meal‐related symptoms and are diagnosed with postprandial distress syndrome (PDS). However, studies evaluating dietary modifications in PDS are sparse. We performed a single‐center randomized trial comparing reassurance and diagnostic explanation (RADE) with or without traditional dietary advice (TDA) in PDS. Methods: Following a normal upper gastrointestinal endoscopy, individuals with PDS were randomized to a leaflet providing RADE ± TDA; the latter recommending small, regular meals and reducing the intake of caffeine/alcohol/fizzy drinks and high‐fat/processed/spicy foods. Questionnaires were completed over 4 weeks, including self‐reported adequate relief of dyspeptic symptoms, and the validated Leuven Postprandial Distress Scale (LPDS), Gastrointestinal Symptom Rating Scale, and Nepean Dyspepsia Index for quality of life. The primary endpoint(s) to define clinical response were (i) ≥50% adequate relief of dyspeptic symptoms and (ii) >0.5‐point reduction in the PDS subscale of the LPDS (calculated as the mean scores for early satiety, postprandial fullness, and upper abdominal bloating). Key Results: Of the 53 patients with PDS, 27 were assigned RADE‐alone and 26 to additional TDA. Baseline characteristics were similar between groups, with a mean age of 39 years, 70% female, 83% white British, and coexistent irritable bowel syndrome in 66%. The primary endpoints of (i) adequate relief of dyspeptic symptoms were met by 33% (n = 9) assigned RADE‐alone versus 39% (n = 10) with TDA; p‐value = 0.70, while (ii) a reduction of >0.5 points in the PDS subscale was met by 37% (n = 10) assigned RADE‐alone versus 27% (n = 7) with TDA; p‐value = 0.43. Response rates did not differ according to irritable bowel syndrome status. There were no significant between‐group changes in the gastrointestinal symptom rating scale and dyspepsia quality of life. Conclusions & Inferences: This study of predominantly white British patients with PDS found the addition of TDA did not lead to significantly greater symptom reduction compared with RADE alone. Alternate dietary strategies should be explored in this cohort. [ABSTRACT FROM AUTHOR]

Since the end of the Cold War, informal security cooperation has been on the rise. Besides formal alliances, states are increasingly establishing so-called “strategic partnerships”. This new form of security cooperation is currently under-researched, although governments consider it an important foreign policy tool. We do not yet know whether security interests are the basis of these arrangements or whether strategic partnerships function as substitutes for or complements to formal alliances. This article addresses both issues by analyzing a new dataset on strategic partnerships with the involvement of G20 countries. I find that two or more states are most likely to be tied by partnerships when the presence of a common threat coincides with the absence of their joint membership in a formal alliance. However, states parties to a formal alliance with a lower commitment, such as a consultation, neutrality, or non-aggression pact, are also likely to be tied to each other by partnerships when they face a common threat.

This article demonstrates that foreign policies of reciprocity entail previously unrecognized tradeoffs. The conventional wisdom in international relations holds that reciprocating another state's cooperative and non-cooperative actions can simultaneously promote cooperation and allow states with compatible preferences to build trust. We present a model that synthesizes recent work on signaling and cooperation to identify a tension between the goals of building long-term trust and inducing short-term cooperation. Specifically, a receiver's highly reciprocal strategy generates strong incentives for hostile senders to behave cooperatively, which reduces the credibility of cooperation as a signal of benign intentions. Conversely, a less reciprocal strategy increases the credibility of senders' cooperative signals, but forgoes the benefits of short-term cooperation with hostile states. Thus, uncertain receivers often face a tradeoff between inducing cooperation and eliciting credible signals. We illustrate these tradeoffs in pre-First World War British foreign policy, and highlight the article's policy implications for contemporary US–China relations. [ABSTRACT FROM AUTHOR]

Sidewalks are an important part of public space, but they are becoming increasingly dangerous, especially at night. Therefore, it is important that sidewalks are adequately illuminated to meet the safety, comfort, and accessibility needs (i.e., provide high levels of pedestrian reassurance) to sidewalk users. The objective of this case study was to quantitatively measure and subsequently explore the spatial and statistical distributions of light intensities along the sidewalks that surround Southern Utah University in Cedar City, Utah. A secondary objective was to develop a set of "adequate lighting" guidelines (i.e., 5 to 10 lux) to help identify areas that could benefit from sidewalks lighting enhancements. A digital light meter was used to measure horizontal light intensity, in lux, at a systematic sample of 208 points along the sidewalks within the study area. Geographic coordinates were also collected for each sample observation to enable mapping and spatial analysis of the light intensity data. Results indicate 61% of the observations have lux values equal to zero (complete darkness), 13.4% met or exceeded the minimum guidelines, while 4.3% fell within the "adequate lighting" guidelines adopted by this case study. These results suggest that sidewalks are too dark in too many places to provide reassurance to sidewalk users in the study area. The mapping and spatial analysis results from this case study also provide information to support targeted visibility enhancements of sidewalks within the study area. [ABSTRACT FROM AUTHOR]

Abstract Background Given the rapid growth of digital media resources, it is worth exploring childbearing women’s use of digital media to address their information needs. The aim of this study was to explore the use of digital media during pregnancy and birth in the local population of Western Victorian women in Melbourne, Australia. Methods A descriptive exploratory approach was used. An online survey consisted of both quantitative and qualitative questions to identify and measure digital media use in pregnancy and the birthing period. Descriptive statistics and Pearson Chi-square test were used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. Results Digital media has become an integral part of the experience in pregnancy with increasing growth of digital media in labour. The most used medium for digital media use was pregnancy applications, followed by websites, social media, YouTube, podcasts, online discussion forums and lastly, labour applications. Information seeking was the main reason for using digital media, and two main themes emerged from the qualitative data; ‘connection with others for social support and reassurance’ and ‘information seeking and providing to assist decision making and providing reassurance’. Conclusion This study highlights the need for future midwifery practice to include digital media sources in antenatal education and care. There is a need for healthcare institutions to improve digital media technology to meet the needs of women. This is crucial as digital media is constantly evolving, and as healthcare providers, we need to integrate digital media with healthcare services.

La libéralisation du secteur des assurances, thème au centre de cette réflexion, nous pousse à affirmer que laisser libre cours à l’initiative privée dans tous les domaines économiques de la vie d’une nation, a toujours été l’une des voies-clé de l’épanouissement de celle-ci. Une garantie de la sécurité pour l’assuré, de l’épargne. L’accroissement de l’esprit de solidarité sous un aspect moderne et le sens de responsabilité, car il n’y a plus de prétexte relatif au manque de confiance grâce à la présence de plusieurs sociétés d’assurances au pays, un facteur de développement économique.

Objective:To study the effect of reassurance and proper mechanical support on quality of life (QOL) and visual analogue score (VAS) pain assessment in patients with mastalgia at a range of follow-ups.Materials and Methods:A prospective follow-up study was conducted among women aged 15–45 years, complaining of breast pain without any abnormality detected clinically and radiologically. After consent to participate and enrollment, all the study participants were counseled and reassured about the non-neoplastic nature of the disease and about wearing proper mechanical support/Bra; this was repeated at each follow-up. VAS was used to assess the pain intensity perceived by the woman at each follow-up, post intervention. The Short Form-36 (SF–36) scale was used to evaluate health related QOL (HRQOL).Results:Among 80 patients, 31.2% were wearing a Bra of fabric other than cotton, 21.2% were wearing a loose fit mechanical support/Brassiere, while 10% were not wearing any mechanical support at baseline. The overall mean VAS score was significantly reduced with each follow-up, indicating decreased perception of breast pain over time. There was a significant difference between the mean SF-36 score between base line and after three months (p

By the time Prime Minister Abe Shinzo and President Park Geun-hye took office, Japan-South Korea relations were already experiencing a downturn over history issues and Lee Myung-bak's unprecedented presidential visit to the disputed islets of Dokdo/Takeshima. Park's refusal to hold a bilateral summit became the symbol of strained ties. Then on November 2, 2015 — 980 days after taking office — Park met Abe for bilateral talks in Seoul. On December 28, the two sides declared a rapprochement with an agreement supporting survivors of wartime brothels. Tensions worsened again during President Moon Jae-in's term (2017–2022), contradicting the narrative that leaders had turned relations around in late 2015. Yet the diplomatic relationship was not on a downward spiral. Japanese and Korean policymakers managed to put a floor under their interactions owing to three stabilizing mechanisms that operated during both the Park and Moon administrations. First, political elites practiced mutual restraint to limit vicious cycles of nationalist recriminations. Second, Tokyo and Seoul carefully calibrated policies toward Beijing while avoiding divergence from each other. Third, reassuring the United States about the cost-effectiveness of its alliances involved trilateral cooperation that also helped stabilize Japan-South Korea relations. [ABSTRACT FROM AUTHOR]

Cyclical mastalgia most common type of breast pain, accounting for 40 percent of all cases referred to breast clinic. there important correlation with the menstrual cycle with this type of mastalgia. the aim of study to detect cyclical mastalgia respond to reassurance with recommendations or respond to medical treatment on the one hand and study effectiveness and side effects of medical treatment of cyclical mastalgia on the other hand. the study including 147 female patients with cyclical mastalgia affecting quality of life attending Afak hospital and private clinic between August 2014 _ August 2021 Data recorded on database, history, clinical examination and investigated by radio - image (mammography or ultrasound) then managed at first with reassurance with recommendations and if patients not respond to reassurance then treated with either evening primrose oil or Cabergoline drug as result (40 %) of patient respond to reassurance with recommendations the remainder (60 %) divided into two groups, one group treated with evening primrose oil the response for such drug was (66 %) and side effect of same drug develop in (4 %) of patients. While another group treated with Cabergoline, the response to this drug was (88%) and side effect develop in (89 %) of patients. conclusion, cyclical mastalgia common condition affecting quality of life needs carefull assessment to avoid missed breast carcinoma and may require medical treatment. [ABSTRACT FROM AUTHOR]

Background: Given the rapid growth of digital media resources, it is worth exploring childbearing women's use of digital media to address their information needs. The aim of this study was to explore the use of digital media during pregnancy and birth in the local population of Western Victorian women in Melbourne, Australia. Methods: A descriptive exploratory approach was used. An online survey consisted of both quantitative and qualitative questions to identify and measure digital media use in pregnancy and the birthing period. Descriptive statistics and Pearson Chi-square test were used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. Results: Digital media has become an integral part of the experience in pregnancy with increasing growth of digital media in labour. The most used medium for digital media use was pregnancy applications, followed by websites, social media, YouTube, podcasts, online discussion forums and lastly, labour applications. Information seeking was the main reason for using digital media, and two main themes emerged from the qualitative data; 'connection with others for social support and reassurance' and 'information seeking and providing to assist decision making and providing reassurance'. Conclusion: This study highlights the need for future midwifery practice to include digital media sources in antenatal education and care. There is a need for healthcare institutions to improve digital media technology to meet the needs of women. This is crucial as digital media is constantly evolving, and as healthcare providers, we need to integrate digital media with healthcare services. [ABSTRACT FROM AUTHOR]

Most victims' cases are not progressed through the criminal justice system, which is a phenomenon linked to low satisfaction with police performance. Little is known about how police can fairly and effectively "let victims down." One mechanism is a call-back, which is prevalent in other professions but less so in policing and could be applied specifically for victims who experience case attrition at early stages. By proactively contacting victims following their initial report, the call-back may offer reassurance and lead to improved levels of satisfaction. We tested this approach with 1326 victims of vehicle and bicycle crimes in a block randomized controlled trial in London, UK. Based on follow-up telephone surveys, the findings suggest that a reassurance call-back policy increases the satisfaction of bicycle theft victims by 5%–15%, but not for victims of vehicle theft, who are largely unaffected by the call-back. The findings are likely driven by the victims' expectations: vehicle theft victims expect their reported cases to progress through the justice system, whereas bicycle theft victims do not; thus, the former remain as disappointed as the participants who did not receive a call-back. These findings are promising, as they offer a new tool for policing that can provide more care to victims of crime. [ABSTRACT FROM AUTHOR]

Angina bullosa haemorrhagica (ABH) is characterized by the recurrent appearance of haemorrhagic bullae on the oropharyngeal mucosa which rupture spontaneously leading to complete recovery within a weeks' time without any scarring. We report the clinical features of six cases of ABH. A cross-sectional observational study was performed. A total of six cases of ABH fulfilling the Ordioni et. al. criteria for diagnosis of ABH were enrolled.The age of our patients were 65, 25, 20, 35, 55 and 48 years. Four of them were females (67%), whereas two were males (33%).Retromolar trigone involvement was most common.The chief complaint in all was reddish bulla(e) in the oral cavity of 1 day duration. Five of the patients had solitary lesions, while one had multiple lesions. The lesions measured from 1 to 3 cm in diameter. Complete blood counts and clotting factors were normal in all patients. All cases healed within a week's time. ABH is not a very common disorder encountered by ENT surgeons, dermatologists, general practitioners, and the lack of knowledge of its normal presentation can lead to unnecessary anxiety and incorrect treatment. The typical hemorrhagic bulla(e) usually erupt after eating hard, hot, or spicy food. These lesions heal spontaneously and treatment is not necessary except for reassurance and mild anxiololytics. [ABSTRACT FROM AUTHOR]

Satisfaction from police performance in cases that are screened out from police investigation is low, particularly for victims who report online. In a randomized controlled trial, we report the impact of reassurance telephone callbacks on satisfaction scores for victims of vehicle crime in London, United Kingdom. Evidence suggests that reassurance callbacks cause victims to express more favorable attitudes toward the police, with more pronounced satisfaction scores among minority victims, particularly those who report their crime online. We argue that callbacks to victims are advantageous in an era of a police legitimacy crisis with diminished resources for law enforcement. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of reassurance and proper mechanical support on quality of life (QOL) and visual analogue score (VAS) pain assessment in patients with mastalgia at a range of follow-ups. Materials and Methods: A prospective follow-up study was conducted among women aged 15-45 years, complaining of breast pain without any abnormality detected clinically and radiologically. After consent to participate and enrollment, all the study participants were counseled and reassured about the non-neoplastic nature of the disease and about wearing proper mechanical support/Bra; this was repeated at each follow-up. VAS was used to assess the pain intensity perceived by the woman at each follow-up, post intervention. The Short Form-36 (SF-36) scale was used to evaluate health related QOL (HRQOL). Results: Among 80 patients, 31.2% were wearing a Bra of fabric other than cotton, 21.2% were wearing a loose fit mechanical support/Brassiere, while 10% were not wearing any mechanical support at baseline. The overall mean VAS score was significantly reduced with each follow-up, indicating decreased perception of breast pain over time. There was a significant difference between the mean SF-36 score between base line and after three months (p<0.0001). Mean scores in all domains of the SF-36 increased. The greatest reduction in mean VAS score was seen in 26-35 years age group and women with a body mass index <18.5 kg/m2. Conclusion: Reassurance and wearing proper mechanical support/Bra are effective for improving QOL and alleviating breast pain/mastalgia. These simple processes should be used for the management of mastalgia. [ABSTRACT FROM AUTHOR]

Since the end of the Cold War, informal security cooperation has been on the rise. Besides formal alliances, states are increasingly establishing so-called "strategic partnerships". This new form of security cooperation is currently under-researched, although governments consider it an important foreign policy tool. We do not yet know whether security interests are the basis of these arrangements or whether strategic partnerships function as substitutes for or complements to formal alliances. This article addresses both issues by analyzing a new dataset on strategic partnerships with the involvement of G20 countries. I find that two or more states are most likely to be tied by partnerships when the presence of a common threat coincides with the absence of their joint membership in a formal alliance. However, states parties to a formal alliance with a lower commitment, such as a consultation, neutrality, or non-aggression pact, are also likely to be tied to each other by partnerships when they face a common threat. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: The aim of this work was to determine dentists’ ability to accurately estimate patients’ anxiety level during dental treatment (ie, “empathic accuracy”) and to determine the strength of the association between empathic accuracy and patient-reported reassurance. Methods: A cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients’ anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS). Results: Agreement between dentists’ assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177) = 0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177) = 0.15; 95% CI, 0.00-0.29, was found between dentists’ empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients’ anxiety scores, r (177) = −0.23; 95% CI, −0.38 to −0.09. Conclusions: Given that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in anoptimal manner.

Abstract Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice.

Crimes on the scale of a collective trauma event (CTE) can generate fear, grief, and a sense of injustice that impact beyond those directly affected. Increasingly, reassurance policing is mobilised to restore a sense of community safety and security. Yet little is evidenced as to what constitutes effective reassurance policing, and its barriers and enablers. This study examined police perceptions of good reassurance practice within Victoria Police, Australia. Two focus groups were conducted (senior command (n = 17) and frontline operational staff groups, (n = 9)) and data were analysed using inductive thematic analysis. Five components of good reassurance practice were identified – (1) understanding the purpose of reassurance; (2) assessing the unique context of each CTE; (3) implementing the key strategies of reassurance; (4) using the core skills of reassurance; and (5) having reassurance guidelines. Based on these findings, key skill and strategy areas are proposed for inclusion in an organisational reassurance framework. Alongside these policy and practice proposals, we recommend that larger scale, multisite, and mixed-method studies of reassurance practices are needed to enable opportunities to triangulate perspectives of diverse police and community groups. [ABSTRACT FROM AUTHOR]

Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Educational messages related to Low back pain (LBP) are often contradictory and drive maladaptive beliefs, as they conflict with the latest research evidence. This study aims to examine participants' reassurance levels in relation to educational messages regarding LBP among the Saudi population with the condition compared to those without it, and to assess the association between levels of reassurance and fear avoidance. Methods: A list of 13 educational messages about LBP was generated from LBP‐educational resources in Saudi Arabia, and from expert consensus on a set of evidence‐based key messages for people with LBP. Consented respondents with LBP of various durations and those without the condition completed a questionnaire containing questions on demographic characteristics, the absence or presence of LBP and its intensity, and the fear‐avoidance beliefs questionnaire (FABQ). We also asked them to rate their level of perceived reassurance regarding the educational messages using a Likert‐type scale from 0 to 10. Results: Participants (n = 1652) reported that the 13 educational messages had reassured them about LBP. However, there was no significant difference between participants with and without LBP (p ≥ 0.05). There was an overall weak association between the responses to the 13 educational messages and the fear‐avoidance questionnaire. However, reassurance levels regarding most of the educational messages were negatively associated with the FABQ. Discussion and conclusion: We demonstrate that people with and without LBP need reassurance about the condition. Furthermore, we show that as reassurance increases, fear‐avoidance decreases, confirming the complex nature of LBP. [ABSTRACT FROM AUTHOR]

Abstract Aim To synthesize evidence on the concept of reassurance in nursing practice. Design Integrative review. Review Method PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962). Results Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

Two states in a dispute refuse to back down. One ties its own hands to strengthen its stand and gain advantage; the other tries to untie the tied hands to preempt disadvantage. Tying hands is a well-studied strategy, but it tells only part of the story, and the response strategy of untying hands remains unexplored. Can a state untie the tied hands of its opponent to give freedom back to its opponent—the freedom to concede? I identify three strategies of untying hands: counterthreat, reassurance, and normative framing. I show experimentally that these strategies can reduce the public costs of backing down and the perceived reputational damage from backing down. Tied hands and audience costs are not static and immutable, but dynamic and malleable by the other side. [ABSTRACT FROM AUTHOR]

Mistrust is a common cause of conflict between individuals belonging to different identity groups. When can such mistrust be overcome? We present a theoretical model of trust-building across social identity groups to address this question. Trust between groups increases when individuals in one group are willing to take a chance on engaging with members of the other group, their engagement is positively reciprocated, and they are able to credibly communicate the experience to their fellow group members, thereby increasing their belief that members of the other group are trustworthy. This process is made easier if the individuals are not too hostile to the out-group, are flexible enough to change their beliefs in response to new information, and are sufficiently attached to their own group to be honest about their experiences with out-group members. [ABSTRACT FROM AUTHOR]

In clinical guidelines for patients with chronic musculoskeletal pain, reassurance is a key element. The purpose of reassuring patients is to change their views on their illness and, thereby, their actions. However, when symptoms persist without pathological findings, reassurance can be difficult to achieve. Drawing on observations of nineteen naturally occurring hospital consultations with chronic musculoskeletal pain patients, followed by individual interviews with both patients and clinicians, we study how they interact in relation to reassurance. Our main aim is to explore the ways in which clinicians explicitly attempt to provide reassurance, and how patients receive these attempts, before reflecting on facilitating and hindering factors for successful reassurance in relation to the sociocultural context in which their interaction takes place. Through a thematic analysis, four dominating elements of explicit reassurance were identified: (1) education through visualisation, (2) validation through technological findings, (3) validation through physical examination and (4) normalising pain. To gain a deeper understanding of the reassurance process, we then narratively explored dialogical extracts containing these elements. The analysis shows a potential lack of congruence between what patients experience, and the biomedical knowledge clinicians rely on. Despite employing a combination of affective and cognitive modes of reassurance, clinicians tend to build their final conclusions not on patients experiences but on biomedical knowledge, which is knowledge that holds epistemic primacy for themselves. In that sense, their efforts to reassure the patients might also be a way in which they seek to reassure themselves., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France., (Copyright © 2024 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Abstract Background There is a need to improve consultations between patients with persistent musculoskeletal low back pain and orthopaedic spine clinicians when surgery is not indicated. Poor communication and lack of education about self- management in these consultations have been shown to be associated with increased distress and higher subsequent health care seeking. Aim To develop a standardised intervention to improve spine care consultations for patients for whom surgery is not beneficial. Method The intervention was developed in six stages. The first three stages included: interviews with patients, an interactive workshop with clinicians from a mix of disciplines, and interviews with spine clinicians about their perspective of the recommendations, their perceived difficulties and potential improvements. Information from these stages was synthesised by an expert panel, creating a draft intervention structure and content. The main features of the intervention and the materials developed were then reviewed by patients and spine clinicians. Finally, the research team incorporated the recommended amendments to produce the intervention. Results In total, 36 patients and 79 clinicians contributed to the development of the intervention. The final intervention includes three components: a pre-consultation letter with information suggesting that surgery is one possible intervention amongst many, introducing the staff, and alerting patients to bring with them a potted history of interventions tried previously. The intervention includes short online training sessions to improve clinicians’ communication skills, during the consultation, in reference to listening skills, validation of patients’ pain, and use of appropriate language. Clinicians are also supplied with a list of evidence-based sources for advice and further information to share with patients. Finally, post consultation, a follow up letter includes a short summary of the patients’ clinical journey, the results of their examination and tests, and a reminder of recommendations for self-management. Conclusion The intervention includes aspects around patient education and enhanced clinician skills. It was developed with input from a multitude of stakeholders and is based on patients’ perceptions of what they would find reassuring and empowering when surgery is excluded. The intervention has the potential to improve the patients care journey and might lead to changes in practice in spine clinicians.

There is a robust body of evidence suggesting that communication skills during consultations are associated with patient satisfaction and adherence. Training practitioners to improve communication and reassurance delivery is therefore desirable. The Consultation-Based Reassurance Questionnaire (CRQ) for people presenting with back pain has not been tested as a tool to examine the reliability and responsiveness of communication training for practitioners. To translate and examine the reliability of the CRQ and to explore its ability to detect change (responsiveness) before and after a single session of training in communication skills. Thirty-five simulated consultations were recorded. 36 second-year physiotherapy students took part, either as a simulated patient or a simulated physiotherapist. All videotape simulations were rated independently by two trained observers, using the CRQ. Correlations indicate that the two raters were significantly and highly correlated (r = 0.9, 95% CI 0.797–0.951). The responsiveness statistics were in the moderate range for the total CRQ score, with moderate responsiveness range for data-gathering and relationship-building, and acceptable responsiveness for generic and cognitive reassurance. The CRQ Scale shows good reliability and acceptable levels of responsiveness to detect change before and after training in communication skills in physiotherapy students. The scale requires testing in real-life settings to establish better responsiveness. [ABSTRACT FROM AUTHOR]

Background Chest pain is a common complaint in the general practitioner's (GP) office. Computed tomography (CT) is one of the main diagnostic tools available for assessing coronary artery disease (CAD), with a low probability of a false-negative result (<1%). Despite normal CT findings, many patients with non-coronary chest pain believe they suffer from CAD. Aims To determine the effect of an intervention on reassurance, treatment satisfaction, and recurring chest pain in patients with non-coronary chest pain at follow-up after 1 month. Methods Patients with chest pain, but with normal coronary CT angiography, i.e. no CAD, were randomized into two groups. The intervention group received extended information about the CT examination, including visualization of their individual coronary calcium score images, before the radiographer conveyed the final examination result. The control group received standard care, i.e. neither extended information nor the examination result and were encouraged to consult their referring cardiologist or GP after 1 week. Items from the Seattle Angina Questionnaire and a question regarding reassurance measured the effect of the intervention at follow-up after 1 month. Results The study included 92 patients, 63 female and 29 male, with a follow-up response rate of 80%. Reassurance and overall treatment satisfaction were significantly higher in the intervention group (P = 0.016 and P = 0.046 respectively). The incidence of chest pain was significantly reduced in the intervention group (P = 0.042). Conclusion This study demonstrated that the intervention group showed significantly higher reassurance, overall treatment satisfaction, and experienced significantly less chest pain at follow-up after 1 month. Clinical Trials Database ID NCT03781661 [ABSTRACT FROM AUTHOR]

Aim: To synthesize evidence on the concept of reassurance in nursing practice. Design: Integrative review. Review Method: PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962). Results: Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely "antecedents of reassurance," "defining attributes of reassurance" and "outcomes of reassurance." Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance. [ABSTRACT FROM AUTHOR]

In western industrialised societies, asymptomatic individuals are increasingly labelled as at-risk of future illness and targeted for public health interventions. These at-risk people are identified through health checks, population studies and national screening programs. The main purpose of communicating such risk to individuals is to motivate them to make lifestyle changes. Many of these risk-labels are controversial, both medically and ethically. Based on the relational theory of risk and a thematic analysis of qualitative interviews, we explore how individuals defined as at-risk perceive and conceptualise information about risk of developing diabetes. The interviews were conducted in 2019 with 26 participants from an ongoing population study in Norway. After participating within the screening, participants were informed that they had elevated or intermediate glycated haemoglobin values, and therefore at risk of developing type 2 diabetes. Our data reveal an ambiguous situation: while receiving information about being at-risk may function as a vulnerability-reminder that might motivate lifestyle changes, it can also create unnecessary fear over a disease that may never occur. Danger and uncertainty were interrelated aspects in the ways in which our participants conceptualised risk. Participants risk perceptions seemed to be regulated by fear, followed by a need for reassurance. Differences in risk perceptions and accounts of lifestyle changes depended on people's trust in expert information versus their own experiences. Trust in medical expertise played a significant role in the ways in which participants constructed their risk, as well as their accounts of lifestyle changes. [ABSTRACT FROM AUTHOR]

Purpose of Review : The purpose of this review is to summarize current approaches to management of functional vision disorder (FVD). Recent Findings: Several retrospective studies of FVD in both adults and children have shed light on the range of outcomes and the prevalence of psychosocial stressors among FVD patients. While the first line of treatment for FVD is reassurance and education, recent case reports highlight the use of additional treatment modalities including psychotherapy, hypnosis, and transcranial magnetic stimulation in specific cases. Summary: Although the epidemiology and diagnosis of functional vision disorder are well described, there is limited evidence supporting treatment modalities. Nevertheless, the majority of patients improve with conservative management including reassurance, education, and appropriate follow-up. Additional approaches such as mental health care referral can be considered in refractory cases. [ABSTRACT FROM AUTHOR]

Background: The social context is critical to children’s pain, and parents frequently form a major aspect of this context. We addressed several gaps in our understanding of parent–child interactions during painful procedures and identified intrapersonal contributions to parental affective responses and behaviors. We used the pain empathy model framework to examine parent–child interactions during venipuncture to determine predictors of parent distraction and reassurance. Aims: We examined relations among parent and child behaviors along with parent fear and child pain and fear. We empirically tested the contribution of top-down influences in predicting the use of two common parent utterances, reassurance and distraction during venipuncture, including parent beliefs about these behaviors. Methods: Venipunctures of 100 5- to 10-year-old children were filmed, and parent–child interactions were coded using the full 35 item Child Adult Medical Procedure Interaction Scale. Two codes were of particular interest: reassurance and distraction. Self-report measures included child fear and pain, parent fear, trait anxiety, empathy, pain catastrophizing, and beliefs about reassurance and distraction. Results: Findings supported original Child–Adult Medical Procedure Interaction Scale codes linking parent “distress-promoting” behaviors with poorer child outcomes and parent “coping-promoting” behaviors with improved child outcomes. Parent traits accounted for a small portion of the variance in parent reassurance and distraction. Conclusions: Findings are consistent with research on coping and distress promoting behaviors. Using a novel framework of the pain empathy model, we found that parent traits largely did not predict their procedural behaviors, which were more strongly related to child distress behaviors during the needle and parent beliefs about the behaviors.

Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; "Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems", comprising the following categories: "Knowledge translation", "Interaction and dialogue", "The health care professional support" and "Form organization". Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain. [ABSTRACT FROM AUTHOR]

Abstract Background Establishing trust and effective communication can be challenging in the emergency department, where a prior relationship between patient and provider is lacking and decisions have to be made rapidly. Venous thromboembolism (VTE) represents an emergent condition that requires immediate decision making. Objective The aim of this paper was to document the experiences, perceptions, and the overall impact of health care provider communication on patients during the diagnosis of VTE in the emergency department. Methods This was a qualitative method study using semistructured interviews to increase understanding of the patient experience during the diagnosis of VTE and impact of the health care provider communication on subsequent patient perceptions. Results A total of 24 interviews were conducted. Content analysis revealed that certain aspects of health care providers’ communication—namely, word choice, incomplete information, imbalance between fear over reassurance and nonverbal behavior—used to deliver and explain VTE diagnosis, treatment, and prognosis increases patients’ fears. Conclusion These interviews elucidate areas for improvement of communication in the emergency care setting for acute VTE.

We conduct an experiment to investigate the joint effects of advisor reassurance and advice source in enhancing the impact of advice on auditors' whistleblowing propensity. Participants from a Big 4 firm assess the likelihood that a questionable act involving a superior will be reported, both before and after receiving advice. We manipulate, between-participants, the advice source (the technical department, an authoritative source vs. a colleague, a non-authoritative source) and advisor reassurance (with vs. without) on the firm's policy on whistleblower protection, holding constant the advice recommendation. Our study is underpinned by the premise that moral agents may require an impetus to do the right thing in the form of advice whose effects may vary by its source and nature. Results are consistent with our hypothesis. Specifically, while auditors' propensity to report a questionable act increases after receiving advice, the increase is significantly higher when the advice is received with reassurance on whistleblower protection than without reassurance, with the effect of reassurance being greater when the advice is from an authoritative source (the technical department) than from a non-authoritative source (a colleague). These results underscore the importance of advice in promoting whistleblowing and demonstrate how the impact of advice is jointly determined by its source and reassurance on whistleblower protection. [ABSTRACT FROM AUTHOR]

Background: There is a need to improve consultations between patients with persistent musculoskeletal low back pain and orthopaedic spine clinicians when surgery is not indicated. Poor communication and lack of education about self- management in these consultations have been shown to be associated with increased distress and higher subsequent health care seeking.Aim: To develop a standardised intervention to improve spine care consultations for patients for whom surgery is not beneficial.Method: The intervention was developed in six stages. The first three stages included: interviews with patients, an interactive workshop with clinicians from a mix of disciplines, and interviews with spine clinicians about their perspective of the recommendations, their perceived difficulties and potential improvements. Information from these stages was synthesised by an expert panel, creating a draft intervention structure and content. The main features of the intervention and the materials developed were then reviewed by patients and spine clinicians. Finally, the research team incorporated the recommended amendments to produce the intervention.Results: In total, 36 patients and 79 clinicians contributed to the development of the intervention. The final intervention includes three components: a pre-consultation letter with information suggesting that surgery is one possible intervention amongst many, introducing the staff, and alerting patients to bring with them a potted history of interventions tried previously. The intervention includes short online training sessions to improve clinicians' communication skills, during the consultation, in reference to listening skills, validation of patients' pain, and use of appropriate language. Clinicians are also supplied with a list of evidence-based sources for advice and further information to share with patients. Finally, post consultation, a follow up letter includes a short summary of the patients' clinical journey, the results of their examination and tests, and a reminder of recommendations for self-management.Conclusion: The intervention includes aspects around patient education and enhanced clinician skills. It was developed with input from a multitude of stakeholders and is based on patients' perceptions of what they would find reassuring and empowering when surgery is excluded. The intervention has the potential to improve the patients care journey and might lead to changes in practice in spine clinicians. [ABSTRACT FROM AUTHOR]

Whilst research has shown how self-criticism may increase both neural and self-report markers of negative emotion, less well-known is how self-reassurance—a compassionately-motivated cognitive self-relating style—may regulate negative emotion. Using fMRI, we invited participants to engage in self-criticism and self-reassurance toward written descriptions of negative life events (mistakes, setbacks, failures). Our results identify that neural markers of negative emotion and self-report markers of trial intensity during fMRI are down-regulated under conditions of self-reassurance, relative to self-criticism. Future work to control for autobiographical memory during this fMRI task is needed, as are controls for how well participants can engage in both thinking styles, to explore how memory/task engagement can contribute to self-reassurance and self-criticism. Engagement in self-reassurance can reduce the "sting" of negative life-events, both neural and self-report, which holds important implications for therapy. [ABSTRACT FROM AUTHOR]

Whilst research has shown how self-criticism may increase both neural and self-report markers of negative emotion, less well-known is how self-reassurance—a compassionately-motivated cognitive self-relating style—may regulate negative emotion. Using fMRI, we invited participants to engage in self-criticism and self-reassurance toward written descriptions of negative life events (mistakes, setbacks, failures). Our results identify that neural markers of negative emotion and self-report markers of trial intensity during fMRI are down-regulated under conditions of self-reassurance, relative to self-criticism. Future work to control for autobiographical memory during this fMRI task is needed, as are controls for how well participants can engage in both thinking styles, to explore how memory/task engagement can contribute to self-reassurance and self-criticism. Engagement in self-reassurance can reduce the “sting” of negative life-events, both neural and self-report, which holds important implications for therapy.