Need For Reassurance Research Articles

An Audit of Hip Radiographs Performed for General Practitioners

AIM: We carried out a prospective study of the GP referrals for hip radiographs to find out the proportion of radiographs falling within the RCR guidelines and to ascertain the reasons for not following the guidelines. MATERIALS AND METHODS: One thousand two hundred and fifty six consecutive hip radiographs were performed for GPs over a 12-month period. Questionnaires were sent to GPs for 873 referrals during an audit period of 18 months Four hundred and fifty three questionnaires were returned with adequate information. The proportion of change in management between the patients falling within the guidelines and those outside the guidelines was compared using Fisher's Exact Test (SPSS Package Version 9) and the corresponding 95% confidence interval (CI) was calculated. RESULTS: Only 194 (43%) of the 453 referrals were within RCR guidelines and 259 (57%) were outside guidelines. In the group where RCR guidelines were followed, 60% were normal, 34% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 44%. In the group where guidelines were not followed 76% were normal, 18% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 37%. There was no evidence of difference in the change in management between these two groups. Twenty per cent of the radiographs showed abnormalities other than hip changes. Of these, only 17% were abnormalities other than degenerative changes and considered significant. CONCLUSIONS: This audit does not reveal why the majority of the requests fell outside guidelines. This may be due to lack of awareness amongst GPs about guidelines, patient pressure, medico-legal problems and the need for reassurance. However, the audit does not show any evidence that following guidelines would increase efficiency of referral. Bhatt R.,et al. (2001). Clinical Radiology56, 970–972.

"A Gentleman and an Officer": A Military and Social History of James B. Griffin's Civil War

In 1861, James B. Griffin left Edgefield, South Carolina and rode off to Virginia to take up duty with the Confederate Army in a style that befitted a Southern gentleman: on a fine-blooded horse, with two slaves to wait on him, two trunks, and his favorite hunting dog. He was thirty-five years old, a wealthy planter, and the owner of sixty-one slaves when he joined Wade Hampton's elite Legion as a major of cavalry. He left behind seven children, the eldest only twelve, and a wife who was eight and a half months pregnant. As a field officer in a prestigious unit, the opportunities for fame and glory seemed limitless. Griffin, however, performed no daring acts, nor did he inspire great loyalty in his men. Instead, he unknowingly provided a unique and invaluable portrait of the Confederate officers who formed the core of Southern political, military, and business leadership. In A Gentleman and an Officer, Judith N. McArthur and Orville Vernon Burton have collected eighty of Griffin's letters written at the Virginia front, and during later postings on the South Carolina coast, to his wife Leila Burt Griffin. Extraordinary in their breadth and volume, the letters encompass Griffin's entire Civil War service, detailing living conditions and military maneuvers, the jockeying for position among officers, and the different ways officers and enlisted men interacted during the Civil War. Unlike the reminiscences and biographies of high-ranking, well-known Confederate officers or studies and edited collections of letters of members of the rank and file, this collection sheds light on the life of a middle officer--a life turned upside down by extreme military hardship and complicated further by the continuing need for reassurance about personal valor and status common to men of the southern gentry. In these letters, Griffin describes secret troop movements in various military actions such as the Hampton Legion's role in the Peninsula Campaign (details that would certainly have been censored in more recent wars). Here he relates the march from Manassas to Fredricksburg, the siege of Yorktown and the retreat to Richmond, and the fighting at Eltham's landing and Seven Pines, where Griffin commanded the legion after Hampton was wounded. Throughout, as Griffin recounts these most extraordinary of times, he illuminates the most ordinary of day-to-day issues. One might expect to find a Confederate officer meditating on slavery, emancipation, or Lincoln. Instead, we are confronted by simple humanity and simple concerns, from the weather to gossip. Monumental historical events intruded on Griffin's life and sent him off to war, but his heartfelt considerations were about his family, his community, and his own personal pride. Ultimately, Griffin's letters present the Civil War as the refinery, the ordeal by fire, that tested and verified--or modified--Southern upperclass values. With a fascinating combination of military and social history, A Gentleman and an Officer moves from the beginning of the Civil War at Fort Sumter through the end of the war and Reconstruction, vividly illustrating how the issues of the Civil War were at once devastatingly national and revealingly local.

Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents

This study investigated the symptomatology and comorbidity of generalized anxiety disorder (GAD) in a clinically referred sample of Italian children and adolescents as a function of age and gender. The sample consisted of 58 subjects (19 children and 39 adolescents), 23 males and 35 females screened from consecutively referred children and adolescents. This sample was divided into two groups of younger children (19 subjects, eight males and 11 females aged 7 to 12 years; mean age, 9.6) and adolescents (39 subjects, 15 males and 24 females aged 12 to 18 years; mean age, 14.9). Feelings of tension, apprehension, the need for reassurance, irritability, negative self-image, and physical complaints were reported in more than 70% of the subjects. Differences in the symptomatic profile between males and females were not significant. Children and adolescents did not show significant differences in the number of symptoms. The need for reassurance was significantly more frequent in children, and brooding was more frequent in adolescents. Other anxiety disorders were commonly comorbid with GAD. More than half of the patients with GAD showed a concurrent depressive disorder; no differences were found for comorbidity between children and adolescents, except for higher rates of separation anxiety disorder in children.

‘God is more weary of woman than of man’: Reflections on a Text in the Golden Legend

The presence of a malodorous taint of misogyny in Christian literature, both ancient and medieval, is a familiar fact that feminist writers, more than male chauvinists, have been keen to push under our noses. What is its explanation? The inferiority of women is a standard theme in male-dominated cultures. Christian literature, for so long the virtual preserve of male celibates, inevitably reflected their anxieties and their need for reassurance. But was there also a genuine theological component, however misconceived, arising from basic Christian convictions about human nature and the moral law?

Delineating a putative phobic-anxious temperament in 126 panic-agoraphobic patients: toward a rapprochement of European and US views

Background: The current US official position, since DSM-III, is that panic attacks represent the hallmark of panic disorder and play a major role in the development of the agoraphobic syndrome. The more favoured view in the European tradition is that neurotic personality and/or prodromal features such as mild depression and excessive worries precede the illness. Method: We studied 126 consecutive cases of panic disorder with or without agoraphobia by DSM-III-R criteria, evaluated by relevant structured and semi-structured interviews. Results: We provide evidence that characterological and prodromal antecedents represent a putative phobic-anxious temperamental substrate occurring in at least 30% of our sample. This temperament consists of three or more of the following traits: (1) increased sympathetic activity with repeated sporadic and isolated autonomic manifestations; (2) marked fear of illness; (3) hypersensitivity to separation; (4) difficulty to leave familiar surroundings; (5) marked need for reassurance; (6) oversensitivity to drugs and substances. Our data further suggest that these attributes are of familial origin, as a result of which the illness tends to declare itself earlier. Limitation: The present investigation is largely correlational without a prospective component; however, the key validating familial data were obtained blindly. Conclusion: Our data support a pathogenetic model whereby genetic diathesis unfolds from subclinical to clinical manifestations along temperamental, panic, phobic and avoidant patterns. We submit that the delineation of the phobic-anxious temperament will be useful in more completely charting the life course of the panic-agoraphobic spectrum; avoidant and dependent (Axis II) patterns appear more distal in the pathogenetic chain and, in many cases, can be conceptualized to be epiphenomenal to the disease process.

Sleep problems of elementary school children. A community survey.

To examine the prevalence, co-occurrence, and correlates of sleep problems among elementary school children. Survey. General community. The parents of 987 children aged 5 to 12 years completed an anonymous survey distributed in their children's schools. The survey form asked about background characteristics, children's sleep environment, sleep habits, adult interventions, sleep history, and specific sleep problems. Bedtime resistance was the most prevalent sleep problem (27%). Sleep-onset delays (11.3%), night waking (6.5%), morning wake-up problems (17%), and fatigue complaints (17%) were also common. Among children with sleep-onset problems, 80% displayed bedtime resistance, while 34% of bedtime resisters had onset problems. Onset problems correlated with more fears, night waking, psychiatric and medical conditions, the need for reassurance and caregiver proximity, and history of sleep problems. Bedtime resistance was associated with an inconsistent bedtime and falling asleep away from bed. Those who display delayed sleep onset and bedtime resistance also wake later, suggesting that sleep-phase delays may maintain these problems. The results confirm bedtime resistance as parents principal sleep-related complaint for this age group but reveal a subgroup more prone to insomnia, night waking, and anxiety-related features. Phase delay findings suggest the importance of limits around wake-up time as well as bedtime. The results highlight the importance of distinctly evaluating bedtime resistance, sleep onset, sleep maintenance, waking, and emotional adjustment.

Televised Sports and Ritual: Fan Experiences

Examination of idiosyncratic sports rituals engaged in by viewers of televised sports revealed complex patterns of negotiation and participation in the televised events. In addition to being well-recognized tools for defining group membership, personal rituals revealed the creation of multistranded connections between fans and teams or players, despite separation by an electronic wall. Personal rituals revealed a balancing of the need for suspense with a need for reassurance, and extended to superstitions and part-play/part-serious efforts to influence game outcome. Exploration of private sports-viewer rituals illuminates the ways individuals alter their experiences of televised sports in order to gain social and cultural empowerment.

Children's news interest during the gulf war: The role of negative affect

Eighty children in grades three to six were interviewed about their affective responses and their interest in war‐related news during the Gulf war. Results showed that children who felt more personally vulnerable and experienced more enduring upset during the war were more interested in neutral/background news (but not in casualty news) and avoided exposure to news coverage of the war more often. Children reported moderate interest in casualty news, and supplemental analyses indicated that one reason for watching such content was a desire to remain informed about the war (surveillance). Also, a need for reassurance appeared to reduce interest in casualty‐related news.

Land without Plea Bargaining: How the Germans Do It

As the death grip of adversary procedure has tightened around the common law criminal trial, trial has ceased to be workable as a routine dispositive proceeding. Our criminal justice system has become ever more dependent on processing cases of serious crime through the nontrial procedure of plea bargaining. Unable to adjudicate, we now engage in condemnation without adjudication. Because our constitutions guarantee adjudication, we threaten the criminal defendant with a markedly greater sanction if he insists on adjudication and is convicted. This sentencing differential, directed towards inducing the defendant to waive his right to trial, makes plea bargaining work. It also makes plea bargaining intrinsically coercive. I have elsewhere had occasion to point to the host of irremediable deficiencies moral, juridical, practical that inhere in the plea bargaining system.' Plea bargaining is such a recent2 and transparent evasion of our cherished common law tradition of criminal trial that its well-meaning practitioners and proponents feel a deep need for reassurance that what they are doing is not so bad as it looks. Rather lately, apologists for American plea bargaining have been sounding a theme purportedly derived from comparative law. As a corollary to the proposition that plea bargaining is not really so bad, the claim is advanced that everybody else does it too. Plea bargaining is said to be universal, at least in the legal systems of advanced industrial countries. 3

Behavioral differences and emotional conflict among male-to-female transsexuals.

Salient differences in behavior between two groups of male transsexuals have been studied. Topics investigated are transsexualism and homosexuality, prostitution and employment, affectlessness, need for reassurance, and deprecation of others. The hypothesis is advanced that those who are leading more stable lives and who are working in gainful employment have developed a stronger self-system which has enabled them to come to terms more effectively with the basic emotional conflict underlying transsexualism than have those who are and have been engaged in homosexuality and prostitution.