Social support and physical literacy in young and middle-aged patients with hypertension: the mediating effects of sense of coherence and self-efficacy.

BACKGROUND: Despite the growing recognition of the importance of social support and physical literacy in managing hypertension among young and middle-aged patients, there is a lack of research exploring the mediating effects of sense of coherence and self-efficacy in this relationship. This study aims to bridge this gap by investigating the interplay between social support, physical literacy, sense of coherence, and self-efficacy, thus contributing to a deeper understanding of effective interventions for hypertension management. METHODS: A cross-sectional study was conducted using convenience sampling to survey 280 young and middle-aged patients diagnosed with hypertension from five community settings in Zhejiang and Anhui provinces between January and February 2024. Measurement instruments included the General Information Questionnaire, Physical Literacy Scale for Young and Middle-aged Patients with Hypertension, Sense of Coherence Scale 13, General self-efficacy Scale, and Perception Social Support Scale. Data analysis was performed using SPSS 27.0 and AMOS 28.0, with reporting following the STROBE checklist. RESULTS: A total of 270 valid questionnaires were collected. The total score of physical literacy for young and middle-aged patients with hypertension ranged from 18 to 90, with a mean score of 62.30 ± 13.92, indicating a moderate level. There was a positive correlation between the physical literacy score and the scores of social support (r = 0.557, P<0.01), sense of coherence (r = 0.392, P<0.01), and self-efficacy (r = 0.466, P<0.01) among young and middle-aged patients with hypertension. Furthermore, social support was found to have multiple mediating effects through sense of coherence and self-efficacy on physical literacy. CONCLUSION: This study sheds light on the interconnectedness of social support, physical literacy, sense of coherence, and self-efficacy among young and middle-aged patients with hypertension. The findings underscore the importance of considering these factors holistically in hypertension management strategies.

Exploring the efficacy of sense of Okayness (SOK) as an antidote for stress in older adults: the role of SOK elevation intervention, heart rate variability (HRV), and cognitive performance in stressful and relaxing situations.

Sense of Okayness (SOK) is an emerging concept that describes a person's ability to remain stable and unshaken in the face of life transitions and hardships. This quality enables effective stress regulation and heightened tolerance to uncertainty. To investigate the possible role of the parasympathetic nervous system (PNS) in mediating the relationship between SOK and stress regulation among older individuals, an analytical sample of N = 69 participants (74% women) with a mean age of 78.75 years (SD age = 6.78) was recruited for a standardized cognitive assessment and stress induction. Baseline heart rate variability (HRV), measured via electrocardiogram (ECG), and SOK assessments were conducted prior to stress induction, along with a baseline cognitive evaluation. Subsequently, participants were subjected to a psychosocial stress paradigm, followed by either a 30-minute SOK elevation intervention (n = 40) or a control condition with nature sounds (n = 29). A second cognitive assessment was administered post-intervention, with continuous HRV measurement through ECG. The results revealed significant HRV changes due to the experimental intervention, though no significant differences were observed between the SOK intervention and control groups. Interestingly, individuals with high trait SOK displayed more stable HRV trajectories, exhibiting a smaller decline during the stress intervention and a milder increase during both the stressor and SOK intervention phases. Overall, these findings do suggest a significant association between SOK, parasympathetic activity, and stress reactivity. These results prompt further investigation into whether personality patterns, such as a strong SOK, may be linked to reduced vagal reactivity and better coping in old age.

Investigation of the relationship between the sense of coherence and the level of depression in mothers of children with autism.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder originating from early childhood. Although there are studies investigating the sense of coherence in caregivers of children with ASD, there is not a previous study in our country. In this study, we aimed to examine the relationship between the sense of coherence and depression levels in mothers of children with ASD. METHOD: Seventy-five mothers of children followed up in rehabilitation centers with the diagnosis of ASD were included in this study. Beck Depression Inventory (BDI) and Sense of Coherence Scale-13 (SOC-13) were administered to mothers. Participants were divided into two groups: a depressive group and a control group according to the BDI cut-off score. SOC-13 total score and sub-scores were compared between these groups. RESULTS: According to the BDI cut-off score, 45 participants (60%) were included in the depressive group. Total SOC-13 score and sub-scores were found to be statistically significantly lower in the depressive group compared with the control group. CONCLUSION: Our study is the first study in our country to examine the relationship between the sense of coherence and depression in mothers of children with ASD. The results showed that there was a significant negative correlation between depression scores and sense of coherence. It is predicted that psychological interventions that will improve the sense of coherence of mothers with children with ASD may play an important role in the treatment of depression, thus leading to an increase in the quality of care provided by parents.

A multimodal cancer rehabilitation programme promoting sense of coherence for women treated for female reproductive cancers: a pilot randomised controlled trial.

PURPOSE: To investigate the feasibility, acceptability, and preliminary effects of a theory-driven multimodal cancer rehabilitation intervention (MCRI) programme among Hong Kong Chinese women treated for female reproductive cancers (FRC). METHODS: A single-blinded randomised controlled trial was conducted in two regional hospitals in Hong Kong involving 35 women treated for FRC. The intervention group (n = 18) received a 12-week MCRI which included 30 modules of app-based health education and three nurse-led individual counselling sessions. The control group (n = 17) received attention from the research nurse through telephone calls. Sense of coherence, health-related quality of life, and cancer-specific distress were measured at baseline (T0), immediately after completion of the intervention (T1) and 12 weeks post-intervention (T2). Twelve intervention completers were interviewed to explore the acceptability of the programme. RESULTS: Recruitment, consent, and retention rates, counselling session attendance rate, and app usage were satisfactory. The intervention participants reported to have significant improvement in physical well-being at T1 (Cohen's d effect size (d) = 1.04, 95% CI 0.24, 1.83), sense of coherence (d = 0.76, 95% CI - 0.03, 1.54), and cancer-specific distress (d = 1.03, 95% CI - 1.83, - 0.21) at T2. Interviewed participants acknowledged the benefits of the programme and provided comments for improvement. CONCLUSIONS: The MCRI is found to be feasible and acceptable and may improve their sense of coherence, distress, and physical health. A full-scale trial using a larger and more representative sample is warranted to confirm the effects of the programme. IMPLICATIONS FOR CANCER SURVIVORS: Women treated for FRC may be benefited from the MCRI in improving sense of coherence, physical well-being, and distress. TRIAL REGISTRATION: This trial was registered on ISRCTN registry with ID ISRCTN73177277.

Control over self and others' face: exploitation and exploration.

The face serves as a crucial cue for self-identification, while the sense of agency plays a significant role in determining our influence through actions in the environment. The current study investigates how self-identification through facial recognition may influence the perception of control via motion. We propose that self-identification might engender a belief in having control over one's own face, leading to a more acute detection and greater emphasis on discrepancies between their actions and the sensory feedback in control judgments. We refer to the condition governed by the belief in having control as the exploitation mode. Conversely, when manipulating another individual's face, the belief in personal control is absent. In such cases, individuals are likely to rely on the regularity between actions and sensory input for control judgments, exhibiting behaviors that are exploratory in nature to glean such information. This condition is termed the explorative mode. The study utilized a face-motion mixing paradigm, employing a deep generative model to enable participants to interact with either their own or another person's face through facial and head movements. During the experiment, participants observed either their own face or someone else's face (self-face vs. other-face) on the screen. The motion of the face was driven either purely by their own facial and head motion or by an average of the participant's and the experimenter's motion (full control vs. partial control). The results showed that participants reported a higher sense of agency over the other-face than the self-face, while their self-identification rating was significantly higher for the self-face. More importantly, controlling someone else's face resulted in more movement diversity than controlling one's own face. These findings support our exploration-exploitation theory: When participants had a strong belief in control triggered by the self-face, they became highly sensitive to any sensorimotor prediction errors, leading to a lower sense of agency. In contrast, when the belief of control was absent, the exploration mode triggered more explorative behaviors, allowing participants to efficiently gather information to establish a sense of agency.

Sense of purpose in life and extending the cognitive healthspan: evidence from multistate survival modeling.

Having a sense of purpose in life predicts better maintenance of cognitive function in older adulthood and reduced risk of mild cognitive impairment (MCI) and dementia. However, little research has examined its influence on the rate of cognitive decline and length of cognitive healthspan. This study evaluated the role of sense of purpose on the risk and timing of transitions between normal cognition, MCI, and dementia. Older adults from the Memory and Aging Project (MAP; n = 1821) and the Health and Retirement Study (HRS; n = 10,542) were followed annually for 19 years and biennially for 12 years, respectively. Multistate survival models assessed whether sense of purpose predicted transitions across normal cognition, MCI, dementia, and death. More purposeful older adults had lower risk of developing MCI (HR = 0.82 in MAP; HR = 0.93 in HRS), higher likelihood of cognitive improvement, and longer cognitively healthy life expectancies. Results suggest sense of purpose may extend the cognitive healthspan.

Number sense deficits in children with developmental dyscalculia, dyslexia, co-occurring disorder and their typically developing peers.

The aim of this study was to explore a number sense deficits in children with developmental dyscalculia, dyslexia, co-occurring disorder and their typically developing peers. A non-symbolic quantity comparison task was used in this study to examine whether children with dyscalculia have number sense deficits. Children aged 10-11 years old from nine primary schools in Taif city, Saudi Arabia, were selected to participate in this study. The children were divided into the dyscalculia group (n = 62), the dyslexia group (n = 60), and co-occurring disorder group (n = 65), and the typically developing peers group (n = 100).4 groups (dyscalculia, dyslexia, co-occurring disorder and typically developing peers group) × 2 stimulus ratio (6:7; 8:12). There were significant differences in non-symbolic quantity comparison tasks between children with dyslexia, co-occurring disorder, and typically developing peers. These results indicate that children with dyscalculia do have number sense deficiencies, but number sense deficiencies are not specific to children with dyscalculia.

A comprehensive dataset for Arabic word sense disambiguation.

This data paper introduces a comprehensive dataset tailored for word sense disambiguation tasks, explicitly focusing on a hundred polysemous words frequently employed in Modern Standard Arabic. The dataset encompasses a diverse set of senses for each word, ranging from 3 to 8, resulting in 367 unique senses. Each word sense is accompanied by contextual sentences comprising ten sentence examples that feature the polysemous word in various contexts. The data collection resulted in a dataset of 3670 samples. Significantly, the dataset is in Arabic, which is known for its rich morphology, complex syntax, and extensive polysemy. The data was meticulously collected from various web sources, spanning news, medicine, finance, and more domains. This inclusivity ensures the dataset's applicability across diverse fields, positioning it as a pivotal resource for Arabic Natural Language Processing (NLP) applications. The data collection timeframe spans from the first of April 2023 to the first of May 2023. The dataset provides comprehensive model learning by including all senses for a frequently used Arabic polysemous term, even rare senses that are infrequently used in real-world contexts, thereby mitigating biases. The dataset comprises synthetic sentences generated by GPT3.5-turbo, addressing instances where rare senses lack sufficient real-world data. The dataset collection process involved initial web scraping, followed by manual sorting to distinguish word senses, supplemented by thorough searches by a human expert to fill in missing contextual sentences. Finally, in instances where online data for rare word senses was lacking or insufficient, synthetic samples were generated. Beyond its primary utility in word sense disambiguation, this dataset holds considerable value for scientists and researchers across various domains, extending its relevance to sentiment analysis applications.

Impact of Glycemic Control on Shoulder Proprioception in Type 2 Diabetes Mellitus: Mediating the Connection - Insights from a Cross-Sectional Analysis.

Introduction: Shoulder proprioception is vital and this cross-sectional study investigated the association between glycemic control and shoulder joint proprioception in Type 2 Diabetes Mellitus (T2DM). Methods: A total of 120 participants, including 60 with T2DM and 60 healthy individuals, were assessed for shoulder joint position sense (JPS) using a digital inclinometer. The T2DM group exhibited significantly greater mean shoulder joint position errors in flexion (4.32° vs 2.15°), abduction, medial rotation, and lateral rotation compared to the healthy group (p < 0.001). Results: The study found significantly greater shoulder joint position errors in the T2DM group compared to the healthy group, highlighting notable proprioceptive deficits in individuals with T2DM. Additionally, a significant positive correlation was found between HbA1c levels and shoulder joint position errors in the T2DM group, suggesting a link between long-term glycemic control and proprioceptive accuracy. Discussion: The significant positive correlation between HbA1c levels and shoulder joint position errors suggests that poor glycemic control is associated with impaired proprioception in T2DM patients. This underscores the need for comprehensive management strategies to mitigate proprioceptive deficits and improve the quality of life in individuals with T2DM.

De novo p.Glu61Ter mutation in GCH1 in a Moroccan patient with dopa-responsive dystonia: a case report.

Dopa-responsive dystonia (DRD) is a hereditary movement disorder due to a selective nigrostriatal dopamine deficiency. It is characterized by onset in childhood or adolescence with marked diurnal fluctuation with or without Parkinsonian features, and is caused by mutations in GCH1 gene. We report in this study the clinical and genetic features of the first DRD Moroccan patient. Using a gene panel sequencing, we identified a heterozygous nonsense variant p. Glu61Ter in GCH1. A subsequent targeted segregation analysis by Sanger sequencing validated the presence of the mutation in the patient, which was found to have occurred de novo. The objective of this study is to report the first description of DRD in Morocco, and highlights the importance of new generation sequencing technology in the reduction of medical wandering and the management of hereditary diseases.

Examining Identity Functioning in Anorexia Nervosa Across Illness and Recovery Stages.

OBJECTIVE: Research suggests that identity functioning (i.e., sense of self) issues may be a core feature of anorexia nervosa (AN). We aimed to investigate differences in identity functioning among women with AN at varying illness and recovery stages, and women with no history of eating disorders (non-ED controls). It was hypothesized that those with current AN (AN-C), weight-restored (AN-WR), and partial recovered individuals (AN-PR) would show poorer identity functioning than fully recovered individuals (AN-FR) and non-ED controls. METHOD: Women (334) with AN-C (n = 74), AN-WR (n = 90), AN-PR (n = 19), AN-FR (n = 22), and non-ED controls (n = 129) completed online self-report measures of identity functioning and ED symptom severity. RESULTS: The AN-C group showed significantly poorer overall identity functioning, poorer consolidated identity, and significantly worse disturbed and lack of identity, than the AN-PR, AN-FR, and non-ED Control groups. The AN-WR group showed significantly poorer overall identity function, and worse lack of identity, than the AN-FR and non-ED Controls, and poorer consolidated identity and disturbed identity than non-ED Controls. Identity scores did not significantly differ between AN-PR, AN-FR, and non-ED Controls. DISCUSSION: Differences in identity functioning are identifiable among individuals at different AN recovery stages, and thus may represent an important state-based feature of AN, making it an important area of consideration in treatment.

"A mini home far away from home." The Thai temple and women's sense of safety in Finland.

Introduction: This article explores the significance of the Thai Buddhist temple for Thai women's sense of safety in Finland. Despite the growing popularity of Buddhism in the country, research literature and media have largely ignored the religiosity of Thai women, focusing instead on negative stereotypes. The article highlights the importance of Buddhism and the temple in the lives of Thai women who have migrated to European countries and challenges biased portrayals of Thai women in previous research. Methods: Based on ethnographic research at the Thai temples in Finland and life story interviews with twelve Thai women. Results: The article argues that the temple plays a crucial role in promoting a sense of safety among Thai women by providing a sense of home, belonging, and meaning. The temple's material and symbolic characteristics, in addition to its communality and relationality, work together to connect individuals with the temple's religious significance, contributing to the women's sense of security. Discussion: These findings speak for the fact that when facing the challenges of Thai women or other religious and ethical minorities, it is necessary to also look to their religion as a source of mental and spiritual well-being.

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study.

OBJECTIVES: To identify the associated factors of self-neglect in older adults from a salutogenic perspective. METHODS: A cross-sectional correlational study was conducted in two communities in Beijing with 486 older adults recruited from April to December 2022. Data were collected by a set of questionnaires. RESULTS: Sense of coherence (ß=-0.138), socio-demographic generalized resistance resources (GRRs) (smoking: ß=0.156), social GRRs (living alone: ß=0.093), psychological GRRs (self-esteem: ß=-0.126), and motivational GRRs (powerful others locus of control: ß=-0.199, chance locus of control: ß=0.119) were all associated with self-neglect among older adults (p<0.05). CONCLUSIONS: Sense of coherence and GRRs are vital to improve self-neglect in older adults. It is suggested to increase the level of self-esteem and the tendency of the health locus of control to largely facilitate self-neglect management in older adults.

Understanding global perspectives for the acceptance of community sanitation welfare schemes through a localised qualitative survey in Kho Nagorian, Jaipur, India.

Community sanitation is a fundamental human right and need. Every year, as per the World Bank, total cost of providing sanitation services is estimated at around 114 billion USD per year. In India, Swachh Bharat Abhiyan (SBA), a public welfare scheme (PWS), is aimed at addressing community sanitation problems. Despite the successful implementation of SBA, local communities still practise open defaecation. To deduce the behavioural patterns governing communal toilet use, interviews were conducted with the local communities in the Kho Nagorian area of Jaipur, Rajasthan, India. This qualitative survey examined attitudes towards the construction of a toilet, awareness towards the SBA scheme, and the willingness to use excreta-based pit humus. The study then discusses the factors that increase the local community's willingness to use these toilets. Results show that open defaecation is still prevalent in society. One way to foster the adoption of toilets is that the construction materials should mainly consist of local materials. As a recourse, places of worship could be used to influence people's perception of hygiene. In addition, community toilets should be cleaned often as well. PWS should not be made accessible at no cost to prevent a sense of entitlement among the people. A small sum should be charged to increase social responsibility towards the PWS. Another way to curb open defaecation is to tap into the sense of entitlement by making effective use of social campaign programs. Further, cross-table analysis revealed that the locals were inclined to use a toilet if they have invested in it. Advertisements were found to be ineffective, and proposals were made to make them effective. These findings aid in understanding public perceptions and can guide the development of public policies. The findings also assist in making tax distribution decisions that reflect public concerns, attitudes, and values.

Shoulder muscle weakness and proprioceptive impairments in type 2 diabetes mellitus: exploring correlations for improved clinical management.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM. Methods: A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer. Results: Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM. Conclusion: This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

Ideotype based genotype selection in a multivariate dataset of sweet potato (Ipomoea batatas L.).

The dataset extensively examines the factors considered when choosing sweet potato genotypes, considering various characteristics. Notably, Moz1.15 demonstrated the highest marketable root yield at 46.46 t/ha, H5.ej.10 exhibited the highest beta-carotene level at 48.94 mg/100 g, and Moz1.9 recorded the highest vitamin C content at 23.89 mg/100 g. Moreover, there were significant correlations (ranging from 0.21 to 0.84) among the yield and quality traits studied in sweet potatoes. Principal component analysis (PCA) confirmed the connections among these traits, identifying four distinct clusters of genotypes, each characterized by specific significant combinations of traits. Factor analysis using the multi-trait genotype-ideotype index (MGIDI) highlighted the considerable impact of sweet potato traits across two growing seasons (2020-21 and 2021-22), facilitating the selection of genotypes with potential genetic gains ranging from 1.86 % to 75.4 %. Broad-sense heritability (h2) varied from 64.9 % to 99.8 %. The use of the MGIDI index pinpointed several promising genotypes, with BARI Mistialu-12 and H9.7.12 consistently performing well over both years. These genotypes exhibited both strengths and weaknesses.

Tactile acuity and active joint repositioning sense in individuals with and without chronic low back pain: a cross-sectional study.

BACKGROUND: Sensorimotor dysfunction, as measured by tactile acuity and active joint repositioning, has been identified as a contributing factor of chronic low back pain (CLBP). Existing research suggests that further research is necessary to improve the characterization of sensorimotor perception in patients with CLBP. OBJECTIVES: The main aim is to investigate whether tactile acuity and repositioning errors differ between individuals with CLBP and controls without CLBP. A secondary aim was to investigate the association between age, body mass index (BMI) and physical activity, and tactile acuity and repositioning sense. METHODS: Cross-sectional study. Sixty-eight participants (36 with, 32 without CLBP) were examined. Two-Point Discrimination (TPD) test (four measures: horizontal and vertical run, left and right side) and Active Joint Reposition Sense (AJRS) test (2 directions: to flexion and to extension) were used. RESULTS: No differences were found for TPD (right horizontal run: p = .069; left horizontal run: p = .066; right vertical run: p = .933; left vertical run: p = .285) or AJRS (flexion: p = .792; extension: p = .956) between participants with and without CLBP. Older subjects had significantly worse tactile acuity (3 sites, p = .018, p = .004, p = .041) and worse repositioning sense (2 directions, p = .026, p = .040,) than younger subjects. Individuals with BMI ≥ 25 had significantly worse TPD compared to individuals with normal weight (2 sites, p = .028, p = .020). CONCLUSIONS: Individuals with CLBP did not have impaired tactile and repositioning accuracy when compared to controls without CLBP. Future studies comparing sensorimotor performance should consider age and BMI as potential confounding factors.

Effects of video-based cervical stabilization home exercises in patients with rheumatoid arthritis: a randomized controlled pilot study.

OBJECTIVE: This study aimed to examine the effects of a remote video-based cervical stabilization exercise program on cervical proprioception, functional status, and disease-related quality of life in patients with rheumatoid arthritis (RA). DESIGN: Patients with RA were evaluated regarding cervical joint positioning error, cervical region functional status (Neck Disability Index), general functional status (Health Assessment Questionnaire), and disease-related quality of life (Rheumatoid Arthritis Quality of Life Scale). Patients were randomized to exercise (n = 14, 10 female) and control (n = 12, 9 female) groups. Patients in the exercise group performed a video-based home exercise program consisting of progressive cervical stabilization exercises three times a week for six weeks in addition to their routine medication. The patients in the control group continued their routine medication only. Evaluations were repeated in both groups in the seventh week following the baseline evaluation. RESULTS: Groups were similar at baseline (p > 0.05). Patients in both groups had low disease activity (DAS-28 CRP ≤ 3.2). The remote video-based exercise program led to significant improvements in cervical proprioception, functional status, and disease-related quality of life (p < 0.05). No significant changes were detected in any parameters in the control group (p > 0.05). Obtained changes were superior in the exercise group compared to the control group (d > 1.00, p < 0.05). CONCLUSION: Cervical stabilization exercises may increase cervical proprioception, improve functional status, and enhance disease-related quality of life in patients with RA when administered as a remote program. TRIAL NUMBER: https://clinicaltrials.gov/study/NCT04948775 , NCT04948775.

Hate, crime and epistemic vulnerability: on sense-making and feelings of (un)safety among Danish Muslims.

This article investigates feelings of (un)safety emerging from knowing and sharing knowledge about hate crime and hate incidents. Drawing on fieldwork and interviews with young Muslims living in the greater Copenhagen area, the article explores the way the interlocutors seek to make sense of their experiences through available epistemic categories, and how this sense-making is shaped by reactions from the surrounding society, e.g., whether it is questioned, supported, ignored etc. Combining criminological and psychological research on direct and indirect harms of hate crime with insights from philosophy on epistemic encounters and their ethical implications the article provides a framework for investigating safety in epistemic interactions. Based on this framework, the article show the often hard work that people perform in order to balance epistemic needs (e.g. the need for knowledge and for recognition) with epistemic risks (e.g. the risk of testimonial rejection, of damaged epistemic confidence, or loss of credibility).