The Complaint of nature, by Alain de Lille, translated from the Latin by Douglas M. Moffat

[De planctu naturae (anglais). 1908]

Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint.

BACKGROUND: Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom. METHOD: The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up. RESULTS: From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors. CONCLUSION: This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.

Relieved after Doctor's Consultation? Primary Health Care Patients' Complaint-related Worries

Worry is one of the central factors in primary health care patients’ experience with their current complaint. Worry is associated with, e.g., patients’ expectations and the outcomes of doctor’s consultations. The aim of this study was to explore primary health care patients’ complaint-related worry and its changes, as well as contributing factors. Furthermore, the reasons behind patients’ pre-consultation worry and possible relief were examined. The study was conducted in a public primary health care centre in Forssa in Southern Finland. Patients, aged 18–39 years, with a current complaint were interviewed before and after a doctor’s consultation. The patients’ characteristics, perceptions of their complaint and their expectations and experiences concerning the consultation were obtained through interviews. In addition, two questionnaires were administered to measure general tendency to illness worry (IWS) and psychiatric symptoms (SCL-90). The patients’ ratings of the intensity of worry and the severity of their complaint were measured with a visual analogue scale (VAS 0–100). Changes in worry were measured by comparing pre- and post-consultation VAS ratings and asking the patients to compare their worry after the consultation with the worry they felt before it. In connection with these ratings the patients also gave reasons for their experiences in their own words. The patients’ doctors assessed the medical severity of the complaints and whether they had found a medical explanation for the complaints. Many patients were very worried before the consultation (65 % scored over 50 points on the VAS). Worry and severity ratings were associated with the duration and course of the complaint, with a general tendency to illness worry and hostility. On average, the patients were less worried after the consultation than before it. Persistent worry was associated with the patients’ uncertainty about their complaint, their perceiving it as severe, expectations for examinations and reporting symptoms of anxiety. Patients were most often worried about the nature of their complaint (e.g. duration or intensity), not knowing what was wrong, the possible harmful effects of the complaint on body functions, the complaint’s prognosis, e.g. will it get better, and their ability to function. Patients were relieved by getting an explanation or treatment or by having a positive view of the complaint’s prognosis. Patients who reported uncertainty (lack of an explanation, worry about the nature of the complaint) or worry about the complaint’s possible bodily harmfulness were relieved by getting an explanation, often accompanied with getting treatment. On the other hand, worries about the ability to function tended to persist. Doctors should bring up patients’ worries for discussion in order to be able to respond to them appropriately. Because it tends to persist, worry about the ability to function should be addressed. Uncertain patients with concerns about their complaint’s bodily harmfulness or psychological consequences need special attention from their doctor.

Warrant that a complaint was presented to Edmund Riselay, Justice of the Peace in Bertie by Henry Nelles, Justice of the Peace in Niagara against William Wintermute and Benjamin Wright of Bertie by Joseph Lindeberry of Clinton

Warrant (1 page, handwritten copy) that a complaint was presented to Edmund Riselay, Justice of the Peace in Bertie by Henry Nelles, Justice of the Peace in Niagara against William Wintermute and Benjamin Wright of Bertie by Joseph Lindeberry of Clinton regarding the suspicion of Wintermute and Wright stealing wheat from the Lindeberry barn. Benjamin Wright seemed the guiltier of the two and therefore it is requested that he be brought before a Justice of the Peace to be examined. This document is stained, but this does not affect the text, April 4, 1837.

Business To Business (B2B) Service Processes: An Approach To Customer Complaint Process Evaluation Towards Service Excellence

Trabalho de Dissertação que identifica as decisões estratégicas relacionadas com a estrutura de gestão de serviços, no contexto de tratamento de reclamações. Os temas de recuperação de serviços e gestão de reclamações são discutidos e são listadas as melhores práticas com o objetivo de prover qualidade de serviço excelente. Este trabalho apresenta uma revisão da literatura sobre gestão de serviços e sua estratégia, e sobre valor aos clientes e sua satisfação. Qualidade de Serviço, Recuperação de Serviço e Gestão de Reclamações são revistos, também para contextualizar o processo de tratamento de reclamações de uma empresa do ramo industrial em ambiente de negócios entre empresas (business to business), cujos dados foram utilizados para construção do modelo de simulação de um processo de tratamento de reclamações. Os resultados desta simulação, junto com o suporte de um questionário sobre tratamento de reclamações, proveram pontos de reflexão e recomendações sobre desenho da estrutura de serviços e de seu desempenho, voltados para a satisfação dos clientes.

Vocal complaint in physical education teachers and its association with the cardiovascular system

Background: We examined the vocal complaints and evaluated the correlation between the vocal handicap index (VHI) and heart rate variability (HRV) in physical education teachers. We evaluated 46 teachers. Method: The subjects were investigated regarding voice complaint and the VHI was applied. HRV was recorded at seated rest for ten minutes and it was analyzed in the time, frequency domains, geometric indices and fractal exponents. The three domains of the VHI were correlated with the indices of HRV. Results: The physical education teachers presented a VHI score much below the standard of the physiological normality. There was correlation of the organic domain of the VHI with the NN50 and pNN50 and correlation of the functional domain and organic domain of the VHI with the HF index of HRV. Conclusion: The physical education teachers evaluated reported vocal complaints that affected their function and it is suggested to be related with the cardiac autonomic regulation.

Emotions in services: complaint in B2C e-commerce

This study proposes a service recovery (SR) model to describe how cumulative satisfaction, loyalty and word-of-mouth are affected by complaints. The model is based on the role of positive and negative emotions in satisfaction with service recovery (SSR) processes. While prior SSR studies usually investigated only negative emotions and satisfaction with a specific transaction, this research considered both positive and negative emotions.