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A systematic approach to nonconformity management and continuous improvements are the key elements of the quality management system. The objective of this paper is to present quality improvement for a manufacturing company producing forgings through the combination of several statistical methods and quality control techniques. First, Pareto analysis was applied, followed by the 8D (eight disciplines) methodology using a structured eight-step approach to problem solving following the PDCA (plan-do-check-act) method. The aim was to identify the problem and discover the critical causes of failures in the management system that allowed the problem to occur, by modifying and combining appropriate quality management methods and tools. The paper introduces a case study considering the forging process in the production of gearboxes, where customer complaints were identified in the last year, demanding the need to eliminate failures. Using the mentioned methods, the root cause of the problem was identified and permanent corrective action was planned and implemented according to the recommendations of the 8D report, which made it possible to reduce the likelihood of a recurrence of this problem and increase customer satisfaction.

Objectives We applied a person-oriented approach and used latent class linear mixed models to identify sleep trajectories that explain memory, concentration, and learning ability problems after retirement. Methods Data consist of prospective surveys from four phases of the Helsinki Health Study between 2000–2017 (n = 3748, aged 55–77 years, 80% women). Multinomial regression was used to examine the associations between sleep trajectories and cognitive function, adjusting for sociodemographic, health-related behavior, and health factor covariates. Results Among statutory retirees, three latent group trajectories of insomnia-related symptoms were identified: stable low, decreasing, and increasing. Among those who had retired for disability reasons, we identified one additional latent group trajectory: stable high. Insomnia symptoms were associated with worse cognitive function. Discussion Early detection of insomnia symptoms would be a potential intervention point to improve both sleep quality and prevent cognitive decline in later life. However, intervention studies are needed.

OBJECTIVE: This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. BACKGROUND: In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. SEARCH STRATEGY AND INCLUSION CRITERIA: To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject-relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer-reviewed articles. MAIN RESULTS AND SYNTHESIS: The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication-and-resolution programmes, complaints procedures, patients-as-partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organisation around disclosure and support, and desired outcomes. PATIENT CONTRIBUTION: This scoping review specifically takes the patient perspective in its methodological design and analysis. Studies were included if they contained an evaluation by patients, and the included studies were analysed on the essential elements for patients. ispartof: HEALTH EXPECTATIONS vol:25 issue:1 pages:264-275 ispartof: location:England status: published

In the current era of digitalization, most hotels are present on the Internet and most booking decisions are made online. Several online public review platforms exist, and it is crucial to know how their specific affordances influence the formulation of online negative reviews, as differences in the make-up of online reviews are likely to affect hotel managers' responses to these reviews and other customers' decisions. This research explores the impact of TripAdvisor's and Booking.com's affordances on the content of hotel reviews. Using a multilingual corpus, we selected 100 negative reviews written in French on each of these two platforms and compared them in terms of review length, the number of constitutive negative review components, how a particular component is realized, and the use of upgraders and downgraders. We predicted reviews to be more explicitly negative on TripAdvisor than on Booking.com because Booking.com's affordances elicit both positive and negative comments, as the platform provides a blank text template for positive comments and one for negative comments, and because it invites feedback in the form of lists instead of narratives, thus decreasing the likelihood of dissatisfaction narratives to unfold. Our results confirm these predictions: TripAdvisor reviews are longer than Booking.com reviews; the former are also more explicit, and include a larger variety of negative evaluations.

This paper addresses how the realizations of different constitutive components of Twitter complaints shape the perception of these complaints. A complaint situation can be defined as consisting of four components which can be expressed by the complainer: the “complainable”, dissatisfaction with respect to the complainable, the person or entity considered to be responsible for the complainable, and the wish for the complainable to be remedied. In this paper, we present three experiments in which we test how complaint perception is impacted by the realization of the complainable (Exp. 1), of the entity responsible for the complainable (Exp. 2), and of the customer’s wish for the complainable to be remedied (Exp. 3).

In most countries, a veterinary disciplinary system is in force to ensure the quality of the veterinary profession and to offer an objective platform for complaints. We present an analysis of 15 years of veterinary disciplinary verdicts (2001–2016) to compare facts and figures and identify which factors are of major influence on the outcome of the verdicts. Rulings were collected from both paper files and the digital database of the veterinary disciplinary council (VDC), categorized, and used to create a database that enabled a statistical analysis. The results showed that complaints pertaining to companion animals are filed predominantly by owners, whereas complaints about livestock are mostly filed by the governmental civil servant (CS). CS complaints mostly address compliance issues. For the complaints made by owners (client complaints, CCs), reporting, communication, and veterinary mistakes appeared to be of statistical significance. Further studies are needed to investigate the impact of the complaints on veterinarians in general and how we can improve the veterinary disciplinary system.

Complaints reflect a person’s or family’s experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: ‘pain management’, ‘sedation’, and ‘infectious disease/infection control’. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision.

This study compared the risk perceptions of medical disputes among veterinarians and veterinary students in Taiwan between 2014 and 2022. Online validity-tested questionnaires were used to collect data, with 106 (73 veterinarians and 33 students) and 157 (126 veterinarians and 31 students) surveys collected in 2014 and 2022, respectively. Respondents would be asked to rate their perceptions on how likely each risk factor constitutes a medical dispute according to their past experiences on a five-point Likert scale from 1 to 5: “Very unlikely, unlikely, neutral, likely, very likely.” The results showed that overall risk perceptions increased significantly in 2022 compared to 2014, with the top risk factors being attitudes during interactions and complaint management among experienced veterinarians. In contrast, students considered medical skills and clients’ perspectives as the top two risk factors, with complaints management ranking as the least significant factor. The findings suggest that effective communication and complaint management are crucial in preventing medical disputes, highlighting the importance of developing these skills in young veterinarians and veterinary students to reduce medical disputes. The study also recommends increasing practical experiences of medical disputes and complaint management in veterinary education to bridge the gap between the perceptions of experienced veterinarians and students.

Although low-frequency noise (LFN) is associated with various complaints, there is still much unknown about this phenomenon. This research aims to provide an extensive description of (1) LFN perceptions, (2) LFN-related complaints, and (3) the characteristics of LFN complainants. In an explorative observational cross-sectional survey study, a sample of Dutch adults reporting to experience LFN (n = 190) and a group not experiencing LFN (n = 371) completed a comprehensive questionnaire. Descriptions of LFN perceptions varied individually and were dependent on different circumstances, although some common patterns were observed. Complaints were wide-ranging and individual, with a reported high impact on daily living. Common complaints included sleeping difficulties, fatigue, or annoyance. Societal consequences were described regarding housing, work, and relationships. Attempts to stop or escape the perception were manifold but often unsuccessful. The LFN sample differed regarding sex, education level, and age from the Dutch adult population, indicating more frequent inability to work, less full-time work, and less years lived in their homes. No further differences in occupational or marital status or living circumstances were found. Although this research supports some previous findings and identifies common patterns, it also highlights the individual nature of LFN-related experiences and the heterogeneity of this group. It is advised to pay attention to the complaints of affected individuals, to inform concerned authorities, and to conduct more systematic and multidisciplinary research using standardized and validated measuring instruments.

Objective. This study aims to design and implement the first deep learning (DL) model to classify subjects in the prodromic states of Alzheimer’s disease (AD) based on resting-state electroencephalographic (EEG) signals. Approach. EEG recordings of 17 healthy controls (HCs), 56 subjective cognitive decline (SCD) and 45 mild cognitive impairment (MCI) subjects were acquired at resting state. After preprocessing, we selected sections corresponding to eyes-closed condition. Five different datasets were created by extracting delta, theta, alpha, beta and delta-to-theta frequency bands using bandpass filters. To classify SCD vs MCI and HC vs SCD vs MCI, we propose a framework based on the transformer architecture, which uses multi-head attention to focus on the most relevant parts of the input signals. We trained and validated the model on each dataset with a leave-one-subject-out cross-validation approach, splitting the signals into 10 s epochs. Subjects were assigned to the same class as the majority of their epochs. Classification performances of the transformer were assessed for both epochs and subjects and compared with other DL models. Main results. Results showed that the delta dataset allowed our model to achieve the best performances for the discrimination of SCD and MCI, reaching an Area Under the ROC Curve (AUC) of 0.807, while the highest results for the HC vs SCD vs MCI classification were obtained on alpha and theta with a micro-AUC higher than 0.74. Significance. We demonstrated that DL approaches can support the adoption of non-invasive and economic techniques as EEG to stratify patients in the clinical population at risk for AD. This result was achieved since the attention mechanism was able to learn temporal dependencies of the signal, focusing on the most discriminative patterns, achieving state-of-the-art results by using a deep model of reduced complexity. Our results were consistent with clinical evidence that changes in brain activity are progressive when considering early stages of AD.

After announcing the launch of a Drag Queen Storytime, the Halton Hills Public Library (HHPL) received positive feedback from the community, but also faced criticism from a small but vocal group of citizens. Complaints reached as high as the mayoral office, challenging the library’s position as a trusted community institution, and testing the rigour of its training, communications, policies, and procedures. Despite the pushback, the library ran a highly successful program and afterward redoubled its commitment to fighting homophobia and promoting equality. This article details how the HHPL came to offer the program, what the response was, as well as suggestions for measuring success and processing complaints., Suite à l’annonce du lancement d’une heure du conte drag queen, la Halton Hills Public Library (HHPL) a reçu des échos positifs de la part de la communauté, mais a également dû faire face aux critiques provenant d’un petit groupe vocal de citoyens. Les plaintes se sont fait entendre jusqu’à la mairie, remettant en cause la position de la bibliothèque en tant qu'institution communautaire de confiance et mettant à l'épreuve la rigueur de sa formation, de ses communications, de ses politiques et de ses procédures. Malgré cette pression, la bibliothèque a mené un programme très réussi et a ensuite redoublé son engagement dans la lutte contre l'homophobie et la promotion de l'égalité. Cet article explique comment la HHPL en est venue à offrir ce programme, qu’elle a été la réaction et offre aussi des suggestions pour évaluer le succès et pour traiter les plaintes.

With the introduction of body worn cameras, new data types have emerged, including activation metadata, which is information on the extent of the implementation of body worn cameras, by whom, and under what conditions. In this paper, we propose an avenue of methodological interest: linking activation metadata with police-recorded behaviour. We take the case of complaints to examine the use of these data for investigations of officers’ misconduct. We used an observational approach, analysing 1.73 million body worn camera activations by more than 3900 frontline officers, juxtaposed with professional conduct data. We find a heterogeneous distribution of implementation, despite a ‘blanket’ body worn camera policy requiring activation. Specifically, distinct types of officers disproportionally under-activate body worn cameras. We show that body worn cameras activation rates are inversely correlated with complaints, although minimally when observed at the population level. We discuss the use of metadata for research as well as for policy.

Contains fulltext : 249104.pdf (Publisher’s version ) (Open Access) BACKGROUND: Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives. METHODS: An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered "yes," they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis). RESULTS: Communication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication. CONCLUSIONS: This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.

Введение. Оказание медицинской помощи сопряжено с высокими рисками причинения вреда здоровью и жизни с вероятностью наступления и развития неблагоприятных событий. Риск-ориентированный подход в управлении и контроле деятельности медицинской организации регламентирован законодательством и реализуется через идентификацию, индикацию и оценку рисков. Перед руководством медицинской организации стоят задачи по определению стратегии управления рисками. При работе с неблагоприятными событиями важен не только реактивный, но и проактивный подход, который реализуется через риск-ориентированное управление. В статье представлен первый этап управления рисками – идентификация рисков. Целью исследования явилась идентификация рисков причинения вреда здоровью при оказании медицинской помощи на основании анализа обращений пациентов. Материалы и методы Для идентификации рисков по результатам анализа обращений пациентов применена технология составления контрольных списков, классификации и систематизации. Нежелательные события, сообщаемые пациентами, систематизированы на однородные кластеры, выделены риски. Для каждого события определен источник риска. Выявление причин нежелательных событий, которые могут являться индикаторами риска, проведено с использованием построения диаграммы Исикавы. Результаты и обсуждения При анализе обращений пациентов за 2017-2021 гг. по данным из различных источников отмечается ежегодное увеличение числа обоснованных жалоб. Анализ обращений позволил идентифицировать нежелательные события, 16,5% [11,7-21,3] которых расценены как инциденты, имеющие риски причинения вреда здоровью различной степени тяжести. Все риски систематизированы в 6 групп: диагностические, лечебные, реабилитационные, идентификационные, связанные с получением травм пациентами, с производственной средой. В группе диагностических и лечебных рисков наиболее часто источниками риска выступают врачи при оказании ими медицинских услуг – 58% [54,1-61,9] и 86% [82,7-89,3], соответственно. Одной из основных причин возникновения диагностических рисков является высокая нагрузка на персонал из-за низкой укомплектованность должностей врачебного и среднего персонала. Большое значение имеет состояние оборудования, на котором выполняются исследования. Нарушения в технологии исследований связаны с несоблюдением алгоритмов проведения диагностических манипуляций, отсутствием утвержденных в медицинской организации стандартных операционных процедур. Заключение Внедрение риск-ориентированного подхода при работе с обращениями пациентов позволяет медицинским организациям осуществлять деятельность по предупреждению, выявлению и предотвращению рисков, создающих угрозу жизни и здоровью граждан, минимизировать последствия их наступления путем совершенствования подходов к осуществлению медицинской деятельности. Так основной целью поставщика медицинских услуг является проведение оценки рисков и построение системы риск-менеджмента. Анализ обращений пациентов позволяет идентифицировать риски, определять их структуру, причины и источники нежелательных событий, что в дальнейшем может служить основанием для выделения индикаторов риска причинения вреда здоровью при оказании медицинской помощи., Introduction. The provision of medical care is associated with high risks of harm to health and life, with the probability of occurrence and development of adverse events. The risk-oriented approach in the management and control of the activities of a medical organization is regulated by law and is implemented through identification, indication and risk assessment. The management of a medical organization is faced with the task of defining a risk management strategy. When dealing with adverse events, not only a reactive, but also a proactive approach is important, which is implemented through risk-oriented management. The article presents the first stage of risk management risk identification. The aim of the study was to identify the risks of harm to health in the provision of medical care based on the analysis of patient complaints. Materials and methods To identify risks based on the results of the analysis of patients' appeals, the technology of compiling control lists, classification and systematization was applied. Undesirable events reported by patients are systematized into homogeneous clusters, risks are highlighted. A risk source is defined for each event. Identification of the causes of undesirable events, which may be indicators of risk, was carried out using the construction of the Ishikawa diagram. Results and discussions When analyzing patient complaints for 2017-2021, according to data from various sources, there is an annual increase in the number of substantiated complaints. The analysis of appeals made it possible to identify undesirable events, 16.5% [11.7-21.3] of which are regarded as incidents with risks of causing harm to health of varying severity. All risks are systematized into 6 groups: diagnostic, therapeutic, rehabilitation, identification, associated with injury to patients, with the production environment. In the group of diagnostic and therapeutic risks, the most common sources of risk are doctors when they provide medical services 58% [54.1-61.9] and 86% [82.7-89.3], respectively. One of the main reasons for the occurrence of diagnostic risks is the high workload on staff due to the low staffing of positions of medical and secondary personnel. The condition of the equipment on which the research is carried out is of great importance. Violations in the research technology are associated with non-compliance with the algorithms of diagnostic manipulations, the absence of standard operating procedures approved by the medical organization. Conclusion The introduction of a risk-based approach when dealing with patient complaints allows medical organizations to work on the prevention, identification and prevention of risks that threaten the life and health of citizens, to minimize the consequences of their occurrence by improving approaches to the implementation of medical activities. Thus, the main goal of a healthcare provider is to conduct a risk assessment and build a risk management system. The analysis of patients' appeals makes it possible to identify risks, determine their structure, causes and sources of undesirable events, which in the future can serve as a basis for identifying indicators of the risk of harm to health in the provision of medical care.

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This study has quantified the number of complaints made about doctors to hospitals in Ireland over a five year period. Complaints about doctors represented a minority of overall complaints to hospitals. They predominantly concerned clinical care and communication issues. There were few patient complaints about unprofessional behaviour. Hospitals rarely referred complaints to the Irish Medical Council. Thus current practice differs significantly from that envisaged in the new legislative framework. There is a need to promote transparent, efficient and effective regulation through a standardised inter-agency approach.

Citizen correspondence sections (letters from readers) constitute a singular element in the communication arsenal of the press media. This research quantitatively analyzes the content of these exchange spaces with recipients in five Cuban newspapers —Granma, Juventud Rebelde, Trabajadores, Guerrillero, and Mayabeque— during the second semester of 2018. For this, said content was divided into two categories: complaints from citizenship and responses from institutions, of which a set of eleven indicators / variables were examined. The results show interesting aspects of the link between the population and public institutions on the Island, a context in which officially recognized communication is controlled in its entirety by the Communist Party of Cuba [PCC], the only legal one since 1965. Las secciones de correspondencia ciudadana (cartas de los lectores) constituyen un elemento singular dentro del arsenal comunicativo de los medios de prensa. La presente investigación analiza cuantitativamente el contenido de estos espacios de intercambio con los receptores en cinco periódicos cubanos —Granma, Juventud Rebelde, Trabajadores, Guerrillero y Mayabeque— durante el segundo semestre de 2018. Para ello se dividió dicho contenido en dos categorías: quejas de la ciudadanía y respuestas de las instituciones, de las cuales se examinaron un conjunto de once indicadores/variables. Los resultados muestran interesantes aristas del vínculo entre población e instituciones públicas en la Isla, un contexto en que la comunicación oficialmente reconocida es controlada en su totalidad por el Partido Comunista de Cuba [PCC], único legal desde 1965.

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The increase of minimum wage in 2018 in Russia turned out to be the most pronounced in regions of the Far North and similar localities due to the exclusion of regional compensation payments and Northern allowances from the minimum wage. We are interested in both studying the effects of the minimum wage’s increase and assessing its value’s compliance. The article suggests a new approach to achieving these objectives based on the number of workers’ complaints to the State Labour Inspectorate. We developed and applied an econometric model to reveal the connection between the rate of compensation payments in a region and the number of complaints regarding the problem that “the employer pays less than the law requires”. As the study’s information base, we used the data gathered from an online dataset of the Federal Service for Labour and Employment, Federal State Statistics Service, and the professional database “Ruslana”. We discovered that in 2018, the number of complaints on the considered topic in the North regions was 2.5 times higher than in other regions. An increase in the value of regional compensation payments is associated with an increase in the number of complaints. The largest number of complaints came from employees of small enterprises, budgetary institutions, and firms experiencing financial difficulties. The legal authorities may use suggested recommendations regarding the legislation of the status of regional compensation payments and Northern allowances in the process of determining the minimum wage. We recommend the employers to use the checklists that allow minimizing the risks of consequences of labour law’s violations in the Far North and similar localities.

Public procurement is a crucial activity undertaken by the public sector. However, public procurement entails a wide range of transaction costs. While many papers focus on the ex-ante transaction costs, it is equally important to evaluate the types of ex-post transaction costs. The disputes stemming from conflicts between procuring authorities and proposers often bring additional costs to both parties. One of the ways to ensure that the procuring authority wins the dispute is using the services of an external law firm to represent the procuring authority in the review process. The aim of the paper is to examine the extent of the use of external law services in the public-procurement review process by procuring authorities and proposers in Slovakia and in the Czech Republic. The focus is also on the impact the use of external law firms in the review process may have on the length of the review process and the outcome of the dispute. Our results suggest that while the use of the external law firm may lead to a higher success rate of the review process on the side of a procuring authority, the same does not apply to proposers. There were no conclusive findings regarding the impact of the outsourcing on the length of the review process.

Background: Occupational skin illnesses are the second most common occupational health hazard following musculoskeletal disorders. Tannery workers have frequent and prolonged exposure to skin irritants and allergens and may have a higher risk of developing occupational dermatitis. Aims and Objectives: The aim of this study is to examine the extent of skin problems and their determinants among male tannery workers. Materials and Methods: The data for the present research was drawn from a cross-sectional household study of tannery and nontannery workers in the Jajmau area of Kanpur, Uttar Pradesh. A total of 284 tannery and 289 nontannery workers were interviewed using purposive sampling technique. Descriptive statistics and multivariate techniques have been used. Results: Tannery workers experienced itching hands or fingers with fissures (21%), scaling of hands or fingers with fissures (18%), red and swollen hands or fingers (11%), and vesicles on the hands or between the fingers (11%). The workers who had moderate/high dermal exposure to chemicals were 35(P < 0.001), and they were 31 (P < 0.001) times more likely to experience vesicles on scaling hands or fingers with fissures, and itching hands or fingers with fissures. The tannery workers engaged in wet finishing work were significantly 3.9 (P < 0.1) times more likely to experienced scaling on hands or fingers with fissures. Conclusion: The study acclaims the mechanization of tannery activities at workplaces, so that risk of skin complaints can be minimized among tannery workers. As the risk of skin complaints is very high with the dermal exposure to chemicals, personal protective equipment must be provided and their use should be included in the curriculum of the ternary workers.

Background: Since the pathophysiology of medically unexplained symptoms (MUS) remains unclear, health care providers often struggle with these patients, especially with a different ethnic and/or cultural background. These challenges are insufficiently addressed in their training and in the organization of care. Aim: To improve health care provider-patient interaction focused on MUS patients in general and in ethnic minorities and refugees in particular through a systematic review of syndromal definitions and epidemiology and organization of care of MUS patients. Methods: Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords ‘Medical unexplained (physical) symptoms (MUPS)’, ‘Somatoform disorder’, ‘Functional syndrome’, ‘Diversity’, ‘Migrants’, ‘Ethnicity’, ‘Care models’, ‘Medical education’, ‘Communication skills’, ‘Health literacy’ Results: Different case definitions result in markedly different epidemiologic estimates for MUS patients. Nevertheless, they are prevalent in a wide range of health care settings. Literature offers evidence of the effectiveness of structural frameworks in approaching MUS patients. Organization of MUS care needs to transcend different levels of care: specialist tertiary and secondary care and primary care involving different qualifications of caregivers need to be aligned. Conclusion: The systematic review identified significant gaps and shortcomings in organization of care. These need to be addressed in order to improve outcomes. Keywords: Medical unexplained (physical) symptoms (MUPS), Somatoform disorder, Functional syndrome, Diversity, Migrants, Ethnicity, Care models Message for the clinic: - Medically unexplained symptoms are highly prevalent but case definitions hamper both recognition and a proper approach. - MUS are ill understood in both the general population as in migrants and refugees. - Interdisciplinary and integrated care through a biopsychosocial model is mandatory.

Background Defensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour. Methods A qualitative interview study investigated the views and experiences of physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change. Results All participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences. Conclusions The findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care.

El presente trabajo contiene el proceso, metodología y actividades realizadas en la práctica profesional como una de las opciones de grado que la facultad de ingeniería civil de la Universidad Santo Tomas tiene en su manual. La práctica profesional se realizó en la Contraloría General de Boyacá en la oficina de Dirección de obras civiles y valoración de costos ambientales, donde se realizó la revisión técnica de control posterior y selectivo como lo es: evaluación de precios unitarios de las obras ejecutadas y en proceso, tramites de denuncias, auditorias focalizadas y la realización de informes a los documentos que son presentados por los municipios y/o entidades, así mismo se describen los procesos que se llevaron a cabo durante el tiempo en pasantía. This document contains the process, methodology and activities carried out during the professional practice, as one of the degree options that the Civil Engineering Faculty from the Santo Tomas University has in its manual. The professional practice was done at the Office of Civil Works Direction and Environmental Costs Assessment from Contraloría General de Boyacá, where the technical review of subsequent and selective control was carried out, such as the unit prices evaluation of works executed and in-process, complaint procedures, targeted audits and technical reports about documents delivered by the municipalities and/or entities. Pregrado

Purpose Several weeks after COVID-19 infection, some children report the persistence or recurrence of functional complaints. This clinical presentation has been referred as “long COVID” in the adult population, and an [18F]-FDG brain PET hypometabolic pattern has recently been suggested as a biomarker. Herein, we present a retrospective analysis of 7 paediatric patients with suspected long COVID who were explored by [18F]-FDG brain PET exam. Metabolic brain findings were confronted to those obtained in adult patients with long COVID, in comparison to their respective age-matched control groups. Methods Review of clinical examination and whole-brain voxel-based analysis of [18F]-FDG PET metabolism of the 7 children in comparison to 21 paediatric controls, 35 adult patients with long COVID and 44 healthy adult subjects. Results Despite lower initial severity at the acute stage of the infection, paediatric patients demonstrated on average 5 months later a similar brain hypometabolic pattern as that found in adult long COVID patients, involving bilateral medial temporal lobes, brainstem and cerebellum (p-voxel

Significance Police misconduct and use of force have come under increasing scrutiny and public attention. The procedural justice model of policing, which emphasizes transparency, explaining policing actions, and responding to community concerns, has been identified as a strategy for decreasing the number of interactions in which civilians experience disrespectful treatment or the unjustified use of force. This paper evaluates whether a large-scale implementation of procedural justice training in the Chicago Police Department reduced complaints against police and the use of force against civilians. By showing that training reduced complaints and the use of force, this research indicates that officer retraining in procedural justice is a viable strategy for decreasing harmful policing practices and building popular legitimacy., Existing research shows that distrust of the police is widespread and consequential for public safety. However, there is a shortage of interventions that demonstrably reduce negative police interactions with the communities they serve. A training program in Chicago attempted to encourage 8,480 officers to adopt procedural justice policing strategies. These strategies emphasize respect, neutrality, and transparency in the exercise of authority, while providing opportunities for civilians to explain their side of events. We find that training reduced complaints against the police by 10.0% and reduced the use of force against civilians by 6.4% over 2 y. These findings affirm the feasibility of changing the command and control style of policing which has been associated with popular distrust and the use of force, through a broad training program built around the concept of procedurally just policing.

Poor indoor air quality (IAQ) in schools is related to increased symptom reporting in students. We investigated whether parental worry about school IAQ influences this association. Data came from survey collected from five Finnish primary schools with observed IAQ problems and five control schools. Parents (n = 1868) of primary school students reported worry about IAQ in schools and symptoms of their children. Associations between observed IAQ problems, worry, and five symptom scores (ie, respiratory, lower respiratory, eye, skin, and general symptoms) were analyzed using multivariate logistic regression and mediation analysis. Parents were on average more worried in schools with observed IAQ problems. Observed IAQ problems were strongly associated with increased worry and all symptoms under study (unadjusted ORs ranged between 1.48 [95% CI 1.48-2.16] and 2.70 [95% CI 1.52-5.17]). Parental worry was associated with all symptoms (unadjusted ORs ranged between 2.49 [95% CI 1.75-3.60] and 4.92 [95% CI 2.77-9.40]). Mediation analyses suggested that parental worry might partially explain the association between observed IAQ problems and symptom reporting (proportion mediated ranged between 67% and 84% for the different symptoms). However, prospective studies are needed to assess causal relationships between observed IAQ problems, worry, and symptom reporting in schools.

Item does not contain fulltext Background: It is uncertain whether self- and proxy-reported cognitive decline in older adults reflect an actual objective cognitive dysfunction in the clinical sense, and if these are predictive for developing dementia. Objective: The aim of the present study is to investigate the cross-sectional and longitudinal relation between subjective cognitive decline and objective cognitive performance, depressive symptoms, and to determine the predictive value for development of dementia. Methods: We included 405 patients without dementia at first visit from the Maastricht memory clinic participating in a longitudinal cohort study. Subjective cognitive decline was measured using a self- and proxy-report questionnaire. All patients underwent a standardized neuropsychological assessment. Follow-up assessments were performed yearly for three consecutive years, and once after five years. Results: Subjective cognitive decline was associated with lower cognitive performance and more depressive symptoms. When comparing self- (n = 342, 84% ) and proxy-reported decline (n = 110, 27% ), it was shown that proxy reports were associated with a more widespread pattern of lower cognitive performance. In participants without cognitive impairment proxy-reported decline was not associated with depressive symptoms. In contrast, self-reported decline was associated with a stable course of depressive symptoms at follow-up. Proxy-reported cognitive decline (HR = 1.76, 95% CI = 1.12- 2.78), and mutual complaints (HR = 1.73, CI:1.09- 2.76) predicted incident dementia while self-reported decline did not reach statistical significance (HR = 1.26, 95% CI = 0.65- 2.43). Conclusion: Proxy-reported cognitive decline was consistently associated with lower cognitive performance and conversion to dementia over 5 years. Self-reported cognitive decline in patients without cognitive impairment might indicate underlying depressive symptoms and thus deserve clinical attention as well. 15 p.

In prisons, participatory mechanisms can foster important outcomes including fairness, legitimacy and dignity. Complaints are one significant (symbolic) mechanism facilitating prisoner participation. Ombud institutions/ Ombudsmen handle complaints externally, providing unelected accountability mechanisms and overseeing prisons around the world. A fair complaints process can stimulate prisoner voice, agency and rights protection, potentially averting self-harm and violence, and facilitating systemic improvements. However, complaints mechanisms are little studied. Addressing this gap, we: i) contextualise discussion by demonstrating that prisoners’ actions have directly shaped complaints mechanisms available today; ii) outline prison complaints mechanisms in the case study jurisdiction of England and Wales; and iii) provide a critical review of literature to assess whether prison complaints systems are, in practice, participatory, inclusive and fair? We conclude that complaints mechanisms hold clear potential to enhance prison legitimacy, facilitate prisoner engagement and agency, and improve wellbeing and safety. However, myriad barriers prevent prisoners from participating in complaints processes, including: culture; fear; accessibility; timeliness; emotional repression; and bureaucracy. The process of complaining and experiences of these barriers are uneven across different groups of prisoners. Our article provides a springboard for future empirical research.

Background Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. Methods Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. Results Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. Conclusion Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.

General practice is a vital aspect of the health service, with large numbers of patient contacts every year1. While general practice is often seen as inherently less risky than secondary care2, errors have been found to occur in between 2–3% of consultations3. A recent study in Irish out-of-hours general practice found a complaints rate of 0.61 per 1000 consultations4. Patient complaints are an under-utilised source of data about quality of care. Typically, complaints are resolved on an individual basis by responding to the person who made the complaint and addressing their concerns.It is acknowledged that receiving a complaint can be a stressful, negative experience for healthcare providers5. It may be beneficial for a healthcare provider who has received a conplaint against them to liase with an indeminfier, who will be in a position to offer help, support, amd reassurance. However, research and policy is shifting towards reframing complaints from a negative experience, to using them as a valuable source of data to support quality improvement efforts. Until recently there has been a lack of valid and reliable systems for examing trends across complaints at a regional and/or national level6, but there are now valid and reliable tools for analysing complaints about hospital and general practice care.The Healthcare Complaints Analysis Tool (HCAT) was developed to systematically analyse complaints about secondary care. Information on the HCAT is available online7. However, while the HCAT is a suitable tool for analysing hospital complaints, it cannot be directly applied to analysing complaints about general practice. This guide outlines how to use the Healthcare Complaints Analysis Tool (General Practice) [HCAT(GP)] to analyse general practice complaints. The HCAT(GP) is based upon the original HCAT, but tailored specifically for general practice. Evaluations of HCAT(GP) have found that it is a valid and reliable tool for analysing complaints about general practice. non-peer-reviewed

La historia de las Recomendaciones comienza exactamente el 17 de marzo de 1919, en la reunión matutina, cuando el delegado norteamericano, Henry Mauris Robinson (1868-1937), ubicado a la derecha de la foto, con anteojos redondos, por debajo del Coronel Lister, un militar británico, presentó enmiendas importantes al artículo 19 del proyecto británico que venía discutiendo la Comisión desde el inicio de sus labores.Las Recomendaciones internacionales del trabajo constituyen un instrumento jurídico de suma importancia. En ocasiones, cumplen una función complementaria a la regulación de un Convenio al que acompañan y en otras cumplen su función normativa en solitario. En cualquier caso, las Recomendaciones tienen igual valor jurídico que los Convenios, ambos instrumentos deben ser objeto de la obligación constitucional de sumisión ante los parlamentos nacionales. Este trabajo analiza el trascendente papel que cumplen las Recomendaciones explicitando el contexto en el que algunas fueron adoptadas y las razones que llevaron a la Organización Internacional de Trabajo (OIT) a preferir una recomendación a un Convenio. El trabajo examina el proceso de adopción de algunas Recomendaciones especialmente significativas y muy pertinentes en la situación actual: trabajo forzoso, relación de trabajo, conflictos humanos y desastres naturales, pisos nacionales de protección social, seguridad e higiene, VIH/SIDA, trabajo marítimo y pueblos indígenas. Se examinan algunas situaciones en las que los mecanismos de control de la OIT se han ocupado de las Recomendaciones (sumisión a los parlamentos nacionales, Estudios Generales, reclamaciones, quejas). Se aportan ejemplos concretos y su evolución. Se sugiere que los documentos que los gobiernos presentan a la Oficina Internacional del Trabajo sobre la sumisión de los Convenios y las Recomendaciones a los parlamentos nacionales tengan una mayor difusión y transparencia. Por su parte, los Estudios Generales cumplen también un papel fundamental para la difusión de las Recomendaciones. Elaborados por la Comisión de Expertos en Aplicación de Convenios y Recomendaciones sobre la base de las informaciones recibidas de los Estados miembro en relación a los Convenios y las Recomendaciones permiten identificar las dificultades que retrasan la ratificación de un Convenio y dificultan la aplicación de una recomendación. También el proceso de reclamaciones y quejas en relación al cumplimiento de Convenios ratificados permite revisar indirectamente el alcance de las Recomendaciones. Este papel complementario de las Recomendaciones se ejemplifica en dos conflictos singulares entre los Gobiernos y algunos interlocutores sociales: la reforma legislativa del trabajo portuario en Portugal y el cumplimiento de consultas tripartitas efectivas relacionadas con las reformas legislativas en Venezuela. El término “Recomendación” figuró entre comillas en el artículo 405 del Tratado de Paz; las comillas no se usaron para los Convenios internacionales, una categoría conocida. En esta sección se comentan las disposiciones del artículo 19 de la Constitución de la OIT que corresponden al artículo 405 del Tratado de Paz. Las Recomendaciones y los Convenios reciben idéntico tratamiento en cuanto a su elaboración, adopción en la Conferencia y distribución de sus textos auténticos (artículo 19, párrafos 1-4). La Conferencia determina si las proposiciones que se elevarán a la consideración de los Estados Miembros tomarán la forma de una [...] “recomendación que ha de someterse al examen de los miembros para darle efecto bajo la forma de ley nacional o de otra manera o bien de un proyecto de Convenio internacional que han ratificar los Estados Miembros” (artículo 19, párrafo 1). Se destaca también que las “Recomendaciones” al igual que los proyectos de Convenios se deben someter a la autoridad o a las autoridades a quienes competa el asunto “al efecto de que le den forma de ley o adopten otras medidas” [artículo 19, párrafos 5,b); 6,b); y 7, iii)]. Se establece un plazo perentorio de un año “pero nunca más de 18 meses después de la clausura de la sesión de la Conferencia” para cumplir con la obligación de someter la recomendación o el Convenio. ESTUDiOS140REVISTA DEL MINISTERIO DE TRABAJO Y ECONOMÍA SOCIAL147“La obligación de someter” los Convenios y las Recomendaciones a las autoridades competentes es la única oportunidad en el que el término “obligación” aparece en la Constitución [artículo 19, párrafos 5,b) y 6,b)]. Se consideraba suficiente la sumisión de los Convenios y las Recomendaciones a las autoridades competentes para incorporar en la legislación y la práctica nacionales las medidas propuestas por la Conferencia. Las autoridades competentes les darían a las Recomendaciones, al igual que a los Convenios, la forma legislativa correspondiente. Los delegados de los ocho países que redactaron estas disposiciones constitucionales fueron conscientes que las autoridades a las que se debería someter las “Recomendaciones” y los Convenios eran las ramas legislativas respectivas. Salvo circunstancias excepcionales que justificasen una demora de dieciocho meses, la obligación de sumisión debía cumplirse en un plazo de un año luego de clausurada la Conferencia. En caso de que un país no cumpliera con la obligación de sumisión de los Convenios o las Recomendaciones, otro país podía protestar ante el Consejo de Administración, que debía informar a la Conferencia sobre el incumplimiento de la obligación de sumisión (artículo 30).La sumisión debía asegurar el vínculo entre el parlamento internacional del trabajo y los parlamentos nacionales que darían “forma de ley” o adoptarían las medidas pertinentes en relación con los Convenios y las Recomendaciones. El hecho de que sea posible ratificar un Convenio – y se impidiese la ratificación de las Recomendaciones – no aumentaba ni disminuía el prestigio de ninguna de las dos normas. El Convenio se comunica “para su ratificación” y las Recomendaciones para “ponerla en ejecución por medio de la legislación nacional o de otro modo” (artículo 19, párrafos 5, a) y 6, a)). Tanto una recomendación como un Convenio merecerían que se le diera “forma de ley”, según las prácticas nacionales. Las actividades normativas de la Organización, de por sí mismas, debían causar suficiente entusiasmo como para que los parlamentos nacionales se empoderasen de los Convenios y las Recomendaciones internacionales del trabajo. El estudio se completa con una visión crítica de la reforma de la Constitución de la OIT que ha permitido la derogación de los Convenios y el retiro de Recomendaciones. Se finaliza con una defensa del papel trascendental de las Recomendaciones, mayor cuanto menos son las ratificaciones de los Convenios. The history of the Recommendations began exactly on 17 March 1919, at the morning session, when the American delegate, Henry Mauris Robinson (1868-1937), on the right-hand side of the photo, with round glasses, below Colonel Lister, a British military officer, submitted important amendments to Article 19 of the British draft that the Commission had been discussing from the beginning of their work.The International Labour Recommendations represent a very important legal instrument. Sometimes, they play a complementary role to the regulation of an accompanying Convention and sometimes fulfil their regulatory role on its own. In any case, Recommendations have the same legal value as Conventions, both instruments should be subject to the constitutional obligation of submission to national parliaments. This paper analyses the important role played by Recommendations, explaining the context in which some of them were adopted and the reasons that led the International Labour Organization (ILO) to prefer a Recommendation to a Convention. The paper examines the process of adopting some particularly significant and very relevant Recommendations in the current situation: forced labour, labour relationship, human conflicts and natural disasters, social protection floor, health and safety, HIV/AIDS, maritime labour and indigenous peoples. It examines some situations in which the ILO monitoring mechanisms have dealt with the Recommendations (submission to national parliaments, General Studies, claims, complaints). Specific examples and their evolution are provided. It is suggested that the documents submitted by Governments to the International Labour Office on the submission of Conventions and Recommendations to national parliaments should be made more widely available and transparent. The General Studies also play a key role in disseminating the Recommendations. Developed by the Committee of Experts on Application of Conventions and Recommendations on the basis of information received from member States concerning Conventions and Recommendations, it is possible to identify difficulties which delay ratification of a Convention and hinder the implementation of a recommendation. Also, the process of claims and complaints in relation to compliance with ratified Conventions allows for indirect review of the scope of Recommendations. This complementary role of the Recommendations is exemplified in two unique conflicts between Governments and some social partners: the legislative reform of dock work in Portugal and the implementation of effective tripartite consultations related to legislative reforms in Venezuela. The term “Recommendation” was enclosed in quotation marks in article 405 of the Peace Treaty; quotation marks were not used for international Conventions, a known category. This section discusses the provisions of article 19 of the ILO Constitution that correspond to article 405 of the Peace Treaty. Recommendations and Conventions receive the same treatment in terms of their elaboration, adoption at the Conference and distribution of their authentic texts (article 19, paragraphs 1-4). The Conference determines whether the proposals to be submitted to Member States for consideration will take the form of a [...] “recommendation for consideration by members in order to give effect to it in the form of national law or otherwise or of a draft international Convention to be ratified by Member States” (article 19, paragraph 1). It is also underlined that “Recommendations”, as well as draft Conventions, should be submitted to the authority or authorities to which the matter relates “for the purpose of giving it the form of law or other measures” [article 19, paragraphs 5 (b); 6(b); and 7, (iii)]. A mandatory period of one year “but not more than 18 months after the closure of the session of the Conference” is established to fulfil the obligation to submit the Recommendation or the Convention. “The obligation to submit” the Conventions and Recommendations to the competent authorities is the only time when the term “obligation” appears in the Constitution [article 19, paragraphs 5, (b) and 6, (b)]. The submission of Conventions and Recommendations to the competent authorities was considered sufficient to incorporate the measures proposed by the Conference into national law and practice. The competent authorities ESTUDiOS142REVISTA DEL MINISTERIO DE TRABAJO Y ECONOMÍA SOCIAL147would give the Recommendations, as well as the Conventions, the appropriate legislative form. Delegates from the eight countries that drafted these constitutional provisions were aware that the authorities to which the “Recommendations” and the Conventions should be submitted were the respective legislative branches. Except in exceptional circumstances justifying an 18-month delay, the obligation of submission should be fulfilled within one year of the closure of the Conference. In the event of a failure by one country to comply with the obligation to submit the Conventions or Recommendations, another country could complain to the Governing Council, which should report to the Conference on the non-compliance with the obligation of submission (article 30).The submission should ensure the link between the international labour parliament and national parliaments that would “shape the law” or take appropriate action on the Conventions and Recommendations. That fact that it is possible to ratify a Convention – and to prevent ratification of Recommendations – did not increase or diminish the prestige of either rule. The Convention is communicated “for ratification” and the Recommendation to “implement it through national legislation or otherwise” (article 19, paragraphs 5, (a) and 6, (a)). Both a Recommendation and a Convention would deserve to be given the “form of a law”, according to national practices. The normative activities of the Organization, on their own, should be sufficiently enthusiastic for national parliaments to empower themselves from the Conventions and the International Labour Recommendations. The study is complemented by a critical vision of the reform of the ILO Constitution that has allowed the repeal of Conventions and the withdrawal of Recommendations. It ends with a defence of the transcendental role of the Recommendations, the more important it is, the less important ratifications of Conventions are.

The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.

Les paroles de plainte sont doublement au cœur d’une approche communicationnelle de la santé au travail. D’une part, elles s’inscrivent dans une dynamique subjective et sociale de médiation du mal-être, d’autre part, elles sont façonnées par les normes communicationnelles agissant dans l’organisation. Une recherche ethnographique montre la régulation communicationnelle des plaintes en organisation ainsi que l’écart entre plainte et souffrance dans les interactions au travail. Apparaissent alors des enjeux sur la parole au travail, son écoute « véritable » et sur la créativité de l’expression au travail, opérateur de santé dans le « travail réel », y compris lorsqu’il s’agit d’une parole négative. Words used to express complaints are at the heart of a communicative approach to occupational health. On the one hand, they are part of a subjective and social dynamic of mediation and, on the other hand, they are shaped by the communicative norms at work in the organization. This ethnographic research shows the communicational regulation of organizational complaints as well as the gap between complaint and suffering in workplace interactions. Also explored are questions about speech at work, "true" listening and the creativity of the expression at work, and the health operator in the "real work", including in the context of negative speech. Las palabras de queja se encuentran doblemente en el centro de una aproximación comunicacional a la salud ocupacional. Por un lado, se inscriben dentro de una dinámica subjetiva y social de la mediación del malestar, y por el otro, están formadas por las normas comunicacionales que actúan en la organización. Esta investigación etnográfica muestra la regulación comunicacional de las quejas en la organización, así como la diferencia entre queja y sufrimiento en las interacciones laborales. También se exploran cuestiones sobre la palabra en el trabajo, la escucha “verdadera” y la creatividad de la expresión en el trabajo, operador de salud dentro de el “trabajo real,” incluso cuando se trata de una palabra negativa.

Background: Sick building syndrome (SBS) is defined as a condition occurring in people who live or work in a modern building and who suffer from complaints such as headache, fatigue, lack of concentration, and irritation of the skin and mucous membranes. Objectives: The aim of this study is to examine the complaints associated with SBS in the employees of our hospital and evaluate the relationship between the characteristics of the work environment and the complaints of SBS. Methods: 890 workers participated in the study. The complaints of the participants were rated and the sum of all complaints was recorded as the Total Complaint Score (TCS). The mean TCS of the participants was compared according to demographic characteristics and work environment characteristics. Results: The most common complaints among the employees were fatigue (40%), and general muscle and joint pain (31.4%). There was a statistically significant difference in TCS according to the position (p < 0.001). The mean TCS was significantly higher in females [13 (0–81)] than in males [6 (0–59)] (p < 0.001). The mean TCS increased with the presence of odor, new wall paint, the presence of fungus/mold on walls, and the presence of rotting/mold smell (p < 0.001, for all). TCS positively correlated with stress level, social relationship, noise level, comfort, cleanliness, number of employees in the same room, presence of odor, new wall paint, presence of rotting/mold, and use of chemical materials for cleaning in the room (p < 0.001, for all), and negatively correlated with room size and number of windows (p = 0.006, p < 0.001, respectively). Discussion: The present study found that the female gender, a high level of education, a high level of stress, a low level of social relationships and work environment characteristics were associated with the complaints of SBS among the employees. Accordingly, we believe that hospital management should be informed in order for the managers to take precautions and make new regulations.

El presente trabajo contiene el proceso realizado en la práctica profesional como opción de grado en la Contraloría General de Boyacá en la Dirección de Obras Civiles y Valoración de Costos Ambientales, donde se hizo una revisión técnica a los documentos que son presentados por parte de las entidades como: evaluación de análisis de precios unitarios de las obras ejecutadas, tramites de denuncias, auditorías y la realización de informes a los procesos evaluados por parte de la misma. Así mismo, se describe cada una de las actividades realizadas durante el tiempo en el cual se desarrolló la práctica, además de sustentar los aportes a la Contraloría General del departamento de Boyacá, que contribuyen a un mejoramiento en la revisión física y técnica a cada una de las entidades públicas administrativas, municipales y departamentales, vigilando que los proyectos realizados se hayan culminado en su totalidad The present work contains the process carried out in the professional practice as an option of degree in the Comptroller General of Boyacá in the Direction of Civil Works and Valuation of Environmental Costs, where a technical revision was made to the documents that are presented by the entities as: evaluation of analysis of unitary prices "AUP" of the executed works, procedures of denunciations, audits and the realization of reports to the processes evaluated by the same. It also describes each of the activities carried out during the time in which the practice was developed, in addition to supporting the contributions to the General Comptroller, which contribute to an improvement in the physical and technical review to each of the public administrative institute, municipal and departmental, ensuring that the projects completed have been completed in their entirety. Pregrado

Bioethicists have long advocated for patients’ rights by deliberating on what physicians should or should not do for the well-being of patients. Part of this advocacy has involved challenging a paternalistic medical model where physicians are seen as authoritative figures above reproach. Through ombudsperson offices, patients can submit complaints that may lead to medical examiners conducting detailed examinations of physicians’ conduct and decision-making. Prior research indicates that complaints can have serious and broad effects on physicians. We conducted a scoping review to explore and evaluate the extent of the quantitative and qualitative literature examining the effects of complaints on physicians in European and Commonwealth countries. We systematically searched electronic databases (CINAHL, MEDLINE and PsycInfo) and grey literature for primary research that collected information directly from physicians on at least one potential effect of formal complaints. After screening the titles/abstracts of 14,913 records and reviewing 137 full-texts, 25 studies were included. The 25 studies reported on several potential effects, including the patient-physician relationship (3 studies), defensive medicine (14 studies), anxiety (8 studies), depression (8 studies), one’s identity as a physician (5 studies), and anger (5 studies). Generally, the effects evaluated in the included studies were negative. Although the existing literature covered a range of possible effects, few studies assessed the same effects via different methods, and in different regions and contexts. The findings of this scoping review suggest that complaints processes can have negative effects on physicians., Les bioéthiciens défendent depuis longtemps les droits des patients en délibérant sur ce que les médecins doivent ou ne doivent pas faire pour le bien-être des patients. Une partie de ce plaidoyer a consisté à remettre en question un modèle médical paternaliste où les médecins sont considérés comme des figures d’autorité irréprochables. Par l’intermédiaire des bureaux d’ombudsman, les patients peuvent déposer des plaintes qui peuvent conduire à un examen détaillé, par un médecin légiste, de la conduite et des décisions des médecins. Des recherches antérieures indiquent que les plaintes peuvent avoir des conséquences graves et étendues sur les médecins. Nous avons effectué une revue de la littérature afin d’explorer et d’évaluer l’étendue de la littérature quantitative et qualitative examinant l’impact des plaintes sur les médecins dans les pays européens et du Commonwealth. Nous avons systématiquement recherché dans les bases de données électroniques (CINAHL, MEDLINE et PsycInfo) et dans la littérature grise les recherches primaires qui ont recueilli des informations directement auprès des médecins sur au moins un impact potentiel des plaintes officielles. Après avoir passé en revue les titres et résumés de 14 913 enregistrements et examiné 137 textes complets, 25 études ont été retenues. Ces 25 études font état de plusieurs répercussions potentielles, notamment sur la relation patient-médecin (3 études), la médecine défensive ou l’évitement (14 études), l’anxiété (8 études), la dépression (8 études), l’identité du médecin (5 études) et la colère (5 études). En général, les impacts évalués dans les études incluses étaient négatifs. Bien que la littérature existante couvre un éventail d’impacts possibles, peu d’études ont évalué les mêmes impacts par différentes méthodes, et dans différentes régions et contextes. Les résultats de cette revue de la littérature suggèrent que les processus de plaintes peuvent avoir des impacts négatifs sur les médecins.

Au Québec, le régime d’examen des plaintes dans le réseau de la santé et des services sociaux contribue à l’amélioration continue des soins en permettant aux usagers de partager leur insatisfaction auprès d’une instance indépendante pouvant émettre des recommandations aux établissements. Le régime permet ainsi de renforcer la participation active de l’usager et donc de démocratiser les soins et services. En plus de sa parenté évidente avec cet objectif d’autonomisation, la bioéthique est omniprésente dans le travail des instances responsables de l’application du régime, soit les commissariats aux plaintes. Cet article met en lumière l’usage implicite de concepts issus de la bioéthique dans le travail quotidien des commissariats aux plaintes. Nous y abordons l’autonomie, sous l’angle de l’autodétermination et de la confidentialité dans l’analyse de la recevabilité des plaintes. Nous y abordons également la justice, sous l’angle de l’équité dans l’allocation des ressources et de la justice épistémique dans le traitement des plaintes. Ensuite, nous abordons les similitudes entre les méthodologies de la bioéthique et du régime d’examen des plaintes, nommément les grilles d’analyse en éthique clinique et la narrativité. Finalement, nous abordons l’importance de l’impartialité, de l’indépendance et de la transparence dans le travail des commissariats aux plaintes. Nous concluons en offrant des pistes de réflexion en vue d’une mise à jour des connaissances empiriques concernant la concrétisation des objectifs de renforcement de la participation de l’usager dans ses soins et de démocratisation des soins et services., In Quebec, the complaints examination process in the health and social services network contributes to the continuous improvement of care by allowing users to voice their dissatisfaction to an independent body with the authority to make recommendations to institutions. This process fosters the active participation of users and therefore contributes to democratizing care and services. In addition to its obvious connection with this empowerment objective, bioethics is ubiquitous in the work of the bodies responsible for applying the process, namely the complaints commissioners’ offices. This article highlights the implicit use of concepts from bioethics in the day-to-day work of complaints commissioners’ offices. We discuss autonomy from the perspective of self-determination and confidentiality in analyzing the complaints’ admissibility. We discuss justice in terms of fairness in resource allocation and epistemic justice in complaints’ examination. Next, we discuss the similarities in methodologies between bioethics and the complaints examination process, namely clinical ethics grids and narrativity. Finally, we discuss the importance of impartiality, independence, and transparency in the work of complaints commissioners. We conclude by offering some reflections on ways to update the empirical knowledge regarding the objectives of fostering users’ participation in their care and democratizing care.

In this case study, we describe an approach to dealing with a complicated, systemic, and multifaceted organizational issue: perceptions of obstetrical violence in the continuum of maternal care from antepartum care, birthing, to post-natal care., Dans cette étude de cas, nous décrivons une approche visant à aborder un problème organisationnel compliqué, systémique et à multiples facettes : les perceptions de violences obstétricales dans le continuum des soins maternels, depuis les soins prénataux, jusqu’à l’accouchement et les soins postnataux.

Overstretched resources and steady increases in the number of complaints filed with the offices of the Quebec Service Quality and Complaints Commissioner prompted us to investigate the complaint-handling systems of health-related organizations operating in Commonwealth and Western European countries. We also examined guidelines used to identify higher priority files (i.e., urgent files). Urgent files can then be prioritized in terms of the time taken to provide a conclusion as well as the depth of the examination. A system where a small fraction of complaints is deemed “urgent” was preferred over systems where complaints are categorized into three or more priority levels, because files categorized in the lowest of three or more priority levels risk being neglected. Applying lessons from other systems and considering the Service Quality and Complaints Commissioner’s mandate, we identified three guiding criteria for determining whether files warrant urgent status: threat to safety, involvement of vulnerable person(s) and risk of recurrence (but only when coupled with safety issues). Since determining which files should be considered urgent is not straight forward, these broad criteria can be adapted and applied on a case-by-case basis., La surcharge des ressources et l’augmentation constante du nombre de plaintes déposées auprès des bureaux du Commissaire aux plaintes et à la qualité des services du Québec nous ont incités à examiner les systèmes de traitement des plaintes des organismes de santé des pays du Commonwealth et de l’Europe occidentale. Nous avons également examiné les lignes directrices utilisées pour identifier les dossiers prioritaires (c.-à-d. les dossiers urgents). Les dossiers urgents peuvent ensuite être classés par ordre de priorité en fonction du temps nécessaire pour fournir une conclusion ainsi que de la profondeur de l’examen. Un système dans lequel une petite fraction des plaintes est considérée comme «urgente» a été préféré aux systèmes dans lesquels les plaintes sont classées en trois niveaux de priorité ou plus, car les dossiers classés dans le plus bas des trois niveaux de priorité ou plus risquent d’être négligés. En appliquant les leçons tirées d’autres systèmes et en tenant compte du mandat du commissaire aux plaintes et à la qualité des services, nous avons identifié trois critères directeurs pour déterminer si les dossiers méritent d’être considérés comme urgents: la menace pour la sécurité, l’implication d’une ou de plusieurs personnes vulnérables et le risque de récurrence (mais seulement lorsqu’il est associé à des problèmes de sécurité). Comme il n’est pas facile de déterminer quels dossiers doivent être considérés comme urgents, ces critères généraux peuvent être adaptés et appliqués au cas par cas.

Previous studies convincingly suggest that the biopsychosocial fear-avoidance model (FAM) may be of added value in understanding chronic disability after traumatic brain injury (TBI). In this model, persistent symptoms occur as a result of catastrophizing and fear-avoidance regarding initial symptoms, leading to depression, reduced mental activity, and greater disability in daily functioning. This study examined the FAM in a large English-speaking TBI sample. A cross-sectional study was conducted in 117 individuals with complicated mild, moderate, or severe TBI at 1-5 years post-injury. Participants completed questionnaires assessing personal, injury-related, and psychological characteristics. Reliability, correlational, and regression analyses were performed. Main outcome measures of chronic disability were depression, disuse (e.g., fewer mental activities), and functional disability. The results revealed that all correlations suggested by the FAM were significant. Catastrophizing thoughts were positively associated with TBI-related symptoms and fear-avoidance thoughts. Main outcome measures were positively associated with fear-avoidance thoughts and TBI-related symptoms. Further, variables in the FAM were of additive value to personal, injury-related, and psychological variables in understanding chronic disability after TBI. The separate regression analyses for depression, fewer mental activities, and disability revealed "fear-avoidance thoughts" as the only consistent variable. In conclusion, this study shows the association of the FAM with chronic disability after TBI, which has implications for assessment and future management of the FAM in TBI in English-speaking countries. Longitudinal studies are warranted to further investigate and refine the model.

Es habitual en el funcionamiento de las Defensorías Universitarias que cuando se presentan consultas, quejas o comunicación de hechos que pueden ser objeto de denuncia e inspección, éstas vengan acompañadas de expresiones de aprensión, temor o, inclusive, explícitas reservas por miedo a sufrir represalias. La confidencialidad y neutralidad debidas en las actuaciones no siempre ofrecen la seguridad emocional y real que las personas que se quejan o informan esperan, requieren o necesitan. Las universidades como organizaciones son contexto de manifestación de temores y miedos comunes ante conductas inadecuadas con los efectos perniciosos que muestra la literatura. La cuestión de las posibles represalias hacia informantes y denunciantes y la manera de atender y prevenirlas, detectarlas y perseguirlas mediante definiciones de políticas explícitas y protocolos de actuación es la reflexión que apunta este trabajo. It is common in the normal performance of the University Ombudsmen that when there are queries, complaints or communication of facts that may be the subject of a complaint and inspection, they are accompanied by expressions of apprehension, fear or, even, explicit reservations for fear of suering reprisals. Due confidentiality and neutrality in proceedings do not always oer the emotional and real security that complainants or reporters expect, require or need. Universities, as organizations, are a context for the manifestation of common fears and fears of inappropriate behavior with the harmful eects shown in the literature. The question of possible reprisals against informants and whistleblowers and the way to attend and prevent them, detect them and prosecute them by means of explicit policy definitions and action protocols is the reflection pointed out in this work.

Role-play tasks have been widely used in pragmatic research to explore spoken interaction. This instrument consists of situational scenarios purposefully designed to make participants elicit specific pragmatic data in controlled situations (Kasper & Youn 2017, Félix-Brasdefer 2018). Notwithstanding the widespread use of role-plays, some drawbacks have been identified concerning design (Hudson et al. 1995, Trosborg 1995, Youn 2015) and real-life consequences (Al-Gahtani & Roever 2012). Against this backdrop, this study presents a learner-centred approach to design situational scenarios based on participants’ examples of complaint situations. Specifically, an exemplar generation task and a likelihood questionnaire (Jianda 2006a, 2006b) were used to elaborate the role-play task. The study reports on the implementation of the learner-centred approach and its effectiveness to construct a role-play task. Furthermore, using retrospective verbal reports, this study discusses whether participants’ engagement in the design of the role-play task encouraged them to act out the situations, as they would do it in real-life contexts. The study evidences the usefulness of adopting a learner-centred approach to design the role-play task. In terms of performance, it seems that, in general, the participants would exhibit similar pragmatic behaviour in a real context. However, they were aware of the lack of real consequences role-play tasks carry. Las tareas de role-play se han utilizado ampliamente en la investigación pragmática para explorar la interacción hablada. Este instrumento se compone de escenarios situacionales diseñados a propósito para que los participantes produzcan datos pragmáticos específicos en situaciones controladas (Kasper y Youn 2017, Félix-Brasdefer 2018). A pesar de su uso generalizado, se han identificado algunos inconvenientes con respecto al diseño (Hudson et al. 1995, Trosborg 1995, Youn 2015) y a las implicaciones en la vida real (Al-Gahtani y Roever 2012). Frente a esto, este estudio presenta un enfoque centrado en el alumno para diseñar escenarios situacionales basados en ejemplos de situaciones de queja generadas por los participantes. Concretamente, se utilizó una tarea de generación de ejemplos y un cuestionario de probabilidad (Jianda 2006a, 2006b) para elaborar la tarea. El estudio informa sobre la implementación del enfoque centrado en el alumno y su efectividad para construir una tarea de role-play. Además, utilizando informes verbales retrospectivos, este estudio analiza si la colaboración de los participantes en el diseño de una tarea de role-play centrada en el alumno facilitó que estos representaran las situaciones como lo harían en la vida real. El estudio demuestra el potencial que supone adoptar un enfoque centrado en el alumno para diseñar la tarea. En términos de producción, parece que, en general los participantes mostrarían un comportamiento pragmático similar en un contexto auténtico. Sin embargo, eran conscientes de la falta de consecuencias reales que conllevan las situaciones de role-play.

Contains fulltext : 219867.pdf (Publisher’s version ) (Open Access) BACKGROUND: Various diagnostic modalities are available to assess the problematic knee arthroplasty. Visualization of soft-tissue structures in relation to the arthroplasty and bone remains difficult. Recent developments in MRI sequences could make MRI a viable addition to the diagnostic arsenal. PURPOSE: To review the diagnostic properties of MRI, to identify certain causes of complaints that may be directly related to implant failure of total (TKA) or unicompartmental knee arthroplasty (UKA); infection, loosening and wear, instability, malalignment, arthrofibrosis, or patellofemoral problems. STUDY TYPE: Systematic review. POPULATION: Twenty-three studies were included: 16 TKA, four UKA, and three cadaveric studies. Causes of knee arthroplasty complaints analyzed were; infection (three), loosening and wear (11), malalignment (five) and instability (four). FIELD STRENGTH AND SEQUENCES: No field strength or sequence restrictions. ASSESSMENT: PubMed, SCOPUS, and EMBASE were searched. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) and the QUality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). STATISTICAL TESTS: The results of the original research articles are stated. RESULTS: Fifteen studies assessed the reproducibility of analyzing infection, loosening and wear, and malalignment. Fourteen of 15 studies were deemed as adequate to good quality. Results showed a moderate to excellent agreement (ICC/K 0.55-0.97). Fourteen studies addressed the accuracy. For infection and loosening and wear the sensitivity and specificity estimates varied between 0.85-0.97 and 0.70-1.00, respectively. The accuracy for malalignment was excellent (r >/= 0.81). For these studies QUADAS-2 analysis suggested few risks of bias. A meta-analysis was not possible due to the heterogeneity of the data. DATA CONCLUSION: This study supports that MRI can be used with overall reproducible and accurate results for diagnosing infection, loosening and wear, and malalignment after knee arthroplasty. Nonetheless, studies regarding the diagnosis of instability, arthrofibrosis or patellofemoral complaints using MRI are limited and inconclusive. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.

El reciente trabajo abarca el proceso y las actividades realizadas en la práctica profesional como una de las opciones de grado que la facultad de Ingeniería Civil de la universidad Santo Tomas tienen en su manual. Esta práctica profesional se realizó en la Contraloría General de Boyacá en la oficina de Dirección de Obas Civiles y Valoración de Costos Ambientales, donde se hizo una revisión técnica a los documentos que son presentados por parte de los municipios y/o entidades como lo son: evaluación de precios unitarios de las obras ejecutadas y en proceso, tramites de denuncias, auditorias especializadas y la ejecución de informes y respuesta de estos mismos a los procesos evaluados por parte de la misma; de igual manera se describe cada una de estos procesos que se realizó durante este tiempo. The recent work covers the process and activities carried out in professional practice as one of the degree options that the Faculty of Civil Engineering of the Santo Tomas University have in its manual. This professional practice was carried out at the Comptroller General of Boyacá in the Office of Civil Works Direction and Environmental Cost Assessment, where a technical review was made of the documents that are presented by the municipalities and / or entities such as: evaluation of unit prices of works executed and in progress, complaints procedures, specialized audits and the execution of reports and their response to the processes evaluated by the same; In the same way, each one of these processes that was carried out during this time is described. Pregrado

Increasing levels of psychosomatic symptoms, and other mental health problems, among adolescents, and especially among girls, have been reported across various countries. The “educational stressors hypothesis” states that this trend can be explained by an increasing amount of stressors in the school environment. This study tests this hypothesis, using repeated cross-sectional data, between the years 1993–2017, from the Health Behaviours of School-aged Children (HBSC) survey. Regression and decomposition techniques are used to investigate the role of school stress for trends in psychosomatic symptoms, and for gender differences in symptoms. Results show that the effects of school stress on psychosomatic symptoms have become stronger over time, but that they can only account for a small share of the overall increase in symptoms since 1993. However, school stress has increased more among girls than among boys, and it explains about half of the growth of the gender gap in symptoms. Thus, school stress accounts for a substantial portion of the increase in symptoms for girls, but only a minor share of the increase for boys. In sum, we found weak evidence for the educational stressors hypothesis in regard to the overall trend in symptoms, but strong evidence for it in explaining the growing gender gap.

Background: Sick leave has major social and economic consequences for both individuals and society. Primary Health Care (PHC) meets people who seek care before they risk going on sick leave. This study examined the impact of self-perceived health on sick leave within 12 months for workers seeking care in PHC. Methods: The study had a prospective longitudinal design with 271 employed, non-sick-listed patients aged 18–64 years seeking care for physical and/or mental symptoms at PHC. In a logistic regression, an estimation of the odds ratio (OR) for belonging to the group workers with >14 days of sick-leave (W-SL) was made. Results: A high number of reasons when seeking care, with an OR of 1.33 (confidence interval 1.14 to 1.56), and lower self-rated health, with an OR of 1.45 (confidence interval 1.10 to 1.91), were determinants for sick leave at 12 months after adjusting for covariates and confounders. Mental symptoms constituted the main reason for seeking care, followed by musculoskeletal pain, and significant differences in proportions regarding most symptoms were shown between the groups with and without sick-leave >14 days. Conclusion: Health care professionals in PHC need to be aware of the risk of future sick leave at comorbidity and low self-perceived health. Preventive rehabilitation interventions should be offered to improve health and prevent sick leave for this group.

In the chronic phase after mild traumatic brain injury (mTBI), microhaemorrhages are frequently detected on magnetic resonance imaging (MRI). It is however unclear whether microhaemorrhages are associated with functional outcome and which MRI sequence is most appropriate to address this association. We aimed to determine the association between microhaemorrhages and functional outcome in the chronic posttraumatic phase after injury with the most suitable MRI sequence to address this association.One hundred twenty-seven patients classified with mTBI admitted to the outpatient clinic from 2008 to 2015 for persisting posttraumatic complaints were stratified according to the presence of MRI abnormalities (n = 63 (MRI+ group) and n = 64 without abnormalities (MRI- group)). For the detection of microhaemorrhages, susceptibility-weighted imaging (SWI) and T2* gradient recalled echo (T2*GRE) were used. The relation between the functional outcome (dichotomized Glasgow Outcome Scale Extended scores) and the number and localization of microhaemorrhages was analysed using binary logistic regression.SWI detected twice as many microhaemorrhages compared to T2*GRE: 341 vs. 179. Lesions were predominantly present in the frontal and temporal lobes. Unfavourable outcome was present in 67% of the MRI+ group with a significant association of total number of microhaemorrhages in the temporal cortical area on SWI (OR 0.43 (0.21-0.90) p = 0.02), with an explained variance of 44%. The number of microhaemorrhages was not correlated with the number of posttraumatic complaints.An unfavourable outcome in the chronic posttraumatic phase is associated with the presence and number of microhaemorrhages in the temporal cortical area. SWI is preferably used to detect these microhaemorrhages.