Consumers' Complaints: Causal attribution and moral emotions in service failures

Purpose: This research investigated consumers’ reactions to service failures, based on Weiner’s attribution theory, by simulating two situations: a teacher that is late to class and a delay in a course registration service.Method: Students at an educational service (n = 388) responded to four versions of scenarios, combining external and internal causes with teacher delay and enrollment problems.Findings: Factor analyzes inductively reflected the theoretical organization of the model: Negative Behavior, Positive Reactions, Internal Attributions, and Negative Emotions. Internal causes led to internal attributions, negative emotions and negative behaviors. Originality: The central role of moral emotions on the attitude towards complaining behavior is discussed, as well as the importance of implementing simple and low-cost managerial measures to improve the quality of care service.

Feel like quitting the job? A causal attribution approach to social and work overload consequences

Purpose In an effort to study the effects of stress factors i.e. work overload and social overload, the authors integrate causal attribution research to develop a stress outcome model. Drawing on Affective Events theory, this study aims to investigate how work and social overload lead to turnover intentions with the mediating role of emotional exhaustion. Design/methodology/approach A quantitative approach to examine the direct linkage of stress factors to turnover intention was tested for 409 respondents working at middle and senior manager level posts in the banking sector of Lahore, Pakistan. Partial least square structure equation modeling technique was applied through Smart_PLS3.0 for hypothesis testing. Findings Results revealed a strong relationship between stress factors (i.e. social overload and work overload) and turnover intentions in the presence of emotional exhaustion as a significant mediator. Originality/value The study adds value to the theory and practice by examining the understudied stress factors (social overload) along with work overload and their consequences on the employees.

Non-invasive Resolution of Pathological Ovarian Masses with Homeopathic Treatment—A Case Series

Background Ovarian masses may be either physiological or pathological. Physiological ovarian masses are non-neoplastic. Pathological masses grow more than 7 cm and persist beyond 3 months; they do not resolve spontaneously, and invasive surgery with removal of reproductive organs is the conventional treatment. It usually results in further co-morbidities and hampers the quality of life of the patient. Objectives This case series of pathological left ovarian masses demonstrates the role of homeopathic treatment in each of two multiparous women where the right ovary was surgically removed previously for similar pathology and in an adolescent girl with increased tumor marker CA-125. Methods Three cases of women with pathological ovarian masses in the left ovary, and advised invasive surgery by attending gynecologists, were treated with homeopathic medicines at the outpatient department of the National Homeopathy Research Institute in Mental Health, Kottayam, Kerala, from 2017 to 2020. Each case was followed up with clinical and ultrasonographic evidence and reported according to the criteria set out in the HOM-CASE guidelines. Result Complete resolution of the ovarian masses was observed in all three cases, evidenced by ultrasonography, with normalizing CA-125 values also observed in the case of endometrial cyst. The patients improved within 4 to 15 months of treatment using Thuja and other individualized homeopathic medicines. The MONARCH score was calculated as +7/13, +9/13, and +9/13 for the three cases, respectively, indicating a positive causal attribution of homeopathy in the resolution of these pathological ovarian masses. Conclusion This case series suggests that individualized homeopathy, and notably Thuja, can be useful in the treatment of pathological ovarian masses.

Causal attribution fractions for epidemiological studies, applied to a UK Biobank study of smoking and BMI

Epidemiological studies often use proportional hazard models to estimate associations between potential risk factors and disease risk. It is emphasised that when the "backdoor criteria" from causal-inference applies, if diseases are sufficiently rare, then the proportional hazard model can be used to estimate causal associations. When the "frontdoor criteria" applies (allowing causal estimates with unmeasured confounders), similar estimates are found to mediation analyses with measured confounders. Reasons for this are discussed. An attribution fraction is constructed using the average causal effects (ACE) of exposures on the population, and simple methods for its evaluation are suggested. It differs from the attribution fraction used by the World Health Organisation (WHO), except for specific circumstances where the latter can agree or provide a bound. A counterfactual argument determines an individual's attribution fraction Af in terms of proportional hazard estimates, as Af = 1 − 1/R, where R is an individual's relative risk. Causally meaningful attribution fractions cannot be constructed for all known risk factors or confounders, but there are important cases where they can. As an example, systematic proportional hazards studies with UK Biobank data estimate the attribution fractions of smoking and BMI for 226 diseases. The attribution of risk is characterised in terms of disease chapters from the International Classification of Diseases (ICD-10), and the diseases most strongly attributed to smoking and BMI are identified. The result is a quantitative characterisation of the causal influence of smoking and BMI on the landscape of disease incidence in the UK Biobank population.

Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers’ (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients’ experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Evidence-Based Homoeopathic Treatment of Acute Herpes Zoster (Shingles): A Case Report

Herpes zoster (HZ), also known as shingles, occurs due to reactivation of varicella zoster. It is manifested by unilateral, painful, vesicular rashes following a dermatome. Homoeopathy is well known for its tremendous results in chronic cases. This article presents the evidence-based significant result of single homoeopathic remedy in an acute case of HZ within a short time period without any post-herpetic neuralgia which usually follows the HZ for months. Three to four doses of Hypericum 30 CH provided significant relief within a day and complete recovery within 10 days. Modified Naranjo score is 9, indicating definite causal attribution. This case proves that by selecting appropriate similimum, promising and positive results are achieved by homoeopathy, be it acute or chronic cases in a safe and gentle way. No such existing homoeopathic literature provides any characteristic information particularly related to HZ in Hypericum. So, future research and clinical trials could be beneficial for better validation of Hypericum as a therapeutic for HZ.

Homoeopathy in the Treatment of Post-Stroke Complications: A Case Report

Background Long-term muscular and neuropsychiatric complications are common in stroke survivors. The main aim of therapeutic modalities for such cases is to limit the extent of disabilities and subsequent increase in the activity of daily living. Every case is different in pathology and manifestation, so requires an individualistic approach. Case A 63-year-old man presented with right upper limb weakness, dysarthria and memory weakness after stroke. He had been undergoing conventional physical rehabilitation therapy but due to feasibility issues, he could not continue and opted for homoeopathic treatment. Following a thorough clinical and psychological evaluation, he was treated with homoeopathic medicines tailored to his specific needs. The Medical Research Council scale for muscle power, the Modified Ashworth Scale for muscle spasticity and the Stroke Impact Scale for quality of life after stroke were used to assess outcomes at various time points. Different physical and cognitive domains showed gradual improvement. Conclusion This case demonstrates the complexities of clinical outcomes following a stroke and how those can be improved through the individualistic approach of homoeopathy. Nevertheless, a firm conclusion regarding causal attribution cannot be drawn from a single case, but a detailed clinical approach may be followed. Large-sample randomised controlled trials are impractical for the individualised approach of therapy or complex clinical conditions; thus, the ‘n-of-1’ trial may be adopted in the long run.