A two-phase approach for periodic home health care planning

International audienceIn this paper, we study the problem of periodic vehicle routing encountered in Home Health Care (HHC). The problem can be considered as a Periodic Vehicle Routing Problem with Time Windows (PVRPTW). It consists in establishing a planning of visits to patients over a given time horizon so as to satisfy the adherence to the care plan while optimizing the routes used in each time period. One two-stage mathematical formulation of this problem is proposed. We then propose a Tabu Search (TS) and a MIP-based Neighborhood Search method to compute the weekly and daily plan, respectively. These approaches are tested on large size instances

Fertility Care Services

The Catholic Church calls married couples to responsible parenthood; this includes both openness to new human life and the avoidance of pregnancy when serious reasons present themselves. Natural methods of family planning respect the dignity of the person and the integrity of the sexual act. They treat fertility as a natural process rather than a disease. Natural family planning (NFP) works with a woman’s menstrual cycle; it uses awareness of fertile and infertile times to achieve or avoid pregnancy and allows married couples, through their awareness, to respect and maintain both the unitive and the procreative aspects of the sexual act. In this chapter, Dr. Fehring points out that the benefits of using NFP are “a better understanding of fertility, increased communication, self- mastery of sexual desires, greater generosity toward new human life, and openness to God’s will.” He also explores the history of fertility awareness methods, their scientific basis, and their efficacy. He discusses some medical side benefits of tracking fertility: it can reveal abnormalities and is an aid in the assessment and treatment of infertility. Daily discussion of fertility enhances communication between spouses. Periods of abstinence, while difficult at times, also provide opportunities for the couple to develop nonsexual expressions of intimacy, thereby enhancing mutual respect and married life. The teaching and use of NFP is an effective way of promoting the culture of life.—Editors

The Future of Professional Education in Natural Family Planning

Nurses and other health care professionals often have little knowledge of methods of natural family planning (NFP) and do not readily prescribe natural methods for their patients. One reason for this is that little or no information on NFP is provided in nursing or medical schools. The holistic, informational, and integrative nature of NFP fits well with professional nursing practice. A university online distance education NFP teacher training program, which offers academic credit and includes theory, practice, and the latest developments in fertility monitoring, has been developed for health care professionals. Professional NFP services in the United States need to meet worldwide standards and include documenting and assessing pregnancy outcomes, tailoring NFP services to the client or couple, and simplifying them for ease of use in a standard health care practice

The Catholic Physician and Natural Family Planning: Helping to Build a Culture of Life

This paper is based on the author\u27s answer to a question from Theresa Notare, director of the Natural Family Planning Program of the U.S. Conference of Catholic Bishops, about what Catholic scientists and physicians can do to promote NFP and what the Catholic Church in the United States can do to help physicians and health professionals promote NFP. The paper reviews the Church\u27s historical call for health professionals to study and to teach NFP methods, briefly analyzes the current state of NFP in Catholic health care, and provides an answer to Dr. Notare from the perspectives of research, education, and practice

Current Medical Research: Summer/Fall 2017

This issue of Current Medical Research (CMR) includes studies that provide evidence that use of natural family planning (NFP) can be helpful for subfertile couples wishing to achieve a pregnancy, the effectiveness of a method of NFP during breastfeeding, and the effects of using NFP on marital relationships. This review also includes evidence on predicting the sex of a baby by timing intercourse, evidence that brain injuries can be reflected in changes in the menstrual cycle, and that women prefer methods of family planning that have no side effects. The issue ends with an in-depth review of new technologies that aid in the use of NFP. Topics covered include subfertile couples, breastfeeding, marriage, predicting the sex of a baby, brain injuries, and new technologies

Family planning success in two cities in Zaire

Both projects described here, Matadi and Kananga, helped health providers in those two cities offer clinical family planning services. But their approaches differed markedly. The family education program in Matadi concentrated on pioneering community-based distribution of contraceptives, with carefully supervised distributors. The Kanaga Project emphasized clinical supervision and pleasing the clients; introduced social marketing with loose supervision of retailers; and provided an information team skilled in face-to-face group meetings, plus a weekly radio program. Four factors common to both projects seemed to contribute to their success: The single-minded dedication of staff members to making family planning work. An uninterrupted supply of affordable contraceptive methods available through outlets at many locations. Enough organizational autonomy to be able to respond to problems as they arose. Such autonomy made project personnel identify more with project goals and feel responsible for achieving project objectives. Regular and supportive supervision of those responsible for service delivery. Both projects emphasized regular contact with clinic personnel - Matadi also included distributors. These contacts bolstered morale by showing that the project administration was closely following service providers'activities and by transmitting to providers the staff's enthusiam for project activities. Supervisory visits included administrative functions such as collecting service statistics and controlling inventory, but these activities were handled in a friendly, nonthreatening manner that encouraged service providers to perform their tasks well. The fourth factor is adequate funding. Both projects had special funding that allowed them to experiment with approaches for increasing contraceptive prevalence. That funding may partly explain their organizational autonomy and may have contributed to the sense of purpose and esprit de corps that developed among project staff. Larger-scale programs in Zaire have operated with significant financial constraints, so it would be unfair to compare them with these more successful projects. Special funding does not guarantee project success but may make it far more likely, conclude the authors.Health Monitoring&Evaluation,Adolescent Health,ICT Policy and Strategies,Early Child and Children's Health,Reproductive Health

Converting Retirement Savings into Income: Annuities and Periodic Withdrawals

To a worker contemplating retirement, there is perhaps no more important question than “How long will my money last?” Congress has a strong interest in the income security of older Americans because much of their income is either provided directly from public programs like Social Security, or in the case of pensions and retirement accounts, is subsidized through tax deductions and deferrals. Many retirees must decide how to convert retirement account balances into income and how to preserve the accounts in the face of several kinds of risk. * Longevity risk is the risk that the individual will exhaust his or her account before death and experience a substantial decline in income. * Investment risk is the risk that the assets in which the individual has invested his or her retirement account will decline in value. * Inflation risk is the risk that price increases will cause the individual’s retirement income to decline in purchasing power. * Unexpected events such as divorce, the death of a spouse, the cost of medical care, or a need for long-term care services are also risks. There are strategies for dealing with each of these risks, but no single strategy can deal effectively with all of them. For example, purchasing a life annuity insures against longevity risk and it shifts the investment risk to the insurer. However, purchasing an annuity depletes the purchaser’s available assets by the amount of the premium. These assets are no longer available to the retiree in the event of a catastrophic illness or other unexpected major expense. To date, the demand for annuities has been low. There are many reasons for the low demand for annuities, but one of the most important has been that many potential annuity purchasers do not value the longevity insurance provided by annuities at its market price. Retirees who choose not to purchase life annuities must decide how much to withdraw from their retirement accounts each year. Because they face uncertainty with respect to both life expectancy and the rate of return on investment, this decision carries its own risks. If withdrawals are too large, retirees risk spending down their savings too quickly, possibly leaving them impoverished. If withdrawals are too small, they might spend too little and leave substantial assets unspent when they die. An analysis conducted by CRS indicates that under specific conditions there is a 95% or greater probability that a man who retires at age 65 will not exhaust his retirement account before the earlier of death or age 95 if his initial withdrawal does not exceed 5% of the account balance and later withdrawals are the same in inflationadjusted dollars. Under the same conditions, there is a 95% or greater probability that a woman who retires at age 65 will not exhaust her retirement account before the earlier of death or age 95 if her initial withdrawal does not exceed 4.5% of the account balance and later withdrawals are the same in inflation-adjusted dollars