Tackling large-scale home health care delivery problem with uncertainty

In this work, we investigate a multi-period Home Health Care Scheduling Problem (HHCSP) under stochastic service and travel times. We first model the deterministic problem as an integer linear programming model that incorporates real-world requirements, such as time windows, continuity of care, workload fairness, inter-visit temporal dependencies. We then extend the model to cope with uncertainty in durations, by introducing chance constraints into the formulation. We propose efficient solution approaches, which provide quantifiable near-optimal solutions and further handle the uncertainties by employing a sampling-based strategy. We demonstrate the effectiveness of our proposed approaches on instances synthetically generated by real-world dataset for both deterministic and stochastic scenarios

The Tackling Men's Health Evaluation Study

Tackling Men’s Health is an intervention developed out of a partnership between the Department of Health, Leeds Rhinos Rugby League Club and Leeds Metropolitan University. The intervention was designed to target men attending Headingley Carnegie Stadium, with the aim of promoting engagement with health services and therefore promoting improved health and wellbeing. The primary aim of the of the Tackling Men’s Health study is to assess engagement in an intervention targeting men attending rugby matches. Secondary aims of the research study are to: To assess the barriers and facilitators associated with implementing a health promotion intervention targeting men attending rugby league games To examine the effect of a multi-component targeted intervention on men’s self reported engagement with health services To examine the effect of a multi-component targeted intervention on men’s awareness of key health issues To examine the effect of multi-component targeted intervention on men’s perceived health status The research study monitored the evolution of the Tackling Men’s Health intervention, which was delivered in sports settings over the course of the 2009 Engage Super league Rugby league season. Seven stakeholders and 20 men who attended Rugby league matches were interviewed to achieve a broad understanding of appropriateness of the processes used in the planning and delivery of the Tackling Men’s Health intervention

Tackling disinvestment in health care services

Rising levels of demand due to ageing populations and increases in long term conditions (White 2007), increased levels of expectation amongst patients and inflationary pressure caused by the rising cost of new technologies are amongst the explanations for the funding shortfalls in government funded health systems across the world (Newhouse 1992). The challenge facing these health systems has also been intensified by the worldwide economic downturn. Within health systems, efforts have been made to increase productivity and efficiency and to control costs without reducing quality (Garner and Littlejohns 2011) but the scale of the task necessitates further action (Donaldson et al. 2010). Beyond productivity and efficiency gains the next logical step for decision makers is disinvestment in cost-ineffective services, prioritisation of funding for one service over another or what Prasad (2012) refers to as ‘medical reversal’. The aims of this study were to explore the experiences of budget holders within the English National Health Service (NHS) in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. This paper begins with clarification of terminology and a summary of the current state of knowledge with regard to health service disinvestment, before presenting and discussing findings. The research suggests that disinvestment activity is varied across organisations and ranges from ‘invest to save’ schemes through to ‘true disinvestment.’ Although the majority of interviewees accept that disinvestment is necessary most had made little progress at the time of interview beyond ‘picking the low hanging fruit’. Interviewees identify a number of determinants of disinvestment such as: local/national relationships, co-ordination/ collaboration and; professional understanding and support

Place-based approaches to child and family services

This paper synthesizes the conceptual and empirical literature on place-based approaches to meeting the needs of young children and their families. A specific focus of the paper is on the potential contribution of place-based approaches to service reconfiguration and coordination. Outline The paper begins by outlining the sweeping social changes that have occurred in developed nations over the past few decades and their impact on children, families and communities. It explores the ‘joined up’ problems faced by families and communities in the contemporary world, and highlights the need to reconfigure services to support families more effectively. The paper then focuses on ‘joined up’ solutions, on what we know about how to meet the challenges posed by the complex problems that characterise our society. Next, the paper explores what a place-based approach involves, and what role it can play in supporting families with young children. The rationale underpinning place-based approaches is outlined and the evidence for the effectiveness of the approach is summarised. The paper then looks at what can be learned from efforts to implement place-based initiatives in Australia and overseas, and explores the issues that need to be addressed in implementing this strategy. The ways in which the early childhood service system might be reconfigured are also considered, and the paper ends with a consideration of the policy and implementation implications.&nbsp

Asylum in Ireland - a public health perspective

This report has two elements, first a review of the literature on refugees and asylum seekrs, with particular to the legal and practical situation in Ireland, and secondly a report of a survey of refugees and asylum seekers carried out in part fulfillment of the requirments for the MPH. The survey had two elements, one a quantitaitve stuy carried out in Dublin and Ennis, and the second a series of focus groups

Tackling concentrated worklessness: integrating governance and policy across and within spatial scales

Spatial concentrations of worklessness remained a key characteristic of labour markets in advanced industrial economies, even during the period of decline in aggregate levels of unemployment and economic inactivity evident from the late 1990s to the economic downturn in 2008. The failure of certain localities to benefit from wider improvements in regional and national labour markets points to a lack of effectiveness in adopted policy approaches, not least in relation to the governance arrangements and policy delivery mechanisms that seek to integrate residents of deprived areas into wider local labour markets. Through analysis of practice in the British context, we explore the difficulties of integrating economic and social policy agendas within and across spatial scales to tackle problems of concentrated worklessness. We present analysis of a number of selected case studies aimed at reducing localised worklessness and identify the possibilities and constraints for effective action given existing governance arrangements and policy priorities to promote economic competitiveness and inclusion

Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study.

INTRODUCTION: Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population. METHODS: IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres. RESULTS: HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother's diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity. CONCLUSION: We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial