Promising but challenging urban freight transport solutions : freight flow consolidation and off-hour deliveries

Although inevitable, urban traffic causes air pollution, noise pollution and congestion. Up to 20% of urban traffic is related to freight transport and service trips and, proportionally, it contributes more to the negative side-effects of urban traffic than passenger related traffic. Throughout the past few decades, a range of solutions to reduce the negative impact of urban freight transport have been researched, tested and implemented. Two possible solutions are: freight flow consolidation and off-hour deliveries. They have two things in common. First, despite the fact that it is generally accepted that there are considerable benefits to both solutions they seem to remain permanently promising and have not been widely adopted yet. Second, they require support of both public and commercial stakeholders to be successful in the long term. The purpose of this thesis is to identify feasible, consensual and successful applications of urban freight flow consolidation and off-hour deliveries. To reach that goal a twofold approach is adopted: (i) reassessing the generally accepted logic behind freight flow consolidation and off-hour deliveries as well as their impact and (ii) evaluating both concepts and/or their applications from the perspective of all stakeholders. One possible freight flow consolidation solution is to implement an Urban Consolidation Centre (UCC). A review of the available UCC impact assessment made me conclude that 87% of UCCs have a positive impact on the number of urban freight vehicle kilometres. However, this positive impact might have to partially be put down to the lack of high-quality urban freight data and the consequent too positive estimations. Despite the dominant attention for UCCs in the literature on urban freight flow consolidation, there are alternative approaches. This thesis identifies and categorizes them and cites existing, often small-scale examples. One possible alternative approach is to use a Mobile Depot for express deliveries and pick-ups. Evaluating this concept revealed that it decreases the amount of emitted pollutants and the number of diesel vehicle kilometres but doubles the operational costs for the express service provider. The thesis also demonstrates that there is no overall stakeholder support for a general shift of urban freight flows to off-hours in Belgium. There are, however, freight flows that are more suited than others to be shifted to off-hours. My research identifies these freight flows and characterizes them. Based on this research, one particularly suited freight flow would be supermarket deliveries. Evaluating a trial that took place in Brussels revealed that there are considerable time and fuel savings when deliveries to two supermarkets in Brussels are shifted to off-hours and that this solution would be able to receive overall stakeholder support when sufficient measures are taken to keep the noise nuisance for local residents to a minimum. Finally, the thesis contributes to the research field of urban freight transport by introducing the concept of stakeholder involvement in the evaluation of urban freight transport solutions by using Multi Actor Multi Criteria Analysis which is an evaluation tool that explicitly includes the goals and objectives of all stakeholders

Unique health care utilization patterns in a homeless population in Ghent

Background: Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system. Methods: Observational, cross-sectional study design. Data from the Belgian National health survey were merged with comparable data collected by means of a face-to-face interview from homeless people in Ghent. 122 homeless people who made use of homeless centres and shelters in Ghent were interviewed using a reduced version of the Belgian National Health survey over a period of 5 months. 2-dimensional crosstabs were built in order to study the bivariate relationship between health care use (primary health care, secondary and emergency care) and being homeless. To determine the independent association, a logistic model was constructed adjusting for age and sex. Results and Discussion: Homeless people have a higher likelihood to consult a GP than the non-homeless people in Ghent, even after adjusting for age and sex. The same trend is demonstrated for secondary and emergency care. Conclusions: Homeless people in Ghent do find the way to primary health care and make use of it. It seems that the universal primary health care system in Ghent with an active guidance by social workers contributes to easier GP access

Which socio-economic factors influence patients' choice to opt for the ED or the GPC during out-of-hours : an explorative study in Flanders

Background: Overcrowding of emergency departments (ED) during out-of-hours health care is a common problem in many Western countries. An appealing alternative for ED’s is the general practices cooperatives (GPC): regional networks of GP’s during the out-of-hours. The aim of this study is to investigate the socio-economic determinants of patients’ choice to opt for one of both health care providers. Methods: We gathered patient level data between May and December 2012 in Flanders (Belgium) from three emergency departments and three general practices cooperatives. Chi square analyses were used in order to study the bivariate relationship between opting for a health care facility (ED or GPC) and various socio-economic factors. To determine the independent association, a logistic regression analysis was conducted. Results: Self-referral to the ED is significantly associated with: being male, being younger, being less educated, having a (lower educated) partner and living in a rural area. Conclusion: The results of this study show that opting for the ED during the out-of-hours is, in general, related to a lower socio-economic status. Therefore the government should focus on patients with a lower socio-economic status when disseminating information on the organisation of health care with an emphasis on the accessibility of the primary health care during out-of-hours. To meet the needs for health care during these out-of-hours, a possible solution could be an integrated facility of GPC and ED with one access to medical care for all patients

The social gradient in doctor-patient communication

Objective: In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. Methods: A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. Results: Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. Conclusion: This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication. Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. Practice implications: By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established

Op bezoek bij de huisarts: gerapporteerd gebruik, gepercipieerde kwaliteit en toegankelijkheid van de huisartsenzorg bij financieel kwetsbare welzijnszorggebruikers

info:eu-repo/semantics/publishe

Beschrijving van de KANS steekproef: representativiteit, demografische en socio-economische kenmerken, gezondheidstoestand en zorggebruik

info:eu-repo/semantics/publishe

KANS cijferrapport: beschrijvende analyse van de gegevens uit de eerste bevraging: socio-demografisch profiel, zorggebruik, zorgtevredenheid, gezondheid, welzijn en sociale contacten van maatschappelijk kwetsbare welzijnszorggebruikers

info:eu-repo/semantics/publishe

Kans theoretische achtergronden en onderzoeksopzet

info:eu-repo/semantics/publishe