Multi-objective optimization in partitioning the healthcare system of Parana State in Brazil

Motivated by a proposal of the local authority for improving the existing healthcare system in the Parana State in Brazil, this article presents an optimization-based model for developing a better system for patients by aggregating various health services offered in the municipalities of Parana into some microregions. The problem is formulated as a multi-objective partitioning of the nodes of an undirected graph (or network) with the municipalities as the nodes and the roads connecting them as the edges of the graph. Maximizing the population homogeneity in the microregions, maximizing the variety of medical procedures offered in the microregions, and minimizing the inter-microregion distances to be traveled by patients are considered as three objective functions of the problem. An integer-coded multi-objective genetic algorithm is adopted as the optimization tool, which yields a significant improvement to the existing healthcare system map of the Parana State. The results obtained may have a strong impact on the healthcare system management in Parana. The model proposed here could be a useful tool to aid the decision-making in health management, as well as for better organization of any healthcare system, including those of other Brazilian States.     

Psychometric analysis of the UK Health and Safety Executive's Management Standards work-related stress Indicator Tool

Abstract

Numerous tools have been developed that attempt to measure work-related stress and working conditions, but few practical instruments in the literature have been found to have a reliable psychometric factor structure. In the UK, the Health and Safety Executive (HSE) Management Standards (MS) Indicator Tool is increasingly used by organizations to monitor working conditions that can lead to stress. In Health and Safety Executive (2004), a factor analysis was conducted demonstrating the reliability of the scales. However, the authors acknowledged that direct reassessment of the same factor structure was impossible as the questionnaire was split into two separate modules for data collection. Furthermore, the tool is designed to enable comparisons between as well as within organizations to take place, yet reliability has only previously been tested at the individual level. The current study is the first to examine the factor structure of the HSE MS Indicator Tool using organizational-level data. Data collected from 39 UK organizations (N=26,382) was used to perform a first-order Confirmatory Factor Analysis (CFA) on the original 35-item seven-factor measurement scale. The results showed an acceptable fit to the data for the instrument. A second-order CFA was also performed to test if the Indicator Tool contains a higher order uni-dimensional measure of work-related stress. These findings also revealed an acceptable fit to the data, suggesting that it may be possible to derive a single measure of work-related stress. Normative data comprising tables of percentiles from the organizational data are provided to enable employers to compare their organizational averages against national benchmarks.     

Changes in the structure of health complaints as related to shiftwork exposure

Abstract

Factor analyses of health complaints in groups with different length of shiftwork exposure show that the structure of these complaints changes with increasing shift experience, indicating the emergence of a shift-specific pattern of health complaints. After about 15 years of shiftwork, complaints related to disturbances of circadian-controlled functions can be found in the first factor whereas other complaints have their dominant loadings on a separate factor, representing general, non-shift-specific impairments. The results indicate that in this way shift-specific components of health impairment can be separated from other non-shift related components.     

Psychophysical conditions of air traffic controllers evaluated by the standard shiftwork index

Abstract

In the ambit of a large epidemiological survey on the Italian population of air traffic controllers, an evaluation of their health conditions was carried out using the Standard Shiftwork Index (SSI). The study took into consideration 572 male air traffic controllers, aged between 23 and 59 years, of whom 301 were engaged in three large Regional Centres, 189 in thirteen Airport Towers and 82. formerly active controllers, were working in administrative offices. The former controllers showed worse health levels, in particular minor psychological disorders and chronic fatigue. Sixteen of them had been transferred to administrative jobs because of health impairment, owing to severe diseases of the nervous, gastrointestinal and cardiovascular systems. Such disorders, and musculoskeletal ones, were mostly reported by the active controllers. The controllers engaged in Regional Centres showed more sleep disturbances than those engaged in towers. Beside age, some personal characteristics appeared to influence health and well-being. Neuroticism was correlated with chronic fatigue, digestive and cardiovascular complaints, minor psychological disorders, cognitive and somatic anxiety. On the other hand, morningness was correlated negatively with sleep disturbances on morning shift, and positively with sleep duration both on morning shift and rest days.     

An examination of the ISO 9001:2000 standard and its influence on the integration of management systems

Abstract

Analysis of the literature and examination of the various models of integration and testing in the field, have revealed five key issues relating to management system integration. This paper examines the recently published ISO 9001 : 2000 quality management system standard to see how it addresses these issues, under the headings of compatibility, scope and organizational culture. The examination reveals that while compatibility with the ISO 14001 and OHSAS 18001 standards has been improved in some areas, a different approach and model of a management system has been used. The paper suggests that differences in the scope of the standards are also likely to give rise to different sub-cultures which will hinder integration, and scope and culture are more important than compatibility. This leads the authors to conclude that new models of integration should be based on an approach and definitions which can be used in any management system, as well as an integrated one. Models of an integrated management system should also emphasize the need for no significant differences in the scope of the integrated systems, and a strong culture which supports the main requirements of TQM.     

Talking of HRD

This paper draws upon research exploring the emergence of HRD within the British National Health Service (NHS), the aim being to investigate how HRD has been talked into being, is talked about and accomplished through talk. HRD is conceptualized as a socialand discursive construction, and as discursive action. It is argued that conceptualizing HRD as a social and discursive construction can help identify and explain changes in ways of thinking and talking about HRD. Conceptualizing HRD as discursive action can help explain and justify HRD activity, in that much of what HRD practitioners and academics ‘do’ is ‘talk’. This paper explores these concepts and introduces a typology of the discourses of training and development (T&D), HRD and strategic HRD (SHRD), labelled Tell, Sell and Gel. It is suggested that this typology is a useful analytical tool for those practising HRD, providing ameans for HRD professionals to identify and analyse, and possibly change, their practices and discourse(s). The paper introduces a way of identifying how HRD might be talked ‘about’ and theorizes how discursive activities (the talk) might be changing.     

Does work during childhood affect the health of Guatemalan adults?

The diversity of potential relationships between child labor and health makes the empirical disentanglement of the causal relationship a difficult exercise. This paper examines the long run impact of child labour on health by controlling for unobserved household specific characteristics. In order to control for the unobserved households specific effect, we estimate a conditional fixed effect model using data on siblings constructed from the Guatemalan National Survey of Living Condition. The estimation results reinforce the conventional wisdom that child labor is harmful for health in the long run. The results can be interpreted as a lower bound of the true impact since healthier children are most likely to offer themselves for employment and to be appointed. The views expressed in this paper are those of the authors and do not necessarily represent those of IMF and IMF policy.     

Healthcare in India: Changing the Financing Strategy

The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one‐fifth of health expenditure being publicly financed. India has large‐scale poverty and yet the main source of financing healthcare is out‐of‐pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to over‐emphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.     

The Effect of Risk Beliefs on Property Values: A Case Study of a Hazardous Waste Site1

Health risk beliefs of homeowners near a landfill site were assessed in a survey and compared to expert judgments of the health risks of living near the site. A bimodal distribution of health risk beliefs suggested sharp disagreement between the experts and at least some of the residents. Correlates of high risk beliefs included perception of odor from the site, exposure to media coverage of the problem, having children living at home, age (younger respondents more concerned), and gender (females more concerned). An aggregated neighborhood health risk belief predicted reductions in home prices even after controlling for home physical characteristics, such as size and other disamenities such as proximity to a freeway. In the 4100 homes near the site, the estimated depression in property values was estimated to total about $40.2 million before the site was closed and to be about $19.7 million after closure. Implications of these results for community conflict and for benefit-cost analysis of hazard site remediation are discussed.     

Estimating the Risks of Smoking, Air Pollution, and Passive Smoke on Acute Respiratory Conditions

Five years of the annual Health Interview Survey, conducted by the National Center for Health Statistics, are used to estimate the effects of air pollution, smoking, and environmental tobacco smoke on respiratory restrictions in activity for adults, and bed disability for children. After adjusting for several socioeconomic factors, the multiple regression estimates indicate that an independent and statistically significant association exists between these three forms of air pollution and respiratory morbidity. The comparative risks of these exposures are computed and the plausibility of the relative risks is examined by comparing the equivalent doses with actual measurements of exposure taken in the homes of smokers. The results indicate that: (1) smokers will have a 55-75% excess in days with respiratory conditions severe enough to cause reductions in normal activity; (2) a 1 microgram increase in fine particulate matter air pollution is associated with a 3% excess in acute respiratory disease; and (3) a pack-a-day smoker will increase respiratory restricted days for a nonsmoking spouse by 20% and increase the number of bed disability days for young children living in the household by 20%. The results also indicate that the estimates of the effects of secondhand smoking on children are improved when the mother's work status is known and incorporated into the exposure estimate.