Relatives' Experiences of Mental Health Care, Family Burden and Family Stigma: Does Participation in Patient-Appointed Resource Group Assertive Community Treatment (RACT) Make a Difference?

The aim of this exploratory cross-sectional study was to investigate the experiences of relatives of individuals with severe mental illness with and without participation in patient-appointed Resource Group Assertive Community Treatment (RACT). A total of 139 relatives (79 with and 60 without RACT) completed the Family Involvement and Alienation Questionnaire, the Burden Inventory for Relatives of Persons with Psychotic Disturbances, and the family version of the Inventory of Stigmatizing Experiences. We found that relatives participating in RACT experienced a more positive approach from the healthcare professionals, as well as a lower degree of alienation from the provision of care. Relatives who did not participate in RACT were more afraid that their ill next of kin would hurt someone. No other differences in family burden were found. Experiences of family stigmatization were similar in both groups. In conclusion, participating in patient-appointed RACT may contribute to a higher level of satisfaction for relatives in their encounter with healthcare professionals and a more positive alliance. Implementation of RACT in new settings would require adaptation to local conditions to facilitate cooperation between healthcare staff and other relevant services. Staff training focuses on the case manager function and needs assessment, as well as how to create an alliance with the patient and his/her relatives.

The effect of dynamic scheduling and routing in a solid waste management system.

Solid waste collection and hauling account for the greater part of the total cost in modern solid waste management systems. In a recent initiative, 3300 Swedish recycling containers have been fitted with level sensors and wireless communication equipment, thereby giving waste collection operators access to real-time information on the status of each container. In this study, analytical modeling and discrete-event simulation have been used to evaluate different scheduling and routing policies utilizing the real-time data. In addition to the general models developed, an empirical simulation study has been performed on the downtown recycling station system in Malmoe, Sweden. From the study, it can be concluded that dynamic scheduling and routing policies exist that have lower operating costs, shorter collection and hauling distances, and reduced labor hours compared to the static policy with fixed routes and pre-determined pick-up frequencies employed by many waste collection operators today. The results of the analytical model and the simulation models are coherent, and consistent with experiences of the waste collection operators.