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Nature based solution for improving mental health and well-being in urban areas

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Abstract

The general disproportion of urban development and the socio-economical crisis in Serbia, followed by a number of acute and chronic stressors, as well as years of accumulated trauma, prevented the parallel physical, mental and social adaptation of society as a whole. These trends certainly affected the quality of mental health and well-being, particularly on the vulnerable urban population, increasing the absolute number of people with depression, stress and psychosomatic disorders. This study was pioneering in Serbia and was conducted in collaboration with the Faculty of Forestry, the Institute of Mental Health and the Botanical Garden in Belgrade, in order to understand how spending time and performing horticulture therapy in specially designed urban green environments can improve mental health. The participants were psychiatric patients (n=30), users of the day hospital of the Institute who were randomly selected for the study, and the control group, assessed for depression, anxiety and stress before and after the intervention, using a DASS21 scale. During the intervention period the study group stayed in the Botanical garden and participated in a special programme of horticulture therapy. In order to exclude any possible "special treatment'' or ''placebo effect", the control group was included in occupational art therapy while it continued to receive conventional therapy. The test results indicated that nature based therapy had a positive influence on the mental health and well-being of the participants. Furthermore, the difference in the test results of the subscale stress before and after the intervention for the study group was F1.28 = 5.442 and p<;.05. According to socio demographic and clinical variables, the interesting trend was recorded on the subscale of anxiety showing that the male participants in the study group were more anxious, with the most pronounced inflection noted on this scale after treatment. The results of this study have shown that recuperation from stress, depression and anxiety was possible and much more complete when participants were involved in horticulture therapy as a nature-based solution for improving mental health.

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... Van den Bosch and Ode Sang (2017) [59] showed strong evidence for an improved effect on heat reduction from green space and then cardiovascular disease (CVD)-related mortality by exposure to NBS (urban natural environments, including blue-green, etc.). The research articles proved the NBS, mainly by the exposure to the green space, could enhance human wellbeing through the cases of depletion of cognitive resources (i.e., less ego depletion) in hot summers [90], improve mental health (recuperation from depression, stress, and anxiety) [91], and minimize the adverse impacts on public health (pollen emissions) [92]. ...
... In summary, achieving sustainable urban development and greening are the more favorable dimensions compared to concerns of previous early years on human adaptation and disaster risk reduction. Evidence assessed almost exclusively from the case studies in developed countries except for a few ones, such as cases in Serbia with numerous acute and chronic stressors and accumulated trauma after the general disproportion of urban development and the socioeconomic crisis [91]. The role of NBS within GI in urban development, especially 'resilience and regeneration', is well recognized in developed countries, such as the awareness of cobenefits of GI for public health. ...
... It was noticeable a majority of research discussed flood risks and resilience. There were 80% of NBS publications that referred to 'reduction' of risk factors associated with urbanization, such as air pollution, heat, noise, flood, and food security issues [99,106,107], also for the mental stress [91], urban poverty [108], and economic inequalities [109]. These factors have been reflected in substantial literature proving the role of NBS for risk management and resilient cities and landscapes. ...
Article
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Nature-based solutions (NBS) is an innovative concept that mimics the processes of natural ecosystems, popularised principally in the European Union. With a substantial body of literature amassed since the term’s inception in 2015, there is a need to systematically review existing literature in order to identify overarching gaps and trends according to disciplinary focus, geographic scope and key themes, to direct future research enquiry and policy recommendations. This review consists of bibliometric analysis and thematic analysis for NBS studies in urbanism. NBS studies were found to relate strongly with other concepts of ‘Ecosystem Services’, ‘Green Infrastructure’, ‘Climate Change’, and ‘Risk management and Resilience’, which align with four major thematic goals set by the European Commission. Within NBS scholarship, a variety of sub-themes have emerged, namely ‘Greening’, ‘Urban Development’, ‘Water’, ‘Wellbeing’ and ‘Governance’. Furthermore, we illustrated that the amount and thematic focus of NBS research have been unevenly distributed around the globe. Analysis of emerging trends showed recent increases in topics such as adaptive governance of NBS, and incorporating social justice in sustainability transitions. Based on an assessment of extant NBS literature we offer some recommendations for future direction of the research fields. Keywords: Nature-based solutions; Sustainable urban development; Green Infrastructure; Ecosystem Services; Climate Change; Adaptive governance.
... The efficient use of eco-design is believed to bring positive outcomes (e.g., stress reduction, reduced emotional exhaustion, customer/employee retention, cost-saving) that are essential for a company's success [6,7]. Over the past few decades, customers' cognitive, affective, and behavioral responses to eco-friendly and healthy design/physical environment of buildings have also been largely researched by academics in the extant literature of environmental behavior and consumer behavior [8,9]. Indeed, there exists substantial evidence about the healing impact of eco-design/green physical environment on individuals' negative feelings, psychological distress, depression, and anxiety [10,11]. ...
... Individuals having interactions with natural items and green atmospherics rather than artificial building environments tend to have a higher level of mental health and well-being [9,12,13]. In addition, they form a favorable attitude toward a building and have a favorable image of a place [5,7]. ...
... Despite many of prior studies' investigation on the importance of eco-design of buildings (e.g., green décor, living plants, eco spaces, green atmospherics) [4,9,11], research that centers on exploring the positive influence of such eco-design on airport customers' approach responses and behaviors are not plentiful to date. In addition, our knowledge regarding the relations among eco-design of places, the reputation of the place, and subjective well-being in determining one's approach decisions are still limited. ...
Article
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This research was an empirical effort to uncover the influence of eco-design of airport buildings on customer approach responses and behaviors. A survey methodology with empirical data analysis was used to attain the research purpose. Our findings revealed that eco-design contributes to enhancing airport reputation and airport customers' subjective well-being. In addition, eco-design, reputation, and well-being directly/indirectly increase customer approach intentions. Our result also indicated that the association between eco-design and airport reputation is under the significant influence of biospheric value. Moreover, airport reputation and subjective well-being mediated the effect of eco-design on intentions. The comparative importance of airport reputation in determining approach intentions was identified. Overall, the proposed theoretical framework satisfactorily accounted for approach intentions. Given the lack of knowledge about eco-design in the airport literature, this research help boosts airport researchers' and practitioners' understanding of the role of eco-design and its criticality in explicating approach formation and behaviors.
... Several intervention studies were identified [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Of them, a minority included patients with MDD only [24][25][26][27][28][29], and the majority [21,[30][31][32][33][34][35][37][38][39] recruited mixed samples including patients with depressive disorders, although separate results for that group were not reported. ...
... Several intervention studies were identified [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Of them, a minority included patients with MDD only [24][25][26][27][28][29], and the majority [21,[30][31][32][33][34][35][37][38][39] recruited mixed samples including patients with depressive disorders, although separate results for that group were not reported. ...
... In the affective disorders group, a single intervention of less than two hours was associated with improvements in variables such as tension-anxiety (Cohen's d = 1. Vujcic et al. [33] explored the benefits of a horticulture therapy program for a mixed sample of 30 patients with ICD-defined adjustment disorder and a reaction to severe stress, anxiety, or depression, who attended a day hospital. Horticultural therapy is a process through which garden-related activities, interaction with plants and closeness to nature are used as a rehabilitative strategy [43]. ...
Article
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Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.
... These effects are reflected particularly in the vulnerable population, increasing the absolute number of people with depression, stress, and psychosomatic disorders (Lecic Tosevski et al., 2007). The factors that are associated with a high prevalence of mental disorders in the urban environment, especially in low-and middle-income Western Balkan countries, can also relate to poverty, age, social environment, wars, and natural disasters (Lecic Tosevski et al., 2007;Vujcic et al., 2017). With increased urbanization, there is a growing interest in research dealing with the daily stressors and defining the mechanisms that contribute to the physical and mental restoration of people in urban areas. ...
... These avenues usually take the form of settings and activities that promote higher levels of physical and mental well-being and usually involve urban green spaces, such as public forests and parks, horticultural activities, as well as occupational and art therapy (Dzhambova et al., 2018;Van den Bosch & Sang, 2017;Vujcic et al., 2017). Throughout the years, botanical gardens around the world, such as the one found in central Belgrade, have been acknowledged as a profoundly important and valuable restorative environments and gained great empirical support in the field of nature-based therapy interventions, merging two important factors-a natural setting and therapeutic activities (Carrus et al., 2017;Sandifer et al., 2015;Vujcic et al., 2017). ...
... These avenues usually take the form of settings and activities that promote higher levels of physical and mental well-being and usually involve urban green spaces, such as public forests and parks, horticultural activities, as well as occupational and art therapy (Dzhambova et al., 2018;Van den Bosch & Sang, 2017;Vujcic et al., 2017). Throughout the years, botanical gardens around the world, such as the one found in central Belgrade, have been acknowledged as a profoundly important and valuable restorative environments and gained great empirical support in the field of nature-based therapy interventions, merging two important factors-a natural setting and therapeutic activities (Carrus et al., 2017;Sandifer et al., 2015;Vujcic et al., 2017). ...
Article
Aim This article aims to make clearer, with supporting evidence, the clinical benefits of the nature-based rehabilitation program (NBRP) and the restorative values of visiting botanical garden for people with stress-related mental disorders. Background Throughout the years, nature-based therapy has been acknowledged as a valuable rehabilitation practice that integrates specially designed natural environments and nature-related activities for people with mental health conditions. Subject and Methods The comparative analyses of parallel conducted the NBRP at botanical garden and occupational therapy realised at the Day Hospital of the Institute of Mental Health in Belgrade included 27 participants divided into two groups. The data collection employed a mixed method combining a Clinical Global Impression (CGI) Scale and on-site observations. Results The positive findings on the psychological recovery of the participants seem to be related to NBRP. The restorative potential of the garden was recognized through the observed interaction between participants and the natural entities employed through the various themed activities. The observed landscape elements especially solitary plant specimens or tall and single-form trees within the garden can be embraced as design guidelines for the development of an evidence-based practice that can support the recovery process of people with mental health conditions. Conclusion Our findings endorse that ongoing social development and progressive urbanization have broadened the interest in scientific research involving nature-based solutions that help preserve the physical and mental health of people in low- and middle-income Western Balkan countries with a high prevalence of mental disorders in the urban environment that relates to social inequalities and natural disasters.
... The green physical environment of green hotels can provide stress reduction, body activity enhancement, health inequality relief, emotion improvement, and increased WB and MH. It will bring various positive effects on the health of individuals and society [1-3, 31,44]. Previous studies claim that people who reside in the natural environment and green spaces can be distressed [14,15]. ...
... This study focused on (1) expected re-patronage intention of green hotel customers, (2) adding ART to base NBSs though the green hotel model, (3) the utility of NBSs as verified through previous studies of environmental science [7,11,26,30,44,66] and ART through environmental psychology [38,40,44,56,[67][68][69]. With these, we intended to accumulate studies of hotel industry hypotheses in the previous studies mentioned above with a research model based on preset hypothesis. ...
... This study focused on (1) expected re-patronage intention of green hotel customers, (2) adding ART to base NBSs though the green hotel model, (3) the utility of NBSs as verified through previous studies of environmental science [7,11,26,30,44,66] and ART through environmental psychology [38,40,44,56,[67][68][69]. With these, we intended to accumulate studies of hotel industry hypotheses in the previous studies mentioned above with a research model based on preset hypothesis. ...
Article
Full-text available
Our research framework in this paper investigated natural-based solutions (NBSs) at green hotels. We employed attention restoration theory (ART) to test the mediating effect of perceived stress (PS), psychological wellness (PW), satisfaction (SA), and the moderating effect of health consciousness (HC) on re-patronage intentions (RI). Data were collected through a survey of 544 customers who frequently visited green hotels in Korea, and structural equation modeling (SEM) was used to test the research hypotheses. The findings generally supported the hypothesized associations of the study variables within our proposed theoretical framework (PS, PW, SF) in order of the mediating effect on RI and confirmed the moderating effect of HC. In addition, the study’s results have important theoretical and practical implications for the environment. In the former case, our results demonstrate the application of ART and NBS by explaining the effect of the relationship among PS, PW, and SF on RI and confirm the mediating effect of the ART (PS, PW, SF) on RI, as demonstrated in previous studies. Moreover, in the latter case our results may encourage green hotels to participate in the prevention of environmental problems.
... Modern hospitality companies are fulfilling the growing demand for green goods from customers with different strategies. Environment-friendly hotels have placed a primary emphasis on preserving the ecosystems and the long-term improvement of the customer's health (Han and Hyun, 2019;Vujcic et al., 2017). Parasuraman et al. (1985) determined that an improved quality of the services is the main factor that is responsible for achieving customer satisfaction. ...
... The main component of NBS is the green spaces that are present inside or outside of a hotel or a building, which are meant for rest, leisure, or physical activities (Trang et al., 2019). Another component of NBS is green surfaces, which represent the greening of gray surfaces outside and inside of a hotel or a building, that include the installation of glass windows, making the indoor and outdoor walls, entrances and rooftops, making concrete sidewalks green, and enhancing the parking area with gray surface cement and green decorations in order to increase the natural light (Vujcic et al., 2017). Similarly, visible green interior or exterior decorations form the third dimension of NBS. ...
... The NBS role was empirically examined under different study settings (Han et al., 2020b;Trang et al., 2019;Van den Bosch and Sang, 2017;Vujcic et al., 2017). These studies found a significant linkage between green space exposure, natural atmosphere, green environment, and urban green space as NBS and an individual's mental health/psychological health and emotional well-being. ...
Article
Given that the polluted environment affects human health, Nature-Based Solutions (NBS) is becoming an emerging issue in the hospitality and tourism industry. This research is designed in order to explore the influence of NBSs on Green Brand Evangelism (GBE) through mental health, emotional well-being, Green Brand (GB) attitude, and Green Brand Loyalty (GBL) in the hotel industry by considering the moderating effect of price fairness. Our theoretical model was built based on the Stimulus-Organism-Response (S-O-R) theory, which successfully embraces the NBS framework, GBL, and GBE. Our findings based on an online survey reveal that NBS as a second-order construct, which embraces the four first-order elements, significantly improves guests' perception of mental health and emotional well-being. The direct and indirect effects of mental health, emotional well-being, GB attitude, and GBL also uncovered and significantly impacted GBE. The hypotheses were generally supported. Furthermore, the moderating impact of price fairness was found.
... All this makes the NBT a complex intervention both to provide and to measure [24]. NBT has been incorporated into healthcare services as a complementary means of treating physical, mental and cognitive disorders by occupational therapists, physical therapists, social workers and psychologists [25][26][27]. NBT differs from conventional therapy by taking place outdoors in and with connection to the natural environment [27][28][29]. The environment may range from wilder nature to therapy gardens specifically designed to support the treatment. ...
... NBT has been incorporated into healthcare services as a complementary means of treating physical, mental and cognitive disorders by occupational therapists, physical therapists, social workers and psychologists [25][26][27]. NBT differs from conventional therapy by taking place outdoors in and with connection to the natural environment [27][28][29]. The environment may range from wilder nature to therapy gardens specifically designed to support the treatment. ...
Article
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Introduction: Nature-based therapy (NBT) has shown positive effects on different health�related outcomes and is becoming a more frequent approach in various rehabilitative interventions. Economic evaluations are widely used to inform decision makers of cost-effective interventions. However, economic evaluations of NBT have not yet been reviewed. The aim of this review was to uncover existing types and characteristics of economic evaluations in the field of nature-based therapeutic interventions. Methods: In this scoping review available knowledge about the topic was mapped. A comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Scopus; Cochrane; PSYCinfo; Web of Science) and grey literature was conducted in November 2021. Data was synthesised in a thematic presentation. Results: Three papers met the inclusion criteria, containing differences in design, types and dose of nature-based therapeutic interventions, outcome measures and target groups (n = 648). The papers showed tendencies toward a good treatment effect and positive economic effect in favour of NBT. Conclusions: Three different cohort studies have tried calculating the economic impact of NBT indicating a good effect of the NBT. The evidence on the economic benefits of NBT is still sparse though promising, bearing the limitations of the studies in mind. Economic evaluation of NBT is a new area needing more research, including high-quality research studies where the economic evaluation model is included/incorporated from the beginning of the study design. This will enhance the credibility and usefulness to policy makers and clinicians.
... It includes only studies that examined the effect of real outdoor nature (no virtual and indoor nature). Only seven articles compared nature-based mindfulness with similar interventions but without contact with nature [118,[126][127][128][129][130][131][132][133][134]. In three articles, the authors ask participants to "pay attention to purpose, in the present moment" (informal mindfulness) [126][127][128]. ...
... In three articles, the authors ask participants to "pay attention to purpose, in the present moment" (informal mindfulness) [126][127][128]. Two articles used horticultural therapy [130,131]. Shi et al. [129] used a mindfulness technique in which the subject focuses on his/her breathing and sensations while walking. Lymeus [118] used restoration skills training (ReST): weekly classes in a garden environment, with exercise instructions aimed to stimulate participants' effortless, restorative transactions with the environment through sensory exploration, and practice in curiosity and detachment. ...
Article
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In recent years, work-related stress has grown exponentially and the negative impact that this condition has on people’s health is considerable. The effects of work-related stress can be distinguished in those that affect workers (e.g., depression and anxiety) and those that affect the company (e.g., absenteeism and productivity). It is possible to distinguish two types of prevention interventions. Individual interventions aim at promoting coping and individual resilience strategies with the aim of modifying cognitive assessments of the potential stressor, thus reducing its negative impact on health. Mindfulness techniques have been found to be effective stress management tools that are also useful in dealing with stressful events in the workplace. Organizational interventions modify the risk factors connected to the context and content of the work. It was found that a restorative workplace (i.e., with natural elements) reduces stress and fatigue, improving work performance. Furthermore, practicing mindfulness in nature helps to improve the feeling of wellbeing and to relieve stress. In this paper, we review the role of mindfulness-based practices and of contact with nature in coping with stressful situations at work, and we propose a model of coping with work-related stress by using mindfulness in nature-based practices.
... One such purposeful nature-based activity is gardening. Favorable associations have been found not only between gardening activities and depression itself [34], but also factors related to depression risk such as stress [35] and social cohesion or interaction [36]. However, most studies that examine the relationship between gardening and depression either specifically target groups of gardeners [34,36] or specifically vulnerable groups of society, such as those already diagnosed with depression or other mental health disorders [37][38][39], people with disabilities [40,41], refugees [42] or the elderly [43,44]. ...
... However, most studies that examine the relationship between gardening and depression either specifically target groups of gardeners [34,36] or specifically vulnerable groups of society, such as those already diagnosed with depression or other mental health disorders [37][38][39], people with disabilities [40,41], refugees [42] or the elderly [43,44]. Often, studies involve interventions, such as horticultural therapy, that have defined treatment goals and are specifically designed to treat people with depression or other health issues [35,[37][38][39]44,45]. This is not the same as 'typical' gardening, which involves gardening in or around one's own home or in community or allotment gardens, usually without the structure of guided activities or intentional therapy. ...
Article
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As the world’s population becomes more urbanized, there is an associated decrease in nature exposure and a rise in noncommunicable diseases, including depression. Previous cross-sectional studies examining urban nature exposure and depression have reported favorable associations. However, many of these studies rely primarily on nature exposure metrics that measure the intensity of nature exposure, while other dimensions of urban nature exposure remain understudied. Therefore, in a cross-sectional, questionnaire-based case study targeting a general urban population (n = 282), we examined the relationship between two less commonly studied urban nature exposure variables (i.e., gardening behavior and greenspace visit frequency) and depression risk while also considering sociocultural background (multivariate logistic regression model). Results indicated that being a gardener was significantly associated with a reduced odds of being at risk of depression and that having a family migration history, but not a self-migration history, was associated with increased odds of being at risk of depression. In the examination of neighborhood socialization frequency and depression risk, we did not determine any significant association. The results of this study, therefore, highlight the importance of considering both people’s sociocultural backgrounds and urban nature exposure in more detail to help plan for and support healthier cities in the future.
... Sixteen studies were RCTs (Bail et al., 2018;Bay-Richter et al., 2012;Bielinis et al., 2021;Brown et al., 2014Brown et al., , 2020Calogiuri et al., 2016;Gidlow et al., 2016;Han et al., 2018;Martens et al., 2011;Müller-Riemenschneider et al., 2020;Ng et al., 2018;Olafsdottir et al., 2020;Song et al., 2015Song et al., , 2018Van Den Berg et al., 2011;Vujcic et al., 2017); eighteen studies (19 papers) were controlled studies (Bang et al., 2017;Barton et al., 2010;Berman et al., 2012;de Brito et al., 2019;Gerber et al., 2017;Hawkins et al., 2015;Holt et al., 2019;Johansson et al., 2011;Lanki et al., 2017;Lee et al., 2011Lee et al., , 2014Lucke et al., 2019;Lyu et al., 2019;Marselle et al., 2013;Oh et al., 2018;Sin-Ae et al., 2016, 2017Yao et al., 2017;Zeng et al., 2020); and sixteen studies were single group before and after designs (Bettmann et al., 2017;Coventry et al., 2019;Furuyashiki et al., 2019;Gonzalez et al., 2011;Hall et al., 2018;Iwata et al., 2016;Kling et al., 2018;Korpela et al., 2016;Mackay et al., 2010;Marselle et al., 2016;McCaffrey et al., 2016;Mourão et al., 2019;Warber et al., 2015;Wilson et al., 2011;Wood et al., 2016;Wyles et al., 2017). ...
... Participants with physical health problems, including long term conditions, were recruited in five studies (Bail et al., 2018;Brown et al., 2020;Hall et al., 2018;Song et al., 2015;Yao et al., 2017). Five studies recruited participants with common mental health problems (Barton et al., 2010;Bay-Richter et al., 2012;Berman et al., 2012;Korpela et al., 2016;Vujcic et al., 2017); four studies recruited participants with a mix of common mental health problems and serious mental illness (Bettmann et al., 2017;Coventry et al., 2019;Gonzalez et al., 2011;Wilson et al., 2011); and two studies exclusively recruited participants with serious mental illness (Iwata et al., 2016;Oh et al., 2018). ...
Article
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Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood −0.64 (95% CI: 1.05 to −0.23), reducing anxiety −0.94 (95% CI: 0.94 to −0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect −0.52 (95% CI: 0.77 to −0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.
... However, it should be noted that the effects of green spaces are not all the same for the provision of air purification; some green infrastructure could promote an increase of air pollutants [100]. In general, articles focused on the relationship between urban natural environments and public health found that urban green space had a positive effect on both physical and mental health as well as human wellbeing [1,81,[101][102][103][104][105], while Kabisch, et al. [106] found that the impact on children and on elderly health remain uncertain. A few studies discussed the importance of urban forest ecosystem management and put forward advantages and disadvantages of current management [26,77,107]. ...
... However, various conclusions about the impact of the urban forest and trees on air purification were found, and further mechanism studies are still needed to determine the specific effects of urban forest on air quality. As for social benefits, UF-NBS research often concerned the effect of urban green spaces on human health, especially on mental health improvement [1,81,[102][103][104]106,110]. Although human health and wellbeing has been widely investigated and discussed by researchers in UF-NBS studies, more attention should be paid to some special group of people; some current studies noticed the health of different age groups [104,106], while more studies are needed on different groups of gender and ethnicity, physical and mental condition, healthy people and those with underlying health problems and other factors. ...
Article
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As human living environments face increasing challenges with resilience, the concept of nature-based solutions (NBS) was proposed in recent years as a way to promote sustainable living in urban environments. Urban forests and trees play important roles in urban ecosystems, while their potential as an NBS is promising. A bibliometric analysis was first conducted to explore the research pattern of NBS in urban environments. Studies of urban forest and tree-based green infrastructure in NBS research were further investigated using a systematic literature review method. The initial studies on NBS have increased since 2015 with 493 documents published from 142 sources in over 70 countries and regions. Keyword analysis showed green infrastructure had a rather high frequency of utility and received considerable attention. As for urban forests as nature-based solutions (UF-NBS) research, the most prominent study approaches used at different scales and the main benefits and typologies of urban forest studied in the articles were identified. UF-NBS research is still relatively scarce at present. Despite the role of urban forest and trees in addressing environmental challenges being well recognized, UF-NBS studies still need to be conducted in a more comprehensive context, taking social and economic aspects into account.
... Connection with nature to recuperate from stress, depression, and anxiety can be beneficial (Kondo et al., 2015;Vujcic et al., 2017). Several studies have indicated that a residential areas' green space is significantly associated with residents' mental health (Victoria et al., 2018), with higher levels of green space exposure associated with better mental well-being (Berg et al., 2010;Boers et al., 2018;Bos et al., 2016;Gascon et al., 2018;Weimann et al., 2015). ...
... This kind of relationship, which also appears between tree cover and landscape preference (Jiang et al., 2014), might be a common aspect of the benefit of tree canopy to welfare. While the increase of psychological distress prevalence observed in the epidemic period could not be completely removed, it could be reduced by the antagonistic effects from tree canopy, which provides supporting evidence for the nature-based strategies to ameliorate the damage caused by public health stress events (Kondo et al., 2015;Vujcic et al., 2017). As the dose-response relationship was identified in the negative interaction effects, the inverse relationship progressively increased in low, medium, and high TCC levels. ...
Article
Background During the COVID-19 epidemic period, people showed a stronger connection to the environment within their communities. Although tree canopy in residential areas has been shown to positively affect psychological distress, it is not clear whether the COVID-19 epidemic played a role in this process. Elucidation of the relationship between tree canopy and the impact on psychological distress during the COVID-19 epidemic could provide valuable information as to the best methods to help individuals cope with urban mental stress events. Methods A total of 15 randomly selected residential areas of Beijing were enrolled in this repeated cross-sectional study. A total of 900 residents were included in the two-waves of the investigation (450 residents per wave) before and during the COVID-19 epidemic (i.e., May 2019 and May 2020). Psychological distress was estimated using the 12-question General Health Questionnaire (GHQ-12). Tree canopy coverage (TCC) was measured through visual interpretation based on the 2013 data sources (World View 2 satellite imagery of Beijing urban areas with a resolution of 0.5 m). The demographic characteristics, distance to the nearest surrounding green or blue space, residential area house price, household density, and construction year were also collected in this study. A multivariate logistic regression, relative risk due to interaction (RERI), and synergy index (SI) were used to explore the relationships among tree canopy, COVID-19, and psychological distress. Results The negative impact of the COVID-19 epidemic on mental health was significant, with the prevalence of psychological distress increased 7.84 times (aOR = 7.84, 95% CI = 4.67–13.95) during the COVID-19 epidemic period. Tree canopy coverage in the group without psychological distress was significantly higher than that of the psychologically distressed group (31.07 ± 11.38% vs. 27.87 ± 12.97%, P = 0.005). An increase in 1% of TCC, was related to a 5% decrease in the prevalence of psychological distress (aOR = 0.95, 95% CI = 0.93–0.98). An antagonism joint action between tree canopy and the COVID-19 epidemic existed (RERI = 1.09, 95% CI = 0.72–1.47; SI = 0.16, 95% CI = 0.05–0.52), and persisted enhancing only in medium (26.45%–33.21%) and above TCC level. Correlation of GHQ items and TCC significantly differed between the COVID-19 non-epidemic and epidemic periods, with the effects of tree canopy on GHQ-12 items covering topics, such as social function and depression, presumably absent because of epidemic limitations. Conclusions This study indicates that the COVID-19 epidemic harmed mental health and verified the positive effects of residential tree canopy on psychological distress in Beijing. We suggest paying more attention to residents in areas of low TCC and dealing with psychological distress caused by public health stress events based on tree canopy strategies.
... A NBI is described as an activity or process aimed to engage people in natural settings such as parks, forests, mountains, beaches, gardens, and savannas, with the goal of improving health-related outcomes for persons across the lifespan [18,[21][22][23]. NBIs (including GSIs) are usually intended to increase the level of exposure to, or contact with, the natural environment [21,22,24]. GSIs generate a multitude of health benefits along multiple pathways [24] through a variety of potential mechanisms [25]. ...
... NBIs (including GSIs) are usually intended to increase the level of exposure to, or contact with, the natural environment [21,22,24]. GSIs generate a multitude of health benefits along multiple pathways [24] through a variety of potential mechanisms [25]. While the term greenspace is applied inconsistently across various disciplines, in the context of this review greenspace is most defined as inclusive of outdoor environs with some form of vegetation such as forests, gardens, prairies, woodlands, with "green" foliage as distinct from savannas, i.e., brown-spaces, or bodies of water, i.e., blue-spaces [26]. ...
Article
Full-text available
Background: Engaging with nature can profoundly impact psychological and physiological health of persons across the lifespan. Greenspace interventions (GSI) encompass a broad range of strategic, nature-based activities for overall health and wellbeing. Within the past 20 years there has been a growing interest in the access to and management of greenspace to mediate the deleterious impact of acute and chronic stress, particularly, physiologic biomarkers of stress such as cortisol. Objective: This review aims to describe the impact of greenspace interventions on cortisol, to present the current state of the science on GSIs as they impact cortisol, and to uncover any limitations of current research strategies to best inform future research. Methods: A scoping methodology was conducted to systematically study this emerging field and inform future research by mapping the literature based on the GSI category, interventional design, cortisol metrics, and subsequent analysis of cortisol. Conclusion: Considerable heterogeneity in research design, aim(s), interventional strategy, and cortisol metrics were identified from a total of 18 studies on GSIs and cortisol outcomes. While studies demonstrated a potential for the positive association between GSIs and stress relief, more rigorous research is needed to represent GSIs as an intervention to mitigate risks of stress.
... The independent variable was the frequency of participation in the types of horticultural activities. The horticultural activities can be generalized into four types based on previous studies [5,[10][11][12] and horticultural therapy [1,2,[6][7][8][9][19][20][21][22][23][24][25][26][27][28]. These include indoor plant activities, outdoor plant activities, arts/crafts activities, and excursions. ...
Article
Full-text available
The purpose of this study was to explore the effect of the frequency of participation in horticultural activity types on psychological well-being and fruit and vegetable intake. The study sought to understand the mediating effect of psychological well-being between the frequency of types of horticultural activities and the frequency of fruit and vegetable intake. Convenience sampling was used to collect 400 valid data through a self-administered questionnaire that inquired about the frequency of four horticultural activity types (indoor plant activities, outdoor plant activities, arts/crafts activities, and excursions), the measure of psychological well-being, and the frequency of fruit and vegetable intake. The results showed that a higher frequency of indoor and outdoor plant activity positively affected psychological well-being. Psychological well-being played a partial mediation role between indoor plant activity and vegetable and fruit intake and a full mediation role between outdoor plant activity and vegetable and fruit intake. The plant-related arts/crafts activities and excursions were not associated with psychological well-being or vegetable and fruit intake.
... They did not ruminate less. • A four-week gardening-based therapy intervention for adult patients with anxiety and depression found significant overall reductions in stress compared to patients in a control art-therapy intervention, and significant reductions in anxiety symptoms in men, though not in women (Vujcic et al. 2017). ...
... Oportunități economice și locuri de muncă în economia verde -promovarea practicilor de ecoturism în zonele naturale SEA permite evaluarea impacturilor generate asupra factorilor de mediu indicate în legislația specifică, însă este necesară promovarea acțiunilor focalizate și pe aspectele actuale aferente dezvoltării sustenabile precum reziliență climatică, regenerare urbană sau planificare și guvernare participativă (Comisia Europeană, 2015). În acest mod, măsurile privind protecția mediului propuse trebuie să implice menținerea și îmbunătățirea calității ecologice, favorizarea stării pozitive de sănătate a populației și utilizarea rațională a resurselor naturale (Vujcic et al., 2017). ...
... Exploring nature and engaging with green space is now linked with health and well-being benefits Pritchard et al., 2020;Roslund et al., 2020;van den Bosch & Sang, 2017). For urban residents, parks (Razani et al., 2018), nature reserves (Bell et al., 2018), street trees (Guo et al., 2020) and gardens (Bitterman & Simonov, 2017;Vujcic et al., 2017) are important locations to relax, find restoration from stress, engage with physical activity and help restore a sense of balance in one's life (Tidball et al., 2019). Such aspects may help offset more serious mental and physiological health problems (Engemann et al., 2019). ...
Article
Full-text available
Domestic (home) gardens provide opportunities for psychological and physical health benefits, yet these environments have received less attention in terms of their therapeutic value compared to other urban green spaces. This is despite their ubiquity and the popularity of gardening as a pastime. This research explored why residents engaged with gardening and the extent to which they recognised any health benefits from the activity. A questionnaire was distributed electronically within the UK, with 5766 gardeners and 249 non-gardeners responding. Data were collated on factors including garden typology, frequency of gardening and individual perceptions of health and well-being. Significant associations were found between improvements in well-being, perceived stress and physical activity and more frequent gardening. Gardening on a frequent basis i.e. at least 2–3 times a week, corresponded with greatest perceived health benefits. Improving health, however, was not the prime motivator to garden, but rather the direct pleasure gardening brought to the participants. There was evidence that satisfaction with one's front garden and the time spent in it increased as the proportion of vegetation was enhanced. The data supports the notion that domestic gardens should be given greater prominence in urban planning debates, due to the role they play in providing health benefits.
... The contribution of activities and events in the neighbourhood park can create an opportunity for health and the environment. For example, spending time and performing horticulture in designed urban green environments can improve mental health (Vujcic et al., 2017). Besides, a well-maintained tree canopy as shelter, giving an excellent feeling to mental health (Astell-Burt & Feng, 2020) as 46.7% of respondents 'extremely satisfied' with this landscape feature in the park. ...
Conference Paper
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This study aims to investigate users' thoughts and experiences concerning the stress in a neighbourhood park in Petaling Jaya. A questionnaire survey is distributed to the park users’ to identify their stress level and response to the neighbourhood park’s current condition. The findings involved the relationship between a neighbourhood park and stress survey and stress score with park features. As a recommendation, a comparison between two different case studies in terms of geographic and demographic factors may lead to more findings in future studies in assisting the development of the neighbourhood park and promoting healthy lifestyles in reducing stress. Keywords: Neighbourhood park; stress; preliminary study eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA CE-Bs by E-International Publishing House, Ltd., UK. This is an open-access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i16.2683
... From parks to community gardens, nature has long been seen as an important part of the urban landscape. There is now a growing interest in the potential of nature-based solutions in cities globally to enable resilience to climate change and meet sustainable development goals (Bulkeley and Davis, 2020;Kabisch et al., 2016;Frantzeskaki et al., 2019;Wild et al., 2020), while the benefits of urban nature to human health and well-being are increasingly acknowledged (Cohen-Shacham et al., 2016;Van den Bosch and Sang, 2017;Vujcic et al., 2017). Cities can therefore play an important role not only in conserving and restoring nature, but also in ensuring that society can thrive with nature (Xie and Bulkeley, 2020). ...
Technical Report
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When it comes to ensuring a new deal for nature and people, cities have much to offer. Urban development and urban life are crucial in determining the nature and extent of biodiversity loss as well as shaping how the majority of the world’s population lives with nature. By restoring, conserving and thriving with nature, cities also have much to gain — from addressing climate change to improving the health and well-being of their communities. In 2021, negotiations in the context of the UN Convention on Biological Diversity (CBD) will resume to decide on biodiversity action over the next decade at the 15th Conference of the Parties to the CBD, in Kunming (China). Now is the critical moment to seize the opportunity for embedding an urban perspective throughout the post-2020 Global Biodiversity Framework. This policy brief describes the crucial role cities hold for realising global goals for nature. Whether or not the global community is able to achieve its goals for biodiversity over the next three decades will critically depend on how both the threats and opportunities of living on an urban planet are addressed. Advancing transformative change for biodiversity will require municipal authorities and a range of other urban actors to mainstream action on both the direct and indirect drivers of biodiversity loss — from land-use change to sustainable production and consumption — while ensuring that the value of nature and its contribution to people and society is widely recognised across urban communities. In this policy brief, we set out how we can harness the urban opportunity in the post-2020 Global Biodiversity Framework (GBF).
... Among socio-economic factors related to NBSs, the age factor was extensively analysed [4], the gender issues, however, have not been so far thoroughly investigated in relation to the NBS term. Existing examples relate only to the selected topics such as perceived values [19] and health benefits [20]. Research conducted so far has related mainly to the gender nature of ecosystem services (ES) [21] and showed that the gender impact is not universal in nature and strongly differs across geographic and temporal scales [18]. ...
Article
Full-text available
The term nature-based solutions (NBSs) is understood as a multidisciplinary umbrella concept that includes aspects such as green/blue infrastructure and urban gardens and forests. However , the important question here is what features of ecosystem-based approaches are essential for them to be considered nature-based? This study aims to answer this question by analysing the potential of allotment gardens (AGs) to be considered as NBSs. To do so, the possibilities and obstacles regarding a Polish case study were analysed based on the following six research questions: (1) How do AGs use blue and green infrastructure? (2) What problem(s) do AGs solve today? (3) What kind of benefits do AGs provide? (4) Do AGs possess implementation and management capabilities? (5) Can AGs be treated as economically efficient? (6) What are the advantages of AGs versus other possible solution(s)? With regards to obstacles, the study has identified: institutional barriers, irregular distribution of benefits, and deficiencies in economic efficiency. Nevertheless, AGs together with other historical urban green/blue infrastructure may be regarded as a kind of unsophisticated NBS, the effectiveness of which is limited. These solutions may be created as independent structures or (historical) green/blue infrastructure may be enlarged, fitted out, linked, and improved to implement NBS projects.
... There is widespread research which shows green spaces have positive effects on human health and well-being (Özgüner and Kendle, 2006;Van Meter, 2019;Deng et al., 2020;Pálsdóttir et al., 2020), including improving the mood, reducing the stress, and preventing chronic illnesses (Rugel, 2015;Buck, 2016;Vujcic et al., 2016Vujcic et al., , 2017Sugiyama et al., 2018). Since hospitals are special environments and considered as stressful places due to the inconvenient health conditions of the patients (Essa and Jabbari, 2020), green spaces of the hospitals are considered as necessary and beneficial to mitigate these difficult conditions to the patients (Ulrich, 1991;Whitehouse et al., 2001); and considered as significantly important on health factors of the patients (Shah Hosseini, 2013), for example, can reduce stresses, and improve their physical and neuropsychological health (Allahyar and Kazemi, 2020). ...
Article
Hospital green spaces are important for the well-being and health of patients, especially in children’ hospitals, because children are usually more sensitive than other groups of the society. Therefore, knowledge of users’ preferences about the landscape design of the hospitals is important to maximize the benefits of green spaces and achieve the desired spaces. This research aimed to examine the views and preferences of the children and therapists on the effective factors in the landscape design of a children's hospital considering the age and spirits of the children during their treatment period. To pursue this aim, 60 sick children, and 60 hospital staff (therapists) evaluated 84 simulated images and responded to the questionnaires. The results showed that there were no significant differences between children’s and therapists’ preferences on the landscape of a children’s hospital. Both respondent groups preferred warm colors. Also, among the types of topiary, design styles, and types of space design, the children preferred animal shapes and cartoon characters, combinations of flowers and turf grasses in planting beds, combinations of water fountains with flower beds instead of water fountains alone. They also preferred weeping-form trees and combined furniture forms with plants. This research showed that therapists can be good representatives for obtaining children's preferences about the landscape design factors. Also, they can be used in such children’s preference studies when a direct assessment of the children’s preferences is less possible. Therefore, these results could help architects and designers to provide better-suited hospital landscapes for children.
... 7 More studies have been done to determine the prevalence of depression, anxiety, and stress (DASS) in patients with diabetes. 2,[8][9][10] Adverse socioeconomic circumstances early in life increase the risk of diabetes mellitus and late-life cognitive disorders. 11 DM often appears as a co-morbidity of a more psychiatric illnesses, complicating its outcome. ...
Article
Introduction: People with diabetes mellitus (DM) may have concurrent mental health disorders and have been shown to have poorer disease outcomes. Objective: The aim of this study to determine the prevalence of DASS in patients with diabetes mellitus without mental disorders, aged 20 years or more, in primary health care, and to determine any association between DASS and patients' sociodemographic and clinical attributes. Methods: This was a cross-sectional study conducted in a primary health care center, in the department of general practice. Patients with DM who visited the doctor and agreed to fill in the questionnaire were included in the study. Data were collected using the questionnaire DASS-21. Descriptive statistics, the Pearson chi-square test, and logistic regression analysis were used to analyze the data. Results: Out of a total of 102 respondents with DM, 29 (28.4%) had some form of psychological symptoms. The prevalence of DASS was 16.7%, 16.6%, and 23.5%, respectively. There was no significant difference between sociodemographic variables according to stress status. Respondents aged 40-49 years more often showed emotional states of depression and anxiety. There was a significant association between emotional status of DASS and HbA1c values. Logistic regression analysis indicated that age (OR=2.57, 95% CI: 1.59-4.13) was a predictor of depression and anxiety. Conclusion: Unpleasant emotional states DASS are common in patients with DM, depression (16.7%), anxiety (16.6%), and stress (23.5%). Age is the strongest predictor of DASS status. The screening and monitoring of unpleasant emotional states in people with diabetes should be performed from a young age.
... Within nature-based therapy, considerable evidence suggests the restorative effects of natural scenery and its associated link with lowered negative emotions and improved positive feelings [36]. The Edge of the Present, comprised of seven differing landscapes-from the snow-covered mountains to the tropical rainforest-achieved a high level of "presence" (known as "communicative realism" [18]) as referred to in a VR setting, whereby participants were heavily immersed in a virtual environment, which could change before them with longer engagement times (e.g., snow falling from the ceiling, grass growing at their feet). ...
Article
Full-text available
Depression and suicidality are characterized by negative imagery as well as impoverished positive imagery. Although some evidence exists supporting the link between positive imagery and enhanced mood, much work needs to be done. This study explored the impact of an immersive virtual reality experience (Edge of the Present—EOTP) on an individual’s mood, state of well-being, and future thinking. Using a 10-min mixed reality experience, 79 individuals explored virtual landscapes within a purposefully built, physical room. A pre and post survey containing mental health measures were administered to each participant. An optional interview following the virtual work was also conducted. The results indicated that positive mood and well-being increased significantly post-intervention. Hopelessness scores and negative mood decreased, whilst sense of presence was very high. This pilot study is among the first to assess the feasibility of a mixed reality experience as a potential platform for depression and suicide prevention by increasing well-being and mood as well as decreasing hopelessness symptoms.
... Within the context of the IPBES framework (Díaz et al., 2018), this means that bird species richness may also provide non-material NCP to human well-being on a continental level. This information may turn out to be crucial for evidence-based policy decisions regarding environmental management (Adams and Morse, 2019) and nature-based solutions to improve human health and well-being (Cariñanos et al., 2017;Marando et al., 2016;Vujcic et al., 2017). Future research needs to further investigate and confirm the causal links of this observed relationship and explore the mechanisms involved including positive emotions, attention restoration and stress reduction (Aerts et al., 2018;Irvine et al., 2019; or the possibility that, on a large spatial scale, bird species richness might simply be a proxy for beneficial landscape properties (e.g. ...
Article
Full-text available
Nature affects human well-being in multiple ways. However, the association between species diversity and human well-being at larger spatial scales remains largely unexplored. Here, we examine the relationship between species diversity and human well-being at the continental scale, while controlling for other known drivers of well-being. We related socioeconomic data from more than 26,000 European citizens across 26 countries with macroecological data on species diversity and nature characteristics for Europe. Human well-being was measured as self-reported life-satisfaction and species diversity as the species richness of several taxonomic groups (e.g. birds, mammals and trees). Our results show that bird species richness is positively associated with life-satisfaction across Europe. We found a relatively strong relationship, indicating that the effect of bird species richness on life-satisfaction may be of similar magnitude to that of income. We discuss two, non-exclusive pathways for this relationship: the direct multisensory experience of birds, and beneficial landscape properties which promote both bird diversity and people's well-being. Based on these results, this study argues that management actions for the protection of birds and the landscapes that support them would benefit humans. We suggest that political and societal decision-making should consider the critical role of species diversity for human well-being.
... This pathway focuses on how prioritising health and well-being in nature-based solutions will further social inclusion. There is a growing body of evidence that 'when contact with nature is combined with physical activity, social connection, living together, and adventure' we can create a range of interventions and initiatives that are 'effective, accessible and affordable in many urban contexts' (Pryor et al. 2006:122; see also van den Bosch and Sang, 2017;Vujcic et al. 2017). Public health strategies that focus on the social and environmental aspects of human health are seen as key (Chu and Simpson, 1994) yet as our example below shows social inclusion as a way of achieving health and well-being can also be instigated and achieved by communities themselves. ...
Research
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Greater understanding of social inclusion is vital to decision making about mainstreaming nature-based solutions. Social inclusion in this context means understanding how vulnerable, marginalised and under-represented voices are included (rather than excluded) in processes and practices to mainstream nature-based solutions. Central to this, is an examination of the specific ways that power is exerted and re-configured to produce and exchange knowledge and extend or create networks when mainstreaming nature-based solutions. Although nature-based solutions and social inclusion are usually addressed separately, there are a myriad of connections between them. Drawing on extensive research on the opportunities and pathways for mainstreaming nature-based solutions in six countries in Europe and at EU level, this report identifies four pathways to mainstream nature-based solutions for social inclusion.
... For example, Wende et al. (2012) reveal that the reduction targets are not integrated through the SEA and highlight the need to develop more concrete action guidelines for the methodological implementation of climate change impacts in the SEA process. Thus, protection measures must seek to improve ecological quality, support for public well-being and the rational use of natural resources (Therivel et al., 2009;Vujcic et al., 2017). ...
Article
Urban areas represent the central point of sustainability initiatives which drive significant changes in cities’ planning, design and management. Given that urban areas are subject to continuous change, efficient and integrated planning and policy strategies are needed to address their complex challenges. This is why the Strategic Environmental Assessment (SEA) plays an essential role in urban planning considering the optimal investment alternatives along with the environmental protection measures. Given that the SEA process considers all impacts on social, economic, institutional and environmental factors, this process must be managed as an adaptive process. Our analysis proposes an evaluation protocol to address sustainability on its economic-environmental-social-institutional dimensions in the evaluation of environmental permits. The evaluation protocol comprised 43 items grouped into three categories (“general presentation”, “sustainability related aspects within the protection measures” and “the strength of the protection measures”). Our analysis, focused on the urban areas from Romania as case study, shows that the environmental permits address sustainability slightly below average. The environmental and institutional dimensions of sustainability achieved the highest scores while those of the economic and social dimensions were quite the opposite. This proved to be helpful in recognizing the strengths and weaknesses of such regulatory documents in terms of their environmental, social, economic and institutional sustainability. Our study contributes to the international literature given that no studies have been elaborated on the evaluation of environmental permits using an evaluation protocol.
... Though gardening has been associated with therapeutic benefits since the 1800s (Clatworthy et al., 2013), recent research has acknowledged the importance of gardens and plants for physical, mental and social wellbeing (e.g. Hall & Knuth, 2019;Keniger et al., 2013;Vujcic et al., 2017). Cultivating this connection forms an integral part of Candide Ltd, a software company based in Bristol (UK), which provides digital solutions for professional and consumer gardening audiences. ...
Article
Full-text available
Botanic gardens and related institutions are positioned as centres of expertise in plant biodiversity and conservation. Together with its collection policy and overall mission, the structured documentation of a garden’s collection of plant material characterises an institution as a botanic garden. However, the currently available tools and processes are not cost-effective or accessible at a global level, nor do they provide the necessary efficiency for the needs and workflows of botanic gardens and plant collection management. In the context of visitation of these gardens, there is also a well-established disconnection between people and plants that many institutions have previously attempted to address through engaging interpretation. Several innovative initiatives towards tackling these challenges are presented here. The paper explains Candide’s application of machine learning in the automatic identification of plants and digital engagement through smartphones to aid visitor experience (including tools such as augmented reality). It goes on to explore the documentation of quality plant records data for collections, and how advancements in Botanical Software’s new collection management system can play a major role in the efforts of the botanic garden community. The ongoing developments in technology available to botanic garden staff and their visitors present positive contributions towards both tackling global challenges associated with plant conservation and engaging diverse audiences in the fascinating kingdom of plants.
... Szereg badań wskazuje na związek między kontaktem z naturą a utrzymaniem i poprawą zdrowia psychicznego populacji (Bratman et al., 2019(Bratman et al., , 2012Chang et al., 2020;Hartig et al., 2014;MacKerron i Mourato, 2013;Roe et al., 2013;Tillmann et al., 2018;Twohig-Bennett i Jones, 2018;Vujcic et al., 2017). W szczególności coraz więcej prac sugeruje, że kontakt z naturą jest czynnikiem protekcyjnym w przewlekłych zaburzeniach psychicznych -psychotycznych (Boers et al., 2018;Ebisch, 2020;Engemann et al., 2018Engemann et al., , 2019Engemann et al., , 2020 czy depresyjnych (Sarkar et al., 2018). ...
Article
Full-text available
In recent years, there has been a major shift towards bringing nature-based interventions (green therapy) into the mainstream of activities improving the psychological well-being of the population. Various interventions generally based on practising mindfulness in nature and training in psychosocial skills are also increasingly integrated into psychiatric rehabilitation. In Poland, the most commonly used therapeutic intervention involving contact with nature has traditionally been horticultural therapy (also known as social and therapeutic horticulture). A variety of therapeutic methods with an established status in other European countries, for example mountain hiking, forest bathing/shinrin-yoku, wilderness therapy, outdoor therapy or adventure therapy, are not sufficiently well-known in Poland. A specific type of therapeutic intervention based on contact with nature is therapy in the mountain setting, which taps into the potential of interventions based on mindfulness, climate therapy, and occupational therapy. The paper outlines the principles of organisation, therapeutic factors, and conditions determining the effectiveness of therapeutic mountain hiking, also known as mountain therapy or psychosocial mountain therapy. In addition, the paper aims to provide an overview of the tasks facing the therapist/guide. Mountain therapy has a strictly defined therapeutic goal which is pursued in a specific mountain environment. It is important to highlight that the effectiveness of therapeutic methods and the plan of the mountain hike are supported by sufficiently strong empirical evidence. The authors propose their own therapy programme in a mountain environment, complete with the preconditions and consecutive stages of the therapeutic process. Multiple research-documented benefits of the mountain setting in psychiatric rehabilitation may convince specialists to incorporate this therapeutic modality more widely into their practice, especially in the context of restrictions related to the current epidemiological situation.
... Whereas, Lee et al. (2011) (N = 12) demonstrated that exposure to a forest setting compared to an urban environment significantly increased the intensity of positive mood and decreased negative feelings. Nature immersion benefits have been found to include negative affect and stress reduction, reduced anxiety, increases in positive emotions, attention restoration, increased creativity, and reduced mortality (Cox et al., 2017;Mitchell & Popham, 2008;Vujcic et al., 2017;Wang et al., 2016;Williams et al., 2018). ...
Article
Immersion in nature provides various psychological benefits to well-being. Recent research examines whether these benefits can be replicated in virtual reality (VR). This study aimed to systematically review the literature on the psychological effects on well-being of virtual immersion in nature. Databases searched included Scopus, EBSCO, Web of Science, Psychnet, and Pubmed with inclusion of peer reviewed articles published in English, between 2015 and 2020 (inclusive to July 2020), in which the research design includes VR-based immersion in nature. A total of 21 quantitative studies were identified. Within these articles, most employed quantitative research methodologies within an experimental design. In regard to psychological well-being, some evidence suggests that virtual immersion in nature significantly decreases negative affect. Conversely, other research found no change or an increase in negative affect. Generally, no significant differences were noted for positive affect. Physiological indicators of stress responses to virtual immersion in nature varied. Overall, research exploring the use of virtual reality immersion in nature is limited and the replication of the potential benefits gained from real immersion in nature is poorly understood. Future research is required to advance understanding and knowledge of the outcomes of virtual immersion in nature on human well-being.
... For instance, patients with dementia, depression, or cardiac rehabilitation showed twice the effect size compared to studies with non-patients [45]. Men also showed greater changes in anxiety than women [47]. However, most previous studies had a small sample size and failed to include multiple subgroups. ...
Article
Full-text available
Although many people affected by COVID-19 suffer from some form of psychological distress, access to proper treatment or psychosocial interventions has been limited. This study aimed to examine the feasibility and preliminary effects of a therapeutic gardening program conducted during the COVID-19 pandemic. The program consisted of 30 sessions and was conducted at 10 nationwide sites in Korea from June to November 2021. Mental health and well-being were assessed using the Mental Health Screening Tool for Depressive Disorders, Mental Health Screening Tool for Anxiety Disorders, Engagement in Daily Activity Scale, brief version of World Health Organization Quality of Life, and Mindful Attention Awareness Scale. Cohen’s d value was calculated for the effect size, and a multilevel analysis was used to determine the longitudinal effects of therapeutic gardening. The effect sizes for depression, anxiety, daily activities, quality of life, and mindfulness were 0.84, 0.72, 0.61, 0.64, and 0.40, respectively. Multilevel analyses showed that all five mental health variables improved significantly over time as the therapeutic gardening program progressed. Therapeutic gardening is promising and applicable as a nature-based intervention to improve the mental health of individuals experiencing psychological distress especially in the COVID-19 pandemic.
... Third, according to attention restoration theory (ART), NBSs of eco-friendly hotels play an essential role in inducing satisfaction and eco-friendly behavioral intentions with a positive effect on customer MH and WB [8,9,[21][22][23][24][25]. ART is a concept of the psychological recovery effect natural spaces provide to humans [20]. ...
Article
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In this study, value-belief-norm (VBN) theory and the social exchange theory (SET) were applied to predict hotel customers’ pro-environmental responsibility behavior intention (PRBI) for the characteristics of NBSs in green hotels—specifically, to investigate the relationship between NBSs as green hotel and PRBI, and to test its mediating effect on pro-environmental perceived (PPV), pro-environmental perceived belief (PPVBE), personal pro-environmental norms (PPN), attitude toward environmental behavior (ATEB), mental health (MH), well-being (WB), and satisfaction (SA) and the moderating effect of locations (urban, rural) among these variables toward pro-environmental responsibility behavior intention (PRBI). Data were collected using a survey of 440 customers who had visited green hotels in the Republic of Korea within the last 12 months. We used to test the research hypotheses by structural equation modeling (SEM). The findings generally supported the hypothesized associations between variables within our proposed theoretical framework and confirmed the moderating effect of location. The study’s results have important theoretical and practical implications for the environment. We investigated the relationship between the characteristics of NBSs and PRBI of green hotels, and we investigated the relationship between psychological state, attitude, and behavior of green hotel customers by applying variables suitable for ART, SET, and VBN. In addition, we verified the moderating effect of customers’ green behavior and attitudes toward green hotels located in urban and rural areas. Moreover, these findings herein may encourage green hotels to participate in preventing environmental problems. It provides primary data on customers’ perception of ecofriendliness in establishing corporate management strategies.
... Restorative settings elicit pleasant moods, engage people's attention without causing them to become stressed, and help individuals achieve a rapid recovery [29]. It is believed that human beings have a widespread innate bond with nature, and such a connection can have several benefits to their health [30,31]. Cutting-edge theories, including Ulrich's "Stress Recovery Theory" [32][33][34], shed light on the power of natural scenes in reducing stress. ...
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... City lifestyles contribute to a decrease in contact with nature due to more screen-time and less opportunities to interact with green spaces [6]. Therefore, more frequent contact with nature was recommended as a NBS to improve mental health and well-being for psychiatry patients [7]. Ordinary city dwellers, e.g., customers and travelers, share a common chance to perceive distresses and suffer bad moods. ...
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Green and blue spaces are nature-based solutions (NBSs) that evoke positive emotions of experiencers therein. There is an impetus to optimize wetland forest landscapes by planning the geographical arrangement of metrics that promote positive emotion. The facial expressions of nature experiencers in photos, downloaded from social media databases with landscape metrics, were evaluated for emotions and given scores. Happy and sad scores were rated by FireFACE v1.0 software and positive response index (PRI) was calculated as happy score minus sad score. Spatial areas and tree height were evaluated from Landsat 8 images and digital model maps, respectively. Visitors at middle and senior ages smiled more frequently in southern parts than in northern parts, and females had higher happy scores and PRI than males. Both green- and blue-space areas had positive relationships with PRI scores, while blue spaces and their area to park area ratios had positive contributions to happy scores and PRI scores in multivariate linear regression models. Elevation had a negative relationship with positive facial emotion. Overall, based on spatial distributions of blue-space area and elevation, regional landscape was optimized so people perceived more happiness in wetlands around Zhejiang and Shanghai, while people in wetlands of Jiangxi and Hubei showed more net emotional expressions.
... Considerable research demonstrated that contact with nature and green spaces can have various positive effects on human health (Allahyar and Kazemi, 2020;Deng et al., 2020;Pálsdóttir et al., 2020;Maas et al., 2006;Rugel, 2015;Sugiyama et al., 2018;Vujcic et al., 2017) and well-being (Bertram and Rehdanz, 2015;Campagnaro et al., 2020;Deng et al., 2020). Research has shown that even a few minutes of contact with nature has psychological benefits. ...
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The environmental design of built spaces can have neuro-psychological effects on humans. The design of hospital environments, especially for children, is probably more important than the other spaces because children are mentally more vulnerable than other social groups. This research aimed to examine the children's and therapists' views and perceptions on the effect of a children's hospital's landscape design elements to improve their neuropsychological health during their treatment period. Sixty sick children and 60 hospital staff (therapists) evaluated landscape images and responded to a questionnaire. Both respondent groups believed in the positive effects of landscape elements on all children's neuropsychological indices, including the increased emotional index, increased cognitive index, and reduced non-symptoms index. Both respondent groups firstly preferred children's features and secondly, water features. These preferences positively affected many neuropsychological indices of sick children. However, children chose water features as their priority, which positively affected sick children's relaxation. However, this view was not consistent with their therapists' views. The children and their therapists were also not in agreement on the impact of other landscape elements (trees, flowers, ground cover plants, turfgrasses, and mulch) on many neuropsychological indices of sick children. Therefore, based on this research, children's therapists cannot be good representatives for their psychological perceptions about the hospital's landscape elements when a direct assessment of children's perceptions is almost impossible. This research has practical recommendations for landscape professionals around the world on the sustainable design of therapeutic landscapes.
... Uhich [8] studied architectural spaces with and without vegetation and noted that people have positive physiological and psychological responses to environments with vegetation. Green space improves the physical and mental health of residents, who benefit via increased attention, reduced stress and anxiety, fatigue recovery, improved mood levels and increased well-being [9][10][11]. Peter [12] demonstrated in a walking experiment that green space is an environment that improves emotions and that people who enter a green space experience lower frustration and higher engagement and excitement. ...
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Citation: Zeng, C.; Lin, W.; Li, N.; Wen, Y.; Wang, Y.; Jiang, W.; Zhang, J.; Zhong, H.; Chen, X.; Luo, W.; et al. Electroencephalography (EEG)-Based Neural Emotional Response to the Vegetation Density and Integrated Sound Environment in a Green Space. Forests 2021, 12, 1380. https:// Abstract: Emotion plays an important role in physical and mental health. Green space is an environment conducive to physical and mental recovery and influences human emotions through visual and auditory stimulation. Both the visual environment and sound environment of a green space are important factors affecting its quality. Most of the previous relevant studies have focused solely on the visual or sound environment of green spaces and its impacts. This study focused on the combination of vegetation density (VD) and integrated sound environment (ISE) based on neural emotional evaluation criteria. VD was used as the visual variable, with three levels: high (H), moderate (M) and low (L). ISE was used as the sound variable, with four levels: low-decibel natural and low-decibel artificial sounds (LL), low-decibel natural and high-decibel artificial sounds (LH), high-decibel natural and low-decibel artificial sounds (HL) and high-decibel natural and high-decibel artificial sounds (HH). These two variables were combined into 12 unique groups. A total of 360 volunteer college students were recruited and randomly assigned to the 12 groups (N = 30). All 12 groups underwent the same 5 min high-pressure learning task (pretest baseline), followed by a 5 min audiovisual recovery (posttest). Six indicators of neural emotion (engagement, excitement, focus, interest, relaxation and stress) were dynamically measured by an Emotiv EPOC X device during the pretest and posttest. Analysis of covariance was used to determine the main and coupled effects of the variables. (1) VD and ISE have significant effects on human neural emotions. In moderate-and high-VD spaces, artificial sound levels may have a positive effect on excitement. (2) A higher VD is more likely to result in excitatory neural emotion expression. (3) Low-VD and high-VD spaces have a higher degree of visual continuity. Both extremely low and extremely high VDs result in a higher expression of stressful emotions than observed for a moderate VD. (4) High-decibel artificial sounds are more likely to attract attention, possibly because artificial sounds are easier to recognize than natural sounds. However, when both the natural and artificial sounds are low, it is difficult to induce higher tones, and the lower the artificial sound decibel level, the easier it is to relax. Additionally, under the influence of an ISE, attention recovery and stress recovery may be negatively correlated. The results show that an appropriate combination of VD and ISE can improve the health benefits of a green space and thus the well-being of visitors.
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Exposure to urban greenspaces promotes an array of mental health benefits. Understanding these benefits is of paramount importance, particularly in low- and middle-income countries (LMICs), where cities are expanding at an unprecedented rate. However, the existing evidence-base for the health benefits of greenspaces has a strong bias towards high-income countries. Here we systematically assess the emerging evidence regarding the mental health benefits provided by urban greenspaces in LMICs. We carried out a scoping review to assess the extent, type and quality of evidence investigating the relationship between greenspaces and mental health in LMICs. We systematically searched the literature databases Web of Science, Medline, Embase and CAB Abstracts using key terms related to greenspaces and mental health in LMICs. We analysed the resulting studies using a narrative synthesis approach, taking into account study quality, to assess the overall effects on mental health. 36 studies met the inclusion criteria and were included in the narrative synthesis. Studies were heterogeneous in design, study population, greenspace and mental health assessment. While more than 90% of LMICs remain unstudied, we found that eight out of ten studies using validated mental health screening tools detected positive associations between greenspaces and one or more mental health outcomes. These studies mostly took place in upper-middle-income countries. However, there still is a lack of evidence from regions with the highest levels of urbanisation, and only four studies assessed lower-middle and low-income countries. Furthermore, the analysis of mediating and moderating factors indicates that the relationship between greenspaces and mental health in LMICs is context dependent and needs to be assessed in relation to locally relevant environmental and cultural settings. Based on the evidence reviewed here, exposure to urban greenspaces can support multiple mental health outcomes in upper-middle-income countries. However, we still know little about poorer, rapidly urbanising countries. Our findings highlight the need for high-quality, context specific research in those urban areas with the highest levels of urbanisation, and the need to address specific challenges regarding mediating and moderating factors. Future studies should combine robust ecological assessments of greenspaces with validated mental health screening tools.
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This study aims to encourage organisational “safeness” during and after the pandemic by integrating green practices and a safe approach for sustainable innovation. The hotel industry was referred considering (1) the COVID-19 pandemic had a significant impact on the industry, (2) safe stay is the current trend which is expected will persist for an extended period, and (3) hotel environmental friendliness is a competitive advantage. The pandemic has redirected customer attention away from hotel features and onto the “safest” hotel that is practically Coronavirus-free. While recognising the negative environmental impact created by the industry, this research proposed a GREEFE framework to connect the fundamental elements of hotel marketing (green marketing mix: green products, green price, green promotion; and green place) with safety measures. The systematic review supported that green is associated with being clean and safe. Therefore, the hoteliers are recommended to ensure a safe hotel stay by going green during and after the pandemic.
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Purpose This review aims to identify the commonly used nature-based therapies, the cohorts that benefit from these interventions, and the potential environmental impact of nature-based therapies. Design/methodology/approach An integrative review methodology was taken. The literature was analysed and synthesised through thematic analysis. Findings Three themes emerged from the analysis: categories of nature-based therapies; benefits of nature-based therapies; and the gains from nature-based therapies are not universal. Evidence of physiological, psychological, social, vocational and quality of life benefits from participation in nature-based therapies was evident in the literature. However, there was insufficient empirical evidence of the benefits for the environment. Practical implications Occupational therapists assist populations across the life course. Consequentially, they can be found working in a diverse range of clinical contexts. This review asserts that nature-based therapies could be a positive addition in many of these contexts. Further, while engagement in activities in natural environments is frequently used by occupational therapists practicing within institution environments, there is evidence to support its use in community service models and potentially in public health strategies. Originality/value This integrative review brings together evidence on a diverse range of nature-based therapies, cohorts, associated benefits and factors that influence these. The lack of empirical evidence on the benefits of nature-based therapies for the environment is acknowledged as a gap in the literature
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In the effort to advance the knowledge of and disentangle the diversity of emerging forest-based initiatives for wellbeing, we propose (1) an umbrella definition (i.e., forest care initiatives (FCIs)), (2) a custom-made repository to collect and systematize information on FCIs in Italy, and (3) discuss a categorization scheme to cluster initiatives into three main categories according to target users, substitutability of the forest ecosystem, and the specificity of the health contributions to which they are aimed. We analyzed 232 initiatives, showing a lively panorama of Italian FCIs, mainly provided by private entities and civil society. FCI developments appear to be occasions for, but are not restricted to, rural and marginal areas delivering inclusive wellbeing services to a wide target user group and business opportunities. However, due to the novelty of this area of investigation, further research is needed to account for benefits and opportunities and to increase knowledge on enabling forest environments.
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Florence Nightingale, nurse and public health practitioner, was a forerunner in outcome assessment (Appleby J, Devlin N. Measuring success in the NHS. In: Using patient-assessed health outcomes to manage the performance of health care providers. London: King’s Fund/Dr Foster; 2004). Clinical outcome assessment (COA), an overarching term for patient-related outcomes, is subcategorised by changes observed/reported by either the patient, clinician or non-clinician or measurable physiological changes. A phenomenal evolution in medical technology has fuelled disease prevention, diagnosis and treatment and patient survival. The utlisation of patient-centred healthcare outputs has progressed more slowly.
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Introduction HT has been widely used to promote mental health. However, heterogeneity and sample size issues of randomised-controlled trials made it challenging to illustrate effect sizes across the evidence. Aim The purpose of this meta-analysis was to explore the effect of HT on mental health. Methods We used the PRISMA framework. A keyword search of Web of Science, PubMed, ProQuest, and Cochrane was performed. The inclusion criteria were HT with RCTs and mental health assessments. A random-effects model was used to perform the meta-analysis. Results A total of 1,056 records were searched, and 18 eligible studies extracted. The included RCTs had no statistical heterogeneity and publication bias. The meta-analysis showed that the HT experimental groups had a significant and positive impact on mental health compared to the control groups (effect size = 0.55). Discussion HT should be considered for enhancing mental health. The included studies had no negative outcomes and the most common HT intervention was at least eight sessions. Therefore, HT should be considered to enhance mental health. However, the concealed allocation and blinding processes should be improved in future studies. Implications for Practice This study recommends that HT should be integrated into healthcare settings to improve mental health.
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Purpose: To assess methodology and its limitations for measuring effects of nature-based intervention (NBI). Patients and methods: Participants were 11 middle-aged female health care workers with lowered capacity to work. NBI included six group appointments in six months study period. Heart rate variability (HRV) and self-reported pain and work exhaustion were measured pre-post study period. Salivary α-amylase samples were collected immediately before and after three individual interventions. Salivary cortisol samples were collected on the same three interventions, on three consecutive days starting from the day of intervention, to assess (a) month effect (pre-post study period) and (b) day effect (intervention day vs non-intervention day). Results: Individual interventions resulted in increase in α-amylase activity. However, the average fold increase decreased from the 3.05 ± 1.20 of the first intervention to 1.91 ± 1.00 and 1.46 ± 0.77 in the second and third intervention, respectively (p < 0.001). Cortisol concentrations were lower on intervention days vs non-intervention days, the difference being indicative (p = 0.050). Pain and work exhaustion decreased during the study period, as well as HRV, although any of these changes was not statistically significant. Conclusion: For a large-scale study, it would be ideal to select assays for both major pathways: hypothalamic-pituitary-adrenal axis can be measured by cortisol, whereas response via autonomic nervous system can be measured by HRV, when roles of sympathetic and parasympathetic nervous systems can be pinpointed separately. Salivary α-amylase can be used when continuous monitoring is not possible. Psychological well-being of participants should be surveyed, as well as their activities and moods on sampling days recorded.
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In recent decades, the interest in social innovation and nature-based solutions has spread in scientific articles, and they are increasingly deployed for cities’ strategic planning. In this scenario, participatory approaches become pivotal to engaging the population and stakeholders in the decision-making process. In this paper, we reflect on the first year’s results and the strengths and weaknesses—of the participatory activities realized in Lucca to co-design and co-deploy a smart city based on human–animal relationships in the framework of the European project Horizon 2020 (IN-HABIT). Human–animal bonds, as nature-based solutions, are scientifically and practically underestimated. Data were collected on the activities organized to implement a public–private–people partnership in co-designing infrastructural solutions (so-called Animal Lines) and soft nature-based solutions to be implemented in the city. Stakeholders actively engaged in mutual discussions with great enthusiasm, and the emergent ideas (the need to improve people’s knowledge of animals and develop a map showing pet-friendly services and places and the need for integration to create innovative pet services) were copious and different while showing many connections among the various points of view. At the same time, a deeper reflection on the relationships among the participatory activities and institutionally integrated arrangements also emerged.
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This paper attempts to empirically analyze green/healthy B&B promotion strategies for tourism recovery after the first wave of COVID-19. The survey will be meaningful in the real world of B&B tourism recovery, and it was conducted during the first Chinese national holiday without travel restrictions. China was the first country to resume travel after COVID-19. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used for testing. The relationships observed among the green/healthy physical environment, well-being perception (WBP), tourist satisfaction (TS), and tourist loyalty (TL) provide a better understanding of how to support sustainable tourism recovery. Green/healthy B&B promotion strategies that focus on a green/healthy physical environment after the health crisis can also be employed in other countries and regions experiencing the same situation.
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According to the most current cancer impact statistics, third most commonly diagnosed cancer worldwide is colorectal cancer. Colon cancer, in addition to its physical symptoms, has been linked to mental health issues in patients, according to the study. Dealing with colorectal cancer drug chemotherapy may lead to depression and anxiety in some people. Others are affected by the physical and mental condition of undergoing many therapies at the same time. Throughout the process of diagnosis, a large number of colorectal cancer patients report clinically relevant degrees as well as a decline in overall mental wellness. In the majority of cases, colon cancer patients are cured following therapy, but those who have survived the disease confront a medical range, physical, and challenges in society, for a variety of mental and physical problems such as anxiety and depression. First, meditation therapy is to urge patients to address their issues and feelings instead of dismissing them, but in the dispassionate and unbiased manner that defines the attentive state. Both the patient and the treating professional may benefit from this treatment method, since it appears to be a very effective therapeutic strategy. After colorectal cancer treatment, in studies, it has been demonstrated that ACT improves mental health, and Internet search engines such as Web of Science and Google Scholar as well as Dialnet were utilized to conduct a systematic literature There were 19 articles that fit the criteria. This includes a discussion of the ACT’s philosophical and theoretical basis, as well as the treatment itself. On the other hand, the study on ACT for enhancing mental health and quality of life is examined. Several of the available trials had serious flaws, making it impossible to establish reliable conclusions about the effectiveness of ACT for improving mental health and quality of life. The study determined that there is only a small amount of data supporting the use of ACT for improving mental health. The aim of this study is the application of the nursing model on improving the mental health of the colorectal patients. In addition, the limits of the current empirical state of ACT are acknowledged, and the importance of further research is highlighted. 1. Introduction Cancer is a major cause of death [1]. Cancer was diagnosed in one out of every fourteen persons in 2012. Eight out of ten cancer victims died within 5 years after diagnosis [2, 3]. As a result of cancer diagnosis and treatment, there is an increase in psychotic disorders. 16.3% and 10.3% of cancer patients in oncological and haematological settings matched the criteria for clinical anxiety and depression, correspondingly, according to a new meta-analysis of 70 studies from 14 countries. There are currently many institutions and experts that agree with Bultz and Carlson’s suggestion that cancer patients’ anguish be identified as the sixth [4]. Salmon Clark McGrath Fisher released the book in 2015 and also found that distress was associated to reduce immune function and higher mortality as well as poorer quality of life [5, 6]. A cancer diagnosis is followed by five years of physical symptoms and psychological suffering, interpersonal strain, and sexual issues for 20–30% of patients [7]. On the whole, cancer patients report feeling pain in the range of 35–96%. So, it is no surprise that it was among the most often reported symptoms of diagnosis and treatment, and it is also a major. Psychiatry can improve the quality of life for cancer patients by decreasing feelings of depression. Treatment efficacy is varied and typically viewed as low [8], which leaves opportunity for therapeutic improvements to improve the effectiveness of psychological oncology therapies. As a relatively recent psychotherapy method in psychosocial oncology, acceptance and commitment therapy (ACT) may be particularly useful in the treatment of cancer-related pain and discomfort. The theoretical foundation for accept theory is examined in this narrative review. This is followed by an evaluation and discussion of the current evidence on ACT in cancer patients, as well as suggestions for further study. 2. Colorectal Cancer and Mental Health Large intestinal cancer called malignancy of the colon starts in the colon (colon). This final section of the digestive system is called the colon. In general, colon cancer affects the elderly most, although it may affect anyone at any age. Typically, colon cancer begins with polyps, which are benign (noncancerous) cell groupings that develop on the colon’s inner wall. A small percentage of these polyps may develop into colon cancer in the long run. It is possible to have little polyps that do not create any problems. Identifying and eliminating polyps before they turn malignant helps prevent colon cancer; therefore, physicians prescribe frequent screening tests as a strategy to avoid the disease colon cancer that can be treated with a combination of surgical procedures and pharmacological therapies including chemotherapy and targeted therapy. Colorectal cancer occurs when colon and rectal cancer merge. Factors that may increase your risk of colon cancer include the following:(i)Older age people: despite the fact that colon cancer affects people of all ages, the majority of patients are over 50 years old. Children have a greater risk of colon cancer than adults, but physicians are unsure.(ii)African American race: in comparison to other races, African Americans have a higher risk of colon cancer(iii)A personal history of colorectal cancer or polyps: the risk of colon cancer in the future is higher for people who have had colon cancer or noncancerous polyps in the past.(iv)Inflammatory intestinal conditions: there are a number of illnesses, such as ulcerative colitis and Crohn’s disease that may raise the risk.(v)Inherited syndromes risk: inheritable mutations in some genes can significantly raise the risk of colon cancer. Occasionally, colon cancer can be traced back to hereditary genes. Family members with familial adenomatous polyposis are more likely to get colorectal cancer due to hereditary nonpolyposis or Lynch syndrome.(vi)History of colon: having a blood relative with colon cancer doubles your chance of getting it.(vii)Diet: colon and rectal cancer may be linked to a normal Western diet heavy in fats and calories but poor in fiber. Researchers have come up with a variety of outcomes. According to several studies, those who consume red and processed meat have a higher chance of developing colon cancer.(viii)A sedentary lifestyle: exercise can reduce the risk of colon cancer in those with sedentary lifestyles.(ix)Diabetes: there is a higher risk of colon cancer in those who have diabetes.(x)Obesity: comparatively, obese persons have a higher chance of developing colon cancer and dying from colon cancer than people who are deemed normal weight(xi)Smoking: tobacco users may have a higher chance of developing colon cancer(xii)Alcohol: drinking too much alcohol might raise your risk of developing colon cancer(xiii)Radiation therapy for cancer: radiation therapy given to the abdomen to treat previous cancers increases the chance of colon cancer 2.1. Treatment Patients’ preferences and general health are taken into consideration while deciding on treatment choices and suggestions, which are based on a variety of criteria, including the kind keep an open mind and ask questions if anything is not obvious. Have a discussion with the doctor about the purpose of each therapy and what to expect during the course of the “Shared decision-making” refers to these sorts of discussion. Together, the patient and your doctor decide on therapies that will help to achieve their health objectives. There are a variety of therapy options for colorectal cancer, which need better treatment decisions by learning more about the studies. Studies have demonstrated that no matter how old the patient is, these different therapy techniques give equivalent advantages. Older individuals, on the other hand, may face distinct; see what effects surgery, chemotherapy, and radiation therapy have on older individuals. All treatment decisions should take these characteristics into account in order to customize the treatment for each patient. There are a number of factors to consider.(i)The patient’s various medical issues(ii)The patient’s general health(iii)Possible adverse effects of the treatment plan(iv)Other drugs that the patient already takes 2.2. Physical, Emotional, and Social Effects of Cancer When it comes to cancer treatment, there are not only physical symptoms and side effects to worry about, but also emotional, palliative care, also known as supportive care, is the process of managing all along with therapies to delay, halt, or eradicate cancer; it is an important element of the care plan. The goal of palliative care is to improve the patient’s quality of life throughout treatment by controlling symptoms and providing nonmedical assistance to the patient. Such care is available to anybody, regardless of age or cancer kind and stage. It is most effective when it was started as soon as possible, following a cancer patient who received palliative care in addition to their cancer therapy that report less severe symptoms, a higher quality of life, and a higher level of satisfaction with their treatment. Palliative treatments come in a variety of forms, including medication, dietary modifications, relaxation methods, emotional and spiritual support, and palliative therapies including chemotherapy, surgery, and radiation therapy. After treatment, we may be asked to explain the symptoms and side effects, as well as to answer questions regarding them. Be careful to let their healthcare provider know if you are having any problems with their treatment. Healthcare providers can treat symptoms and side effects more promptly if they know about them in advance to keep their self from becoming more significant (Table 1). Reference Sample demographics at baseline Cancer site and stage Study design Theoretical framework Mental health measures Results [9] N = 542, 57% male, mean age = 71 years, France 63% colon cancer, 37% rectal cancer, 41% stage I, 26% stage II, 19% stage III, 2% stage IV, and 12% unknown Cross-sectional, population-based, case-controlled (N = 1,181 controls), surveyed at 5-, 10-, and 15-year postdiagnosis None SF-36 : MCS, EORTC QLQ-C30: emotional functioning scale, STAI Mental health and anxiety were not significantly different between cancer survivors and noncancer controls [10] N = 1,703, 60% male, 71% aged between 60 and 80 years, Australia Type of CRC not reported, 55% stage 0, I, or II, 35% stage III or IV, and 11% unknown Longitudinal, surveyed at 5, 12, 24, 36, 48, and 60 months postdiagnosis, population-based None BSI During the 5-year research period, 32–44% of participants reported significant levels of psychological discomfort. According to the study’s findings, three distinct distress trajectories were found, including continuous low distress (19%), medium discomfort that varied between time points (30%), medium distress that rose progressively over time (39%), and (13%). Distress was mentioned more frequently by males than when it came to males in distress, they tended to be younger, with less education, a weak social network, and advanced [11] N = 339, 55% male, mean age = 71 years, Israel Type of CRC not reported, 18% stage 0 or I, 62% stage II, and 20% stage III Cross-sectional, surveyed between 2- and 6-year posttreatment None BSI, IES, MAC Survivors who were single and unmarried reported the highest levels of anxiety and help married and unmarried survivors have similar levels of family support, but higher family support was exclusively associated with decreased suffering among married survivors [12] N = 439, 57% male, mean age = 65 years, Germany 59% colon cancer, 41% rectal cancer, 51% local, 31% regional, 17% distal, and 1% unknown Longitudinal, surveyed at 1-, 3-, 5-, and 10-year postdiagnosis, population-based, case-controlled (N = 2,028 controls) None EORTC QLQ-C30: emotional functioning scale Patients who had been diagnosed with cancer had significantly poorer emotional functioning at 1-, 3-, and 10-year postdiagnosis compared to controls; however, the differences were not clinically significant (>10 points). Comparing younger survivors (age 60) to older survivors (age 70 at diagnosis), younger survivors (age 60) reported substantially poorer emotional functioning 1 and 3 years after diagnosis. [13] N = 491, 62% male, mean age = 72 years, 76% non-Hispanic White, USA 100% rectal cancer, 53% local, 41% regional, 1% distal, and 5% unknown Cross-sectional, surveyed at least 5 years postdiagnosis, case-controlled: ostomies (n = 246 cases) vs. anastomoses (n = 245 controls) None Modified COH-QOL-ostomy, SF-36 version 2: MCS As a result of their ostomies, ladies with anastomoses reported a worse psychological well-being; there was also a higher rate of depression among male and female survivors who had ostomies compared to those who did not. [14] N = 1,419, 53% male, mean age = 70 years, Netherlands 59% colon cancer, 41% rectal, 33% stage I, 38% stage II, 26% stage III, 2% stage IV, and 1% unknown Cross-sectional, surveyed at an average of 8 years postdiagnosis (minimum of 5 years postdiagnosis), population-based, case-controlled (N = 338 normative population controls) None HADS Anxiety symptoms were recorded by 20% of survivors, whereas depression symptoms were reported by 18%. Anxiety levels in survivors were higher than those in the normative group when using a stricter cutoff point of less than 11. Depressive symptoms were higher in survivors than in the normative population when using a stricter cutoff of less than 11
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The literature presents consistent results concerning the positive effect of restorative environments on the recovery of psychophysiological stress and attention fatigue. However, there is a need for studies addressing specific population groups. This study developed a systematic review to identify the main findings about the effect of restorative environments in people with disabilities. The scarcity of publications was verified, as well as the lack of research in developing countries. Some studies showed the occurrence of restoration in people with disabilities. We suggest the development of experimental research taking into account other senses, such as hearing and touch.
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Objective To investigate the effect of applying horticulture activity on stress, work performance and quality of life in persons with psychiatric illness. Methods This study was a single-blinded randomized controlled trial. Using convenience sampling, 24 participants with psychiatric illness were recruited to participate in a horticultural programme and were randomly assigned to experimental and control groups. Two participants dropped out from experimental groups after assignment. Ten participants in the experimental group attended 10 horticultural sessions within 2 weeks, while 12 participants in the control group continued to receive conventional sheltered workshop training. Participants were assessed before and after programme using Chinese version of the Depression Anxiety Stress Scale (DASS21) and the Personal Wellbeing Index (PWI-C), and the Work Behavior Assessment. Results There was a significant difference in change scores of the DASS21 (p=.01) between experimental and control group. There were no significant differences in change scores of the PWI-C between the two groups. Conclusion Horticultural therapy is effective in decreasing the levels of anxiety, depression and stress among participants in this pilot study, but the impact of the programme on work behavior and quality of life will need further exploration.
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Technical Report
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Links between natural environments and mental health: evidence briefing Purpose of briefing This briefing note is part of a series that summarises evidence of the relationships between the natural environment and a range of outcomes. This briefing focuses on links between natural environments and mental health. The notes are aimed at: policy makers, practitioners, practice enablers (including Natural England, Natural Resources Wales etc.), local decision makers, and the wider research community. They highlight some of the implications for future policy, service delivery and research. It is intended they will inform practitioner planning, targeting and rationales, but not the identification of solutions or design of interventions. Barriers to access or use are not considered in these notes. The other briefings in the series published so far cover physical activity, obesity, physiological health, connection with nature, and learning. The notes consider evidence of relevance to the UK and outcomes for both adults and children. Please see EIN016 for methodology, glossary and evaluation resources.
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Sick leave due to stress-related disorders is increasing in Sweden after a period of decrease. To avoid that individuals living under heavy stress develop more severe stress-related disorders, different stress management interventions are offered. Self-assessed health, burnout-scores and well-being are commonly used as outcome measures. Few studies have used sick-leave to compare effects of stress interventions. A new approach is to use nature and garden in a multimodal stress management context. This study aimed to explore effects on burnout, work ability, stress-related health symptoms, and sick leave for 33 women participating in a 12-weeks nature based stress management course and to investigate how the nature/garden activities were experienced. A mixed method approach was used. Measures were taken at course start and three follow-ups. Results showed decreased burnout-scores and long-term sick leaves, and increased work ability; furthermore less stress-related symptoms were reported. Tools and strategies to better handle stress were achieved and were widely at use at all follow-ups. The garden and nature content played an important role for stress relief and for tools and strategies to develop. The results from this study points to beneficial effects of using garden activities and natural environments in a stress management intervention.
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The research was conducted to provide answers to two research questions: (1) what is the level of posttraumatic stress disorder (PTSD) and depressive symptoms in children and adolescents; and (2) which variables correlate with PTSD and depression level, in a way that they present risk factors for development of symptoms. Research was conducted fourteen months after the end of the bombing, on the sample of 629 children and adolescents from Vojvodina. It was registered that significant extent of PTSD symptoms exists in almost 60% of children and adolescents exposed to the bombing (59.6%). For the prediction of PTSD level, a tendency for using specific coping strategies appeared especially important. The best predictors of depression level were personality characteristics, which form a pattern known as negative affectivity.
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Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.
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Knowledge on the impact of the psychosocial work environment on the occurrence of stress-related disorders (SRDs) can assist occupational physicians in the assessment of the work-relatedness of these disorders. To systematically review the contribution of work-related psychosocial risk factors to SRDs. A systematic review of the literature was carried out by searching Medline, PsycINFO and Embase for studies published up until October 2008. Studies eligible for inclusion were prospective cohort studies or patient-control studies of workers at risk for SRDs. Studies were included in the review when data on the association between exposure to psychosocial work factors and the occurrence of SRDs were presented. Where possible, meta-analysis was conducted to obtain summary odds ratios of the association. The strength of the evidence was assessed using four levels of evidence. From the 2426 studies identified, seven prospective studies were included in this review. Strong evidence was found that high job demands, low job control, low co-worker support, low supervisor support, low procedural justice, low relational justice and a high effort-reward imbalance predicted the incidence of SRDs. This systematic review points to the potential of preventing SRDs by improving the psychosocial work environment. However, more prospective studies are needed on the remaining factors, exposure assessment and the relative contributions of single factors, in order to enable consistent assessment of the work-relatedness of SRDs by occupational physicians.
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To summarize briefly, key general points in this presentation include the following: To promote wellness, healthcare facilities should be designed to support patients in coping with stress. As general compass points for designers, scientific research suggests that healthcare environments will support coping with stress and promote wellness if they are designed to foster: 1. Sense of control; 2. Access to social support; 3. Access to positive distractions, and lack of exposure to negative distractions; A growing amount of scientific evidence suggests that nature elements or views can be effective as stress-reducing, positive distractions that promote wellness in healthcare environments. In considering the needs of different types of users of healthcare facilities--patients, visitors, staff--it should be kept in mind that these groups sometimes have conflicting needs or orientations with respect to control, social support, and positive distractions. It is important for designers to recognize such differing orientations as potential sources of conflict and stress in health facilities (Schumaker and Pequegnat, 1989). For instance, a receptionist in a waiting area may understandably wish to control the programs on a television that he or she is continuously exposed to; however, patients in the waiting area may experience some stress if they cannot select the programs or elect to turn off the television. Some staff may prefer bright, arousing art for corridors and patient rooms where they spend much of their time; however, for many patients, such art may increase rather than reduce stress. A difficult but important challenge for designers is to be sensitive to such group differences in orientations, and try to assess the gains or losses for one group vis-a-vis the other in attempting to achieve the goal of psychologically supportive design. Designers should also consider programs or strategies that combine or mesh different stress-reducing components. For example, it seems possible that a program enabling patients to select at least some of their wall art or pictures would foster both control and access to positive distraction. As another example, the theory outlined in this paper suggests that an "artist-in-residence" program, wherein an artist with a caring, supportive disposition would work with patients, might foster social support in addition to control and access to positive distraction. Running through this presentation is the conviction that scientific research can be useful in informing the intuition, sensitivity, and creativity of designers, and thereby can help to create psychologically supportive healthcare environments.(ABSTRACT TRUNCATED AT 400 WORDS)
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Few follow-up studies of depression have evaluated depressive symptomatology over time at both threshold and sub-threshold levels. To evaluate long-term longitudinal symptomatic course after an episode of severe depression. A total of 61 participants from a previous study cohort underwent a detailed interview covering the longitudinal course of depression and pharmacological treatment over 8-11 years of follow-up. Of the follow-up months, 52% were spent at an asymptomatic level, 15% at minor symptom level, 20% at residual symptom level and 13% at full depression level. Also, 30% of follow-up months were spent in an episode of depression, and 18% of patients never achieved asymptomatic status during follow-up. The percentage of patients at each symptom level remained relatively stable after the first 2 years, but levels in individuals fluctuated, with a mean of two changes in symptom levels per follow-up year. After severe episodes, sub-syndromal levels of depression are common and persistent, with considerable fluctuation suggesting a continuum between sub-syndromal subtypes and full depression.
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Many urban societies are faced with a growing incidence of poor health because of mental stress and sedentary lifestyles. Urban green spaces are increasingly seen as a counter to hectic city living and as restorative settings. This study investigates the preferences for site characteristics green-space visitors have when they are seeking stress relief compared to their general green-space preferences. This study developed a conceptual framework integrating physical and social characteristics of different green-space types in Vienna, Austria and investigated the preferences of 692 on-site visitors. A stated choice model with digitally calibrated images found that visitors’ general preferences are similar to their site preferences when seeking stress relief. However, for stress relief, visitor numbers played a more important role in their green-space choices, while litter and trail environment played a larger role in general preferences. The stress-relief preferences of respondents did not differ remarkably subject to their own reported stress level. Recommendations for green-space planning are derived.
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This study investigated the impact of nature experience on affect and cognition. We randomly assigned sixty participants to a 50-min walk in either a natural or an urban environment in and around Stanford, California. Before and after their walk, participants completed a series of psychological assessments of affective and cognitive functioning. Compared to the urban walk, the nature walk resulted in affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance). This study extends previous research by demonstrating additional benefits of nature experience on affect and cognition through assessments of anxiety, rumination, and a complex measure of working memory (operation span task). These findings further our understanding of the influence of relatively brief nature experiences on affect and cognition, and help to lay the foundation for future research on the mechanisms underlying these effects. Available here: http://authors.elsevier.com/a/1QdlwcUG4~B3U
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The aim of this study is to develop and construct the elements of a new evaluation tool to assess the effectiveness of a horticultural therapy. Delphi method was applied to classify the realms of evaluation and specify their components and constituting items. Delphi process was performed through three rounds and 24 professionals attended all the rounds as panel members. Some of the items were revised or removed according to the results of such tests as content validity ratio, agreement rate, convergency and stability of each item. On the contrary, a few new items were added by accepting the opinions of the professional panels. Previous to the Delphi, the realms of evaluation were classified into physical, cognitional, psycho-emotional and social ones on the basis of literature review, professionals' consultation and in-depth interview with practitioners. At the first round, 112 items constituting four realms were reviewed. The numbers of items to be reviewed were reduced to 107 at the second round and to 102 at the third round. As a result, 98 items in 4 realms were decided as proper evaluation points of horticultural therapy. The compositions of the four respective realms are as follows: 5 components and 27 items in physical realm; 4 components and 25 items in cognitional realm; 2 components and 24 items in psycho-emotional realm; and 4 components and 22 items in social realm. These realms, components and specific items derived from this study constitute indices to evaluate the effectiveness of horticultural therapy. In addition, they might be utilized as good guidelines for planning horticultural therapy programs.
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Aim To summarize the evidence from randomized controlled trials (RCTs) on the effects of horticultural therapy (HT). Methods Studies were eligible if they were RCTs. Studies included one treatment group in which HT was applied. We searched the following databases from 1990 up to August 20, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi-Web, GHL, WPRIM, and PsyclNFO. We also searched all Cochrane Database and Campbell Systematic Reviews up to September 20, 2013. Results Four studies met all inclusion criteria. The language of all eligible publications was English and Korean. Target diseases and/or symptoms were dementia, severe mental illness such as schizophrenia, bipolar disorder, and major depression, frail elderly in nursing home, and hemiplegic patients after stroke. These studies showed significant effectiveness in one or more outcomes for mental health and behavior. However, our review especially detected omissions of the following descriptions: method used to generate randomization, concealment, blinding, and intention-to-treat analysis. In addition, the results of this study suggested that the RCTs conducted have been of relatively low quality. Conclusion Although there was insufficient evidence in the studies of HT due to poor methodological and reporting quality and heterogeneity, HT may be an effective treatment for mental and behavioral disorders such as dementia, schizophrenia, depression, and terminal-care for cancer.
Book
The psychological concept of burnout refers to long-term exhaustion from, and diminished interest in, the work we do. It’s a phenomenon that most of us have some understanding of, even if we haven’t always been affected directly. Many people start their working lives full of energy and enthusiasm, but far fewer are able to maintain that level of engagement. Burnout at Work: A Psychological Perspective provides a comprehensive overview of how the concept of burnout has been conceived over recent decades, as well as discussing the challenges and possible interventions that can help confront this pervasive issue. Including contributions from the most eminent researchers in this field, the book examines a range of topics including: The links between burnout and health How our individual relationships at work can affect levels of burnout The role of leadership in mediating or causing burnout The strategies that individuals can pursue to avoid burnout, as well as wider interventions. The book will be required reading for anyone studying organizational or occupational psychology, and will also interest students of business and management, and health psychology. © 2014 Michael P. Leiter, Arnold B. Bakker and Christina Maslach.
Article
Introduction Social and therapeutic horticulture has been shown to be a useful intervention for a wide range of vulnerable groups, including those with a mental health problem and/or learning or physical disabilities. However, there is still a need for additional research that examines evidence of its effectiveness. Method This study analysed scores in four areas ( social interaction, communication, motivation, and task engagement) collected as part of routine assessment during a programme of social and therapeutic horticulture. The sample comprised a heterogeneous group of participants and included a range of vulnerable people, predominantly those with a learning disability or a mental health problem. Findings Scores for social interaction were significantly higher after 90 days of participation. This effect appeared to be most evident in participants with a learning disability. Conclusion Social and therapeutic horticulture provides the opportunity for social interaction. Increased scores relating to social interaction suggest that the programme was effective in promoting such interaction and that it may, therefore, promote social inclusion among vulnerable and isolated groups.