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The Effect of Sunlight on Postoperative Analgesic Medication Use: A Prospective Study of Patients Undergoing Spinal Surgery
Abstract
Exposure to natural sunlight has been associated with improvement in mood, reduced mortality among patients with cancer, and reduced length of hospitalization for patients who have experienced myocardial infarction. Our aim was to evaluate whether the amount of sunlight in a hospital room modifies a patient's psychosocial health, the quantity of analgesic medication used, and the pain medication cost.
A prospective study of pain medication use was conducted in 89 patients undergoing elective cervical and lumbar spinal surgery where they were housed on either the "bright" or "dim" side of the same hospital unit. Analgesic medication was converted to standard morphine equivalents for interpatient comparison. The intensity of sunlight in each hospital room was measured daily and psychologic questionnaires were administered on the day after surgery and at discharge.
Patients staying on the bright side of the hospital unit were exposed to 46% higher-intensity sunlight on average (p = .005). Patients exposed to an increased intensity of sunlight experienced less perceived stress (p = .035), marginally less pain (p = .058), took 22% less analgesic medication per hour (p = .047), and had 21% less pain medication costs (p = .047). Age quartile was the only other variable found to be a predictor of analgesic use, with a significant negative correlation (p <.001). However, patients housed on the bright side of the hospital consistently used less analgesic medications in all age quartiles.
The exposure postoperatively of patients who have undergone spinal surgery to increased amounts of natural sunlight during their hospital recovery period may result in decreased stress, pain, analgesic medication use, and pain medication costs.
... Changes in lighting conditions have broad effects on diverse physiological and behavioral functions, including circadian rhythm, mood, and cognition [1,2]. In humans, light therapy can alleviate depression, promote cognitive function, and relieve pain symptoms [3][4][5][6][7][8][9][10][11][12]. It provides a solution for the treatment of brain diseases with the advantages of non-invasiveness, few side-effects, and low cost. ...
... Although clinical evidence documenting the relationship between light therapy and pain is scarce, light therapy is a promising, available, and safe intervention to manage chronic pain. A prospective study evaluated the effect of natural sunlight on pain among patients undergoing spinal surgery [9]. The results showed that patients staying on the bright side of the room had decreased pain, analgesic medication use, and pain medication cost than those staying on the dim side [9]. ...
... A prospective study evaluated the effect of natural sunlight on pain among patients undergoing spinal surgery [9]. The results showed that patients staying on the bright side of the room had decreased pain, analgesic medication use, and pain medication cost than those staying on the dim side [9]. Patients with fibromyalgia and US military veterans often report experiencing pain; Burgess and colleagues conducted three studies on the effect of bright light therapy in these two populations. ...
Light is a powerful environmental factor influencing diverse brain functions. Clinical evidence supports the beneficial effect of light therapy on several diseases, including depression, cognitive dysfunction, chronic pain, and sleep disorders. However, the precise mechanisms underlying the effects of light therapy are still not well understood. In this review, we critically evaluate current clinical evidence showing the beneficial effects of light therapy on diseases. In addition, we introduce the research progress regarding the neural circuit mechanisms underlying the modulatory effects of light on brain functions, including mood, memory, pain perception, sleep, circadian rhythm, brain development, and metabolism.
... Previous studies have investigated the influence of natural light on patients' recovery/rehabilitation in healthcare establishments (Beauchemin & Hays, 1996;Devlin & Arneill, 2003;Walch et al., 2005). Devlin and Arneill (2003) found that hospital rooms with poor lighting may alter patients' circadian rhythms, which results in eye fatigue and headaches. ...
... Beauchemin and Hays (1996) showed that inpatients diagnosed with severe depression who were placed in sunny hospital rooms recovered more quickly than those who were assigned to dull or shadowed hospital rooms. Walch et al. (2005) observed that patients undergoing spinal surgery who were exposed to increased amounts of natural light experienced less perceived stress and less pain and required less analgesic medication. In fact, Walch et al. (2005) found that the exposure to daylight had positive results on patients undergoing chemotherapy, specifically, it leads to a 22% decrease in the use of analgesics and a 21% reduction in healthcare costs. ...
... Walch et al. (2005) observed that patients undergoing spinal surgery who were exposed to increased amounts of natural light experienced less perceived stress and less pain and required less analgesic medication. In fact, Walch et al. (2005) found that the exposure to daylight had positive results on patients undergoing chemotherapy, specifically, it leads to a 22% decrease in the use of analgesics and a 21% reduction in healthcare costs. ...
The present study aims to evaluate a conceptual framework that explains patients' attachment to a healthcare establishment by considering the effect of a natural/green environment as nature-based solutions (NBS), mental health value, emotional wellbeing, and satisfaction. An online survey method was utilized to reach Romanian patients. Using this procedure, a total of 386 cases were used for the data analysis. Structural equation modeling was utilized as the data analysis method. Our findings reveal that natural/green environment as NBS significantly influences patients' mental health value, emotional wellbeing, and satisfaction, which contributes to an increase in their attachment to the healthcare facility. In addition, the mediating role of mental health value, emotional wellbeing, and satisfaction is uncovered. Our results can help healthcare managers and researchers develop strategies to effectively integrate natural/green features as NBS in the interior spaces of healthcare settings.
... The existing literature suggests that the presence of windows can improve patient health outcomes and recovery during an inpatient stay by providing access to daylight and outside views (Huisman et al., 2012;Gharaveis & Kazem-Zadeh, 2018;Shepley et al., 2012;Ulrich et al., 2010;Ulrich, 1984). Improvements in health outcomes and symptoms associated with daylight exposure and access to window views in patient rooms include lower pain levels (Walch et al. 2005;Ulrich, 1984), reduced depression and anxiety symptoms (Benedetti et al., 2001;Walch et al., 2005), reduced delirium (Shepley et al., 2012;Zaal et al., 2013;Smonig et al., 2019), shorter overall length of hospital stay (Park et al., 2018;Joarder & Price, 2013;Choi, 2007;Ulrich, 1984), and reduced mortality rates among hospitalized patients (Beauchemin & Hays, 1998;Ely et al., 2001). The stress-reducing effects of views through windows in healthcare settings have been emphasized in the theory of supportive design, which centers on the healthcare facility's role in fostering coping with stress, an obstacle to healing (Ulrich, 1991) and the biophilia hypothesis, which states that humans have an inherent inclination to seek connections with nature (Kellert & Wilson, 2003). ...
... The existing literature suggests that the presence of windows can improve patient health outcomes and recovery during an inpatient stay by providing access to daylight and outside views (Huisman et al., 2012;Gharaveis & Kazem-Zadeh, 2018;Shepley et al., 2012;Ulrich et al., 2010;Ulrich, 1984). Improvements in health outcomes and symptoms associated with daylight exposure and access to window views in patient rooms include lower pain levels (Walch et al. 2005;Ulrich, 1984), reduced depression and anxiety symptoms (Benedetti et al., 2001;Walch et al., 2005), reduced delirium (Shepley et al., 2012;Zaal et al., 2013;Smonig et al., 2019), shorter overall length of hospital stay (Park et al., 2018;Joarder & Price, 2013;Choi, 2007;Ulrich, 1984), and reduced mortality rates among hospitalized patients (Beauchemin & Hays, 1998;Ely et al., 2001). The stress-reducing effects of views through windows in healthcare settings have been emphasized in the theory of supportive design, which centers on the healthcare facility's role in fostering coping with stress, an obstacle to healing (Ulrich, 1991) and the biophilia hypothesis, which states that humans have an inherent inclination to seek connections with nature (Kellert & Wilson, 2003). ...
... This study confirms findings from several previous studies that have demonstrated the importance of access to daylight and views through windows in fostering a restorative healthcare environment that improves patient experience, satisfaction, and perception of healing (Choi & Beltran, 2004;Choi et al., 2012;Walch, et al., 2005;Park et al., 2018;Ulrich, 1984;Verderber & Reuman, 1987). While patient room windows are designed into hospitals with the intention of J o u r n a l P r e -p r o o f delivering these outcomes, glare and heat conditions often necessitate occlusion of these windows by shades or blinds (Sherif et al., 2015). ...
Previous research has demonstrated the benefits of access to daylight and views on patient experience and outcomes. However, there is a lack of research investigating the relationship between window features, such as blinds, and patient experience as well as the mediating impacts of daylight quality versus access to views on the relationship between these variables. Using a nationwide online survey, 652 participants rated daylight satisfaction, view access, experience of room, hospital, and care quality based on their most recent inpatient hospital stay. Participants were also asked to rate their satisfaction based on images of patient rooms with and without blinds. Findings revealed that participants who stayed in rooms with open blinds reported significantly higher ratings for room, hospital, and care quality experience. Also, the relationship between these ratings and blind positions was mediated by ratings of daylight and view access. This study can help healthcare designers and stakeholders improve patient experience through optimizing daylight and view access in patient rooms.
... Lights out: increasing natural daylight has the potential to: patients also took 22% less analgesic medication per hour and had 21% less pain medication (Walch et al. 2005), and increase in natural light is associated with reductions in various factors including 25% less staff sick leave, 32% less tiredness, 45% fewer headaches, 31% fewer sore throats and a tangible decrease in stress (Bartick et al. 2010). Taking two of the five interrelated factors of decision making in nursing, the intervention must be tailored to the type of patient and the particular clinical environment that it will be run in (Thompson et al. 2004). ...
... It is widely acknowledged that natural light provides significant health benefits over synthetic light, including reducing depression, decreasing fatigue, improving alertness, modulating circadian rhythms, and treating conditions such as hyperbilirubinemia among infants (Ulrich et al. 2008 (Bartick et al. 2010), reduced levels of depression, reduced pain and reduced requests for medication (Walch et al. 2005). Natural light also decreases medical error rates (Ovitt 1996 cited in Harris et al. 2009). ...
... The literature review showed that increased natural light provides significant health benefits (Ulrich et al. 2008 Reduction in sleep disturbances (Bartick et al. 2010). Reduced pain and requests for medication (Walch et al. 2005). Reduced depression (Mathews 2013). ...
In 2015/16 National Health Service (NHS) hospitals in England spent over £570 million on energy, consumed over 10,983,151 megawatt hours of energy and produced 4.6 million tonnes of carbon dioxide equivalent (MtCO2e) from energy. In a survey of 70 NHS energy managers, it was reported that energy conservation is important to NHS organisations. However, to NHS healthcare staff energy conservation is a low priority and sometimes considered to be in conflict with their primary driver, which is delivering excellent patient care. This study assessed the implications of running a behaviour change intervention in a NHS hospital designed to reduce energy whilst putting patients first. To the researcher’s knowledge to date, there has not been a published academic study that has directly measured the sustainability (economic, environmental and social) benefits of running an energy behaviour change intervention in a hospital. In addition, all published information on energy behaviour change in hospitals relates to general acute-care hospitals. Therefore, this study addresses current research gaps by undertaking an academic study using mixed method data collection to directly measure the potential sustainability (economic, environmental and social) benefits to patients, staff and the organisation of running an energy behaviour change intervention in a NHS community hospital. The study was run in three older persons’ in-patient acute-care wards in a NHS community hospital (the Trust) in the South of England over a nine month period. The quantitative data collection methods used in this study included the use of air temperature, relative humidity, sound, carbon dioxide and light monitors together with window movement sensors to directly measure and monitor the ward environment. Other quantitative data collection methods used include the use of Trust management information to measure and monitor patient length of stay and movement sensors on patient beds to measure and monitor patient wellbeing in relation to rest and recovery. Together with Trust management information on staff satisfaction in relation to sickness levels and staff retention. The qualitative data collection methods used in this study included staff comfort surveys (n = 30 participants, 463 surveys) and staff focus groups (n = 30 participants, 6 focus groups) to directly measure the staffs’ experience and indirectly measure the patients’ experience. The study produced an economic and environmental saving of 13% in electricity consumption. Other environmental savings included an 11% decrease in artificial lighting loads, a 1 decibel reduction in mean noise levels, 0.6 degree Celsius reduction in median air temperature and 27% reduction in window movements during the heating season. Social savings included a 22% increase in patient rest when compared to the control group. In addition, this nurse led behaviour change intervention created the quieter periods required for better patient outcomes, which continued for at least a month after the intervention before gradually tailing off but not stopping during the monitoring period. It took up to a month to implement quieter periods showing a delay in the effect. Switching off small power equipment took effect immediately and continued for a month after the intervention, before tailing off over the next month and completely stopping the following month. The study also showed that the nursing staff had a heightened awareness of the environmental impacts on the wards as a result of the evidence based information used during the intervention, particularly in relation to noise and temperature, which creates risks in terms of acceptability of the approach to the nursing staff participating in the intervention, who reported their wards were cold as a result of controlling temperatures to remain within the CIBSE recommended levels (22-24⁰C) during the heating season.
... As described in the Introduction, research shows that biophilic design can yield positive effects on health and well-being [12,13,17]. Biophilic interventions have been shown to improve relaxation, reduce stress and depressive symptoms, and provide pain relief [43,44,[51][52][53][54][55][56][57][58][59][60][61]. Herein, we show examples of residential spaces combining biophilic design principles with beneficial self-care components individualized for persons living with migraines, chronic pain and depression ( Figure 2). ...
... These descriptions are intended to promote cross-disciplinary discussion on innovative interior design for people living with chronic diseases. [43,44,[51][52][53][54][55][56][57][58][59][60][61]. Herein, we show examples of residential spaces combining biophilic design principles with beneficial self-care components individualized for persons living with migraines, chronic pain and depression ( Figure 2). ...
... Recent review articles on biophilic design point out research gaps on the relationships between biophilic attributes and health-related outcomes [9,13,16,17,24,160]. To the best of our knowledge, there are only a few reports on combining biophilic interventions with pharmacotherapies [43,61]. With respect to studies on self-care for specific chronic diseases, we include references on systematic review and meta-analysis (SR/MA) when available; however, given the diversity of research evidence for biophilic interventions and individual self-care modalities (ranging from small-group observational and pilot studies, longitudinal studies, narrative reviews, RCTs and SR/MA), presenting such a cross-disciplinary topic as an SR/MA would be difficult at the present time. ...
The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.
... Exposure to natural sunlight has been associated with improvement in mood, reduced mortality and decreased stress, pain and analgesic medication use and pain medication cost in patients who have undergone spinal surgery. [3] Among hormonal effects by light, the (reduced) secretion of melatonin from the pineal gland is the most important. ...
... and patient-reported outcome parameters related to postoperative pain management in a large number of patients in clinical routine. A former study evaluated the effect of sunlight on postoperative analgesic medication use and found that patients staying on the bright side of the hospital required 22 % less opioid equivalent compared to those on a dark side, suggesting a hypothetical connection of pain perception and light intensity.[3] Thus, it could be suggested that pain perception after surgery and light intensity might be connected.However, analgesic consumption is only a surrogate of pain after surgery that can be affected by many different factors. ...
... Since our data show no significant relation of light intensity with maximum pain perception as well as the secondary outcomes pain during movement, tiredness, the assumption of light intensity in patient rooms having an influence on patients' pain perception cannot be confirmed by our observational data.However, regarding the differences in sample size, study conditions and methods of the two studies no definite comparison can be made. While the former study included only patients undergoing spinal surgery, calculated mean light exposure by taking measurements twice a day five times each from three different points of the patients' room as well as having variant primary outcomes as pain medication use and cost, it is difficult to compare these two studies.[3] However, we found an unexpected positive correlation of daylight intensity and postoperative nausea. ...
Light intensity affects humans in multiple ways. We aimed to characterize the potential impact of light intensity on patients’ pain management experience in the perioperative setting. Within the German multicenter registry project QUIPS, we collected patient reported outcomes (PROs) concerning pain and side effects, demographics and perioperative pain medication, and measured the light intensity in their rooms on the first postoperative day. Primary endpoint was maximum pain intensity rated on the numerical rating scale (NRS, 0-10). Secondary endpoints were pain intensity during movement, mood, nausea, tiredness and satisfaction. Measurement of light intensity was done with a calibrated light meter. For analysis, we used linear and log-linear regression models with age, gender, pre-existing chronic pain, ASA status, and logarithmized light intensity as independent variables. Data of 539 surgical patients from 9 hospitals were included. We found no significant effect of light intensity on the primary endpoint. However, we observed a strong positive correlation between nausea and light intensity.
Perspective: Our study indicates that further investigations about the clinical importance of light exposure with regard to nausea and other medical conditions might be worthwhile.
Trial registration: QUIPS is registered in the German Clinical Trials Register (DRKS00006153)
... But sunlight can generate heat, especially during the day [16]. Research proves that patients with higher light intensity experience less stress and pain and only need 22% fewer pain relievers than patients whose rooms are in shaded areas or where the sun's intensity is less [17]. Textures can also be seen visually, such as the shape of the patterns applied to an element. ...
... But sunlight can generate heat, especially during the day [16]. Research proves that patients under higher light intensity experience less stress and pain and only need 22% fewer pain relievers than patients whose rooms are in shady areas or where the sun's intensity is less [17]. ...
People with Mental Disorders (ODGJ) are less likely to recover completely. Still, there is a chance to recover and return to their normal activities Therapy that can make people with mental disorders carry out activities like ordinary people is occupational therapy. However, Indonesia still needs to offer an occupational therapy room design that can support the therapeutic process. This research developed an occupational therapy room modeling that can help the recovery process of people with a mental health condition with a neuroarchitecture approach through a 360o panoramic illustration. This research collects data from reliable sources regarding people with mental disorders, health workers, occupational therapy, neuroarchitecture, and theories regarding visual, texture, thermal, aroma, and audial. After that, space exploration is carried out based on ergonomics and considers the patient's senses. Based on the analysis results, it produces several rooms: outdoor areas, individual therapy rooms, group therapy rooms, entertainment rooms, work rooms, and toilets. The illustration of space modeling shows the use of interior elements such as the dominant color of the space, green and blue, the placement of high ceilings in the room that accommodates creative activities, and the low ceiling for the room accommodates privacy activities. In addition, space modeling also shows the type and placement of the furniture in every kind of space. Doctors or health experts can consider this modeling when making interior design guidelines for occupational therapy rooms.
... Van (2006) conducted a study proving that lighting has an effect on the hormones and nervous system in the body [42]. Walch (43) stated that daylight in hospital rooms positively affects patients' mental health and reduces the use of painkillers. [43]. ...
... Walch (43) stated that daylight in hospital rooms positively affects patients' mental health and reduces the use of painkillers. [43]. Within the scope of this study, 7 publications were identified as an evidence of the positive benefits of light (Table 3). ...
The design of healthcare structures is a complex and constantly evolving issue due to the need for addressing various interrelated functions. Today, user involvement in the design phase is considered to be one of the main pillars of successful design. However, in healthcare structures, efforts toward this end are often hampered by the need for identifying the various requirements of multiple user groups and for setting priorities between different requirements of these groups. Recently, the effects of physical environmental conditions on user satisfaction have become more important in health building designs. Along with the rise of user satisfaction in design, the concept called 'evidence-based design' is increasingly attracting the attention of researchers and has become the theoretical concept of the healing physical environment in design. The aim of this study is to determine the gaps and areas needed to improve the effects of the physical environment on the user in terms of evidence-based design strategies. In this context, scientific studies on the design of health buildings between 2012 and 2021 were systematically reviewed and analyzed according to the evidence-based pyramid method with kohen kappa analysis within the scope of evidence-based design criteria. A total of 1641 articles were identified for the scope of the study. Among these a total of 48 scientific studies were analyzed fitted to the criteria of the study. The impacts of physical environment on users are evaluated on two main types of user groups: (1) patients and relatives and (2) healthcare workers. The results reveal that evidence design principles are mostly evaluate in terms of patients and there are gaps in evidence-based design literature for healthcare personnel and more studies should be undertaken by multidisciplinary teams for the development of design strategies.
... arding the evaluation of daylight access in healthcare facilities, the existing literature is rather limited. Florence Nightingale first mentioned in her book 'Notes on Hospitals' that patients in rooms with daylight and direct sunlight exposure had better overall experience and faster recovery rates than patients in darker rooms [10]. Research by Walch et. al. (2005) evaluated sunlight exposure and related psychological health benefits to patients who had specific kinds of surgery. Their findings suggest that patients who were in rooms with higher sunlight intensity, experienced less perceived stress, less pain, therefore, using fewer analgesic medications, and the medication costs were reduced [11] ...
... al. (2005) evaluated sunlight exposure and related psychological health benefits to patients who had specific kinds of surgery. Their findings suggest that patients who were in rooms with higher sunlight intensity, experienced less perceived stress, less pain, therefore, using fewer analgesic medications, and the medication costs were reduced [11]. The benefits of sunny patient rooms were also investigated in a study by Joarder et. ...
This research investigates the daylight performance of a typical healthcare patient room, focusing on a design direction putting in the first place the visual comfort of a patient. Furthermore, the research examines the impact on the energy efficiency of each design option. The main scope of the study is to investigate whether it is possible to design daylit spaces that improve the health and well-being of patients without though creating a high energy-consuming building. The methodology used is based on computer simulations using the plugin Climate Studio in the software Rhinoceros. Climate Studio has implemented the widely validated simulation engines of EnergyPlus and Radiance, which are used for thermal and daylight simulations accordingly. For this research, the most widely used healthcare in-patient room is investigated, the double room. The parameters under study are eight room orientations, six different window configurations, and eight types of glazing with different characteristics. Various dynamic annual metrics are used for the daylight performance such as the Useful Daylight Illuminance, the Spatial Daylight Autonomy, and the Annual Sunlight Exposure. The findings show that even if the building design process focuses on healthier indoor environments and adequate visual comfort, there are still options that do not compromise the energy efficiency of a building.
... od. A research by Bauchemin and Hays (1996) studied the length of stay of depressed patients with seasonal affective disorder in sunny rooms and dull rooms of a psychiatric inpatient unit. Findings showed that patients in sunny rooms stayed for an average of 16.9 days compared to 19.5 days for patients in dull rooms, a difference of 2.6 days [16]. Walch et. al. (2005) evaluated whether sunlight exposure can modify the psychological health of a patient, the analgesic medication taken, and the cost of pain medication. The study focused on patients undergoing elective cervical and lumbar spinal surgery. The findings showed that when patients were staying on the bright side of the hospital they were expo ...
... The findings showed that when patients were staying on the bright side of the hospital they were exposed to 46% higher-intensity sunlight. At the end, the study showed that patients exposed to increased intensity of sunlight, experienced less perceived stress, marginally less pain, they used 22% less analgesic medication per hour which reduced the medication costs by 21% [17]. ...
It is generally accepted that access to daylight and sunlight can have a positive impact on people's health and well-being. This study aims to carry out a research on natural lighting performance of the most common typologies used for in-patient units. A preliminary investigation identifies the typical in-patient rooms in a number of healthcare premises in Cyprus. At the same time, the current study presents a review of the existing literature on lighting assessment in healthcare facilities with an emphasis on the impact of daylighting on patients' health. Moreover, natural lighting analysis simulations were conducted with advanced software tools, i.e. Radiance IES implemented in IES-VE 2017. The research study aims to evaluate the correlations between the room's orientation and geometrical parameters, (i.e., dimensions, height, window to floor ratio), and the daylighting performance in the spaces under study. For the daylighting assessment of the in-patient spaces, a number of widely used indicators were employed including Daylight Factor (DF), Uniformity Daylight Factor (UDF), Spatial Daylight Autonomy (sDA), Annual Sunlight Exposure (ASE) and Useful Daylight Illuminance (UDI). The research study discloses significant differences in the levels of natural lighting metrics for different geometrical configurations and for different orientations, thus indicating the importance of the appropriate architectural design in achieving high daylighting performance of the spaces under study, as well as the need for further systematic research in the field.
... Pesquisas têm apresentado que espaços construídos que possuem associação de iluminação natural e com o contato com o espaço exterior, há melhora do desempenho de alunos em sala de aula (DEMIR; KONAN, 2013;HESCHONG, 2003a); e aumento da produtividade em estabelecimentos de escritório (HESCHONG, 2003b;LOFTNESS et al., 2008;MAYHOUB;CARTER, 2010). Existem evidências ainda de benefícios relacionados ao estado de saúde de pacientes em hospitais (BEAUCHEMIN; HAYS, 1996HAYS, , 1998CHOI;BELTRAN;KIM, 2012;WALCH et al., 2005). Por outro lado, edificações que não proporcionam iluminação natural adequada privam seus ocupantes da manutenção à sua saúde e do bem-estar enquanto nelas permanecem. ...
... Pesquisas têm apresentado que espaços construídos que possuem associação de iluminação natural e com o contato com o espaço exterior, há melhora do desempenho de alunos em sala de aula (DEMIR; KONAN, 2013;HESCHONG, 2003a); e aumento da produtividade em estabelecimentos de escritório (HESCHONG, 2003b;LOFTNESS et al., 2008;MAYHOUB;CARTER, 2010). Existem evidências ainda de benefícios relacionados ao estado de saúde de pacientes em hospitais (BEAUCHEMIN; HAYS, 1996HAYS, , 1998CHOI;BELTRAN;KIM, 2012;WALCH et al., 2005). Por outro lado, edificações que não proporcionam iluminação natural adequada privam seus ocupantes da manutenção à sua saúde e do bem-estar enquanto nelas permanecem. ...
A pandemia de COVID-19 impôs novos modos de relação entre as pessoas e seus ambientes e nos desafiou a avaliar e repensar o habitat humano de modo a acomodar e dar suporte a tais mudanças. Assim, o objetivo deste trabalho é abordar características físicas da moradia em sua relação com a satisfação ambiental no contexto da quarentena. Para tal, são apresentados os resultados de uma pesquisa da qual participaram 1858 pessoas, majoritariamente do Sul do Brasil, realizada por meio de questionário online aplicado de abril a maio de 2020, num momento de maior isolamento social no país. Os participantes caracteristicamente avaliaram a própria moradia de forma positiva, porém aspectos ligados à oferta de espaço e de acesso a elementos naturais (como plantas e luz natural) estiveram entre os mais citados como características deficientes da habitação. Além disso, condições inadequadas de iluminação estiveram relacionadas a alterações de padrão de sono ou nível de alerta. Observou-se ainda que moradores de casas, bem como residentes de habitações com mais quartos, apresentaram avaliações mais positivas da moradia como lugar para se passar a quarentena. Essas relações foram discutidas a partir do conhecimento acerca do papel que o controle da privacidade e o acesso a elementos naturais têm para a promoção de bem-estar, e por conseguinte, da satisfação. O estudo põe em ênfase a responsabilidade da arquitetura na promoção da qualidade de vida, permitindo repensar para um futuro próximo a adequabilidade dos contextos ambientais às condições do habitar humano.
... Pesquisas têm apresentado que espaços construídos que possuem associação de iluminação natural e com o contato com o espaço exterior, há melhora do desempenho de alunos em sala de aula (DEMIR; KONAN, 2013;HESCHONG, 2003a); e aumento da produtividade em estabelecimentos de escritório (HESCHONG, 2003b;LOFTNESS et al., 2008;MAYHOUB;CARTER, 2010). Existem evidências ainda de benefícios relacionados ao estado de saúde de pacientes em hospitais (BEAUCHEMIN; HAYS, 1996HAYS, , 1998CHOI;BELTRAN;KIM, 2012;WALCH et al., 2005). Por outro lado, edificações que não proporcionam iluminação natural adequada privam seus ocupantes da manutenção à sua saúde e do bem-estar enquanto nelas permanecem. ...
... Pesquisas têm apresentado que espaços construídos que possuem associação de iluminação natural e com o contato com o espaço exterior, há melhora do desempenho de alunos em sala de aula (DEMIR; KONAN, 2013;HESCHONG, 2003a); e aumento da produtividade em estabelecimentos de escritório (HESCHONG, 2003b;LOFTNESS et al., 2008;MAYHOUB;CARTER, 2010). Existem evidências ainda de benefícios relacionados ao estado de saúde de pacientes em hospitais (BEAUCHEMIN; HAYS, 1996HAYS, , 1998CHOI;BELTRAN;KIM, 2012;WALCH et al., 2005). Por outro lado, edificações que não proporcionam iluminação natural adequada privam seus ocupantes da manutenção à sua saúde e do bem-estar enquanto nelas permanecem. ...
A pandemia de COVID-19 impôs novos modos de relação entre as pessoas e seus ambientes de vida e nos desafiou a avaliar e repensar o habitat humano de modo a acomodar e dar suporte a tais mudanças. Assim, o objetivo deste trabalho é abordar características físicas do ambiente de moradia em sua relação com a satisfação ambiental no contexto da quarentena. Para tal, são apresentados os resultados de uma pesquisa da qual participaram 1858 pessoas, majoritariamente da região Sul do Brasil, realizada por meio de questionário online aplicado ao longo do período de abril a maio de 2020, num momento de maior isolamento social no país. Os participantes caracteristicamente avaliaram a própria moradia de forma positiva, porém aspectos ligados à oferta de espaço e de acesso a elementos naturais (como plantas e luz natural) estiveram entre os mais citados como características deficientes da habitação. Além disso, condições inadequadas de iluminação estiveram relacionadas a alterações de padrão de sono ou nível de alerta. Observou-se ainda que moradores de casas, bem como residentes de habitações com mais quartos, apresentaram avaliações mais positivas da moradia como lugar para se passar a quarentena. Essas relações foram discutidas a partir do conhecimento acerca do papel que o controle da privacidade e o acesso a elementos naturais têm para a promoção de saúde e bem-estar, e por conseguinte, da satisfação. O estudo põe em ênfase a responsabilidade da arquitetura na promoção da qualidade de vida, permitindo repensar para um futuro próximo a adequabilidade dos contextos ambientais às condições do habitar humano. ABSTRACT: The COVID-19 pandemic imposed new relations between people and their living environments and challenged us to review and rethink the human habitat to accommodate and support such changes. The aim of this work is to address physical characteristics of the living environment in relation to environmental satisfaction in the context of quarantine. To this end, we present the results of a survey which was attended by 1858 people, mostly from South Brazil, conducted through an online questionnaire applied from April to May 2020, at a time of greater social isolation in the country. Participants typically evaluated their own housing in a positive way, but aspects linked to the provision of space and access to natural elements (such as plants and natural light) were among the most frequently cited as deficient characteristics of housing. In addition, inadequate lighting conditions were related to changes in sleep patterns or alertness. It was also observed that residents of houses, as well as residents of houses with more rooms, presented more positive ratings of the house as a place to spend the quarantine. These relations were discussed based on the knowledge about the role that the control of privacy and access to natural elements have for the promotion of health and well-being, and therefore, satisfaction. The study highlights the responsibility of architecture in promoting quality of life, allowing to rethink for the near future the adequacy of environmental contexts to the conditions of human inhabit.
... Serotonin is classified as a pain suppressant hormone. [12] Under skin reduce the feeling of pain daylight Light VitaminD 4 4. International applied practices Emphasis will be placed on applications of some international hospitals in the field of Daylight to building a comprehensive theoretical framework for Daylight in hospitals, within their indoor spaces as follows: ...
... Most of the rooms had an acceptable diversity in terms of lighting. F. Unification of lighting: the lighting near the patient was homogeneous, and there was no difference between the illumination of the patient and the lighting in the surrounding area, which reduces stress on the patient 9. Conclusions Through the implementation of the practical side, the following conclusions were reached: 12 1-Patient rooms overlooking the east and south façades help recover patients compared to rooms on the north and west façades. 2-The closer the lighting is above the patient's head, and the TV wall, the more comfortable the feeling of space is, helping the patients heal. ...
Environmental sustainability is one of the most important, and one of the sustainability criteria is Daylight that trying to provide it in hospital spaces and which improve the patients status(healing of patients), by looking at studies concerned with the role of Daylight in the design of local hospitals, we find a knowledge gap emerged regarding the lack of studies that dealt with the design of Daylight in local hospitals and its effect on the healing of patients (a special problem for the research). The goal of the research is to determine the role of Daylight in hospital design. Research hypothesis: the Daylight affect the healing of patients at local hospitals by achieving comfortable zone at patient room and this affected by the orientation of these rooms and relationships between the location of head of patient and the TV wall at these rooms, in the practical side we select two hospitals and prepare the sites measurements by using LUX meter instrument, In this aspect, the intensity of the light and the indicators associated with it were measured, as a group of patients rooms were elected on multiple facades of the hospital building, as these rooms were numbered and their location in the plans based on the numbering system in the hospitals and then the details of the room were determined dimensions, the window’s location and its relationship with the bed, the location of the patient’s head in the room and the location of the TV wall (the front facing the patient’s head), as a mock net was drawn 95 cm from the ground level and the net was 50 cm away from the walls and the distance between One point and another is approximately 85 cm in both directions, and a mock square grid (2 meters * 2 meters) was drawn on the wall opposite the patient’s head (the TV wall) and the distance between one point and another is 50 cm. If the hospitals’ engineering plans were obtained, then the rooms for the patients’ rest were elected in the wards, provided that every two rooms were facing each other in the same wing after the sun’s movement was determined. The direction of those rooms was determined. The research reached a number of conclusions on designing natural lighting in local hospitals and determining within measures specific to the Iraqi environment. The most important conclusions of the eastern and southern directive were the orientation of the eastern and southern patient rooms to better rooms for patients, which in turn helps to heal patients.
... Viewing nature scenes may decrease pain perceptions by eliciting positive emotional responses and decreasing stress. Prospective environmental studies suggest that briefly viewing nature (7) can produce rapid and significant recovery from stress. Blood pressure typically declines within three minutes of viewing Video or VR presentations provide a relatively inexpensive strategy for pain relief (8) . ...
... The therapeutic and beneficial effect of sunlight and melatonin is widely documented in the literature, such as reducing the risk of dementia as well as reducing postoperative pain and increasing recovery. 15,16 Melatonin has even been reported to affect the degree of osseointegration of titanium implants. 17 Danilov and Kurganova 18 also discuss the involvement of melatonin efficacy in relation to pain syndromes. ...
Cite this article: Bone Joint Res 2023;12(3):199–201.
... Existing studies suggest that exposure to daylight and window views can positively impact patients' recovery and health outcomes during inpatient hospital stays in general. [5][6][7][8][9][10] The theory of supportive design and the biophilia hypothesis have also emphasized that having views of the natural surroundings, including trees, plants, and water, through windows can support improved physiological and psychological health outcomes among patients. [11,12] From a biological standpoint, the impacts of daylight exposure on patients' health, circadian rhythm, and psychological symptoms have been explained through physiological mechanisms caused by incident daylight exposure of the retina and serotonin secretion in the body. ...
Background
Heart disease is the leading cause of death in the United States. The length of stay (LOS) is a well-established parameter used to evaluate health outcomes among critically ill patients with heart disease in cardiac intensive care units (CICUs). While evidence suggests that the presence of daylight and window views can positively influence patients’ LOS, no studies to date have differentiated the impact of daylight from window views on heart disease patients. Also, existing research studies on the impact of daylight and window views have failed to account for key clinical and demographic variables that can impact the benefit of such interventions in CICUs.
Methods
This retrospective study investigated the impact of access to daylight vs. window views on CICU patients’ LOS. The study CICU is located in a hospital in the southeast United States and has rooms of the same size with different types of access to daylight and window views, including rooms with daylight and window views (with the patient bed located parallel to full-height, south-facing windows), rooms with daylight and no window views (with the patient bed located perpendicular to the windows), and windowless rooms. Data from electronic health records (EHRs) for the time-period 2015–2019 (n=2936) were analyzed to investigate the impact of room type on patients’ CICU LOS. Linear regression models were developed for the outcome of interest, controlling for potential confounding variables.
Results
Findings indicated that patients receiving mechanical ventilation in rooms with access to daylight and window views had shorter LOS durations (16.8 h) than those in windowless rooms. Sensitivity analysis for a subset of patients with LOS ≤3 days revealed that parallel bed placement to the windows and providing access to both daylight and window views significantly reduced their LOS compared to windowless rooms in the unit (P=0.007). Also, parallel bed placement to the window significantly reduced LOS in this patient subset for those with an experience of delirium (P=0.019), dementia (P=0.008), anxiety history (P=0.009), obesity (P=0.003), and those receiving palliative care (P=0.006) or mechanical ventilation (P=0.033).
Conclusions
Findings from this study could help architects make design decisions and determine optimal CICU room layouts. Identifying the patients who benefit most from direct access to daylight and window views may also help CICU stakeholders with patient assignments and hospital training programs.
... • Reduce depression [39] • Reduce pain medication intake [40,41] • Reduce stress for patients and caregivers [33] • Enhance recovery from surgery [42] • Reduce length of stay in hospital for some patients [43,44]. ...
The iHUB’s Living Laboratory Healthcare Sector Wide project aims to enable Healthcare Facilities (HCFs) to address multiple energy challenges: high energy use, peak demand, renewable energy utilisation, energy costs and the environmental impact of energy sources. As the largest portion of HCF energy use is attributed to indoor climate control and air quality, this report examines key performance indicators (KPIs) and metrics for indoor environment quality from the perspectives of health, building services, resilience and smart technologies. It is hoped that a broader set of KPIs, beyond typical normalised annual energy use intensity metrics (e.g., kWh/m2/year), can help build a sound business case for energy efficiency and renewable energy projects in HCFs, and add value to the core service of health care. This integrated systems approach is consistent with an EU Directive that requires energy efficiency improvements in buildings in the EU (addressing energy, climate change mitigation and adaptation objectives) to consider additional benefits for health and wellbeing, productivity and building value.
While the primary function of HCFs is patient/occupant care, the health and well-being of hospital users (patients, residents, staff and visitors) is affected by the quality of the indoor environment, impacting on their physical and psychological health. The main building quality / building services that are considered to contribute to indoor environment quality (IEQ) are thermal comfort, acoustic comfort, visual comfort, and indoor air quality. Some performance requirements for individual IEQ parameters are typically included in codes, standards and design guides. These building services are seen as supporting healthcare services but are also subject to scrutiny on cost and environmental impacts. This report highlights a vision of an integrated health and energy approach within the context of resource constraints, health-delivery models, climate change and resilience.
... /fpubh. . beneficial to physical and mental health (5), as they can reduce mental fatigue (6), relieve pressure (7), effectively improve cognitive ability (8), increase vitality (9), provide opportunities to participate in public activities, and promote public health benefits (10). The range of this research has been extended to include medical landscapes (11), psychological and social health (12), and all kinds of urban health benefits (13,14). ...
With the development of the urban park, people's cognition of the relationship between the environment and public health has been improved, and higher requirements for the living environment have been put forward. As an important group of park users, youths often have different needs regarding the health benefits brought by urban parks. To explore the potential relationship among youth's satisfaction with urban parks, their usage behavior, and health benefit perception, this article presents some constructive suggestions for the development of healthy landscapes in urban parks. Researchers have selected five typical urban parks from different areas in Qingdao, China. Furthermore, we have used the survey method by combining the practices of “issuing questionnaires, observing and interviewing” with the goal of collecting data on 500 park visitors in autumn, including information on social demography, the satisfaction of park landscape variables, and usage behavior and health perception. A linear regression model has been used to analyze the correlation among “landscape variables,” “usage behavior,” and “health benefit perception.” Results have shown that urban green landscapes and waterscapes can significantly affect youth's social health perception and static behavior. Moreover, static behaviors such as relaxation have a great impact on mental health perception. The results of this study will be beneficial in understanding youth's needs for landscapes when using urban parks. In addition, it will provide insight for the urban planners and landscape designers to design urban parks from the perspective of youth.
... took 22 per cent less analgesic medication per hour (p = .047), and had 21 per cent less pain medication costs (p = .047).', see: Walch et al. (2005). 506 The authors reported that: 'Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). ...
There is strong evidence that a poor indoor climate has a significant impact on people's health and well-being, and that in turn has wider socio-economic consequences, such as via its impact on work attendance, productivity and performance.
Four indoor hazards in particular were identified and used in the analysis: Damp and mould; Noise pollution; Indoor temperature (excess cold), and; Lack of daylight.
The objective of this study was to undertake a detailed analysis of the impact of the indoor climate across all age groups in the EU and the UK, Norway and Switzerland.
... Access to daylight and views through windows has proven critical for fostering a therapeutic and supportive healing environment (1)(2)(3)(4), ultimately manifesting in better patient outcomes such as shortened length of stay and reduced pain medication use (5)(6)(7)(8)(9)(10)(11). Although the relevance of these design factors from an experience and clinical quality perspective are clear, less is understood about how these factors make a hospital a more competitive choice for patients seeking care. ...
Evidence-based design has been fundamental to designing healthcare environments for patient outcomes and experience, yet few studies have studied how design factors drive patient choice. 652 patients who recently received care at hospitals across the United States were administered an online discrete choice survey to investigate the factors playing into their choice between hypothetical hospitals. Discrete choice models are widely used to model patient preferences among treatment alternatives, but few studies have utilized this approach to investigate healthcare design alternatives. In the current study, respondents were asked to choose between hypothetical hospitals that differed in patient room design, window features of the room, appointment availability, distance from home, insurance coverage, and HCAHPS ratings. The results demonstrate that patient room design that allowed unobscured access to daylight and views through windows, in-network insurance coverage, closer distance from home, and one-star higher patient experience rating increased the likelihood of a patient's hospital choice. The study broadly explores discrete choice model's applicability to healthcare design and its ability to quantify patient perceptions with a metric meaningful for hospital administrators.
... Daylight is an essential element for patients' wellbeing. Research shows that patients in sunny rooms feel less pain and stress and take less medication as compared to patients in rooms with less sunlight (Walch et al. 2005). This case study uses the LEED standard as a guideline for the daylight illuminance level calculation. ...
... Økt forekomst av dagslys kan redusere depresjon og forkorte innleggelser for deprimerte personer (Benedetti et al., 2001). Enkelte studier peker også på at økt dagslyseksponering reduserer opplevd smerte og stress ved sykehusinnleggelser, begrenser bruk av smertestillende medikamenter og reduserer antall liggedøgn (Walch et al., 2005). ...
Background and aim: The purpose of this article is to demonstrate how we can use nature cabins and their natural surroundings therapeutically. Method: Published research of relevance for this therapeutic practice is discussed in relation to and informed by experiences from practice, collected through conversations with therapists using the Outdoor care retreat at Rikshospitalet in Norway. Results: The literature review demonstrates how therapy in nature cabins can influence cognitive and emotional processes. All physical environments carry symbolic meanings; therefore, no therapy setting is neutral, and the setting will affect the client and therapist. Place attachment may contribute to create a safe foundation for exploration and self-development. The experiences from practice demonstrate how nature and natural objects are rich in potential for the creative application of symbols in therapy and opens for different stories on growth and development. Conclusions and implications: The evidence-based approach of this article supplies a therapeutic rationale to use cabins in natural surroundings more strategically for positive therapeutic outcomes. Keywords: nature, architecture, therapy settings, hospital environments
... Thus, the effect of indoor daylight levels on the clinical recovery process of the patient remains controversial. In addition, studies on the relationship between light levels and surgery outcomes have been limited to spinal surgery (13) or cardiac surgery (14), etc. and the sample size of these studies was generally small. There has not been an independent study on patients who undergo general surgeries. ...
Background
Indoor daylight levels can directly affect the physical and psychological state of people. However, the effect of indoor daylight levels on the clinical recovery process of the patient remains controversial. This study was to evaluate the effect of indoor daylight levels on hospital costs and the average length of stay (LOS) of a large patient population in general surgery wards.
Methods
Data were collected retrospectively and analyzed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured daylight levels in the patient rooms of general surgery and assessed their association with the total hospital costs and LOS of the patients.
Results
A total of 2,998 patients were included in this study with 1,478 each assigned to two daylight level groups after matching. Overall comparison of hospital total costs and LOS among patients according to daylight levels did not show a significant difference. Subgroup analysis showed when exposed to higher intensity of indoor daylight, illiterate patients had lower total hospital costs (CNY ¥13070.0 vs. ¥15210.3, p = 0.018) and shorter LOS (7 vs. 10 days, p = 0.011) as compared to those exposed to a lower intensity.
Conclusions
Indoor daylight levels were not associated with the hospital costs and LOS of patients in the wards of general surgery, except for those who were illiterate. It might be essential to design guidelines for medical staff and healthcare facilities to enhance the indoor environmental benefits of daylight for some specific populations.
... 46 Patients recovering from elective cervical and lumbar spinal surgery on the more brightly daylit side of another hospital experienced less perceived stress and took less analgesic medication than those in rooms on the more dimly daylit side. 47 Likewise, in yet another hospital, female patient stay post heart attack was also shorter in sunnier rooms compared to less daylit rooms. 48 Place and Well Benefits of day-lighting are also seen for nonpatient populations. ...
Overwhelmingly, evidence shows that health is directly correlated with the environment. It is thus imperative for integrative medicine practitioners to incorporate information about optimal environments in their toolkits for disease prevention.
... [62][63][64] Daylight has been associated with healing effects in healthcare, 65,66 contributing to less post-surgery pain medication and faster recovery. [67][68][69][70][71][72] Exposure to sunlight outdoors benefits health through vitamin D synthesis, which is essential for maintaining normal blood levels of calcium and phosphorus and thus ensuring healthy bones. 73,74 Additionally, sufficient levels of vitamin D have been found to protect against cancer, diabetes, influenza, cardiovascular and autoimmune diseases, [75][76][77] as well as mental health disorders like depression or schizophrenia. ...
Typical home lighting practice is mainly centred on visual aspects to enable safe movement between spaces, flexibility in multiuse spaces, a sense of aesthetics and energy efficiency. Whilst lighting impacts on the health of residents have not received similar consideration, this area is gaining increasing interest. This is even more important and actual in the context of the recent pandemic where people have been working or studying from home. A combination of bright daytime light and night-time darkness is essential for circadian entrainment and maintenance of a regular daily sleep–wake cycle, whereas exposure to light at night can negatively impact circadian rhythms and sleep patterns and ultimately lead to potential health problems. Additionally, lighting also has the potential to affect health through associated effects such as flicker, glare, optical hazards or electromagnetic fields. This article discusses the main areas of concern related to home lighting and outlines general recommendations to limit detrimental effects and contribute to good health.
... Reviews of controlled trials suggest that modifying some of the physical attributes of the healthcare environment may lead to reported improvements in the patient experience [7][8][9][10][11]. For example, attributes of the hospital have been associated with a shorter average length of stay [12,13] and significant differences in psychological and physical health outcomes for patients (such as a reduction in stress or pain) [14,15]. ...
The physical environment of a treatment centre may impact the well-being of patients and their perceptions of care. Outpatients with haematological cancer may be in contact with the treatment centre over long periods and could be particularly affected. This study aimed to identify haematological cancer patients' perceptions of supportive design elements in the hospital they attended and associations with self-reported mood or well-being. Outpatients from three large metropolitan hospitals in Australia were mailed a self-report questionnaire and responded to statements about the treatment centre concerning their sense of control over the physical surroundings; access to social support; and access to positive distractions. Participants also reported whether they felt the overall environment affected their mood or wellbeing. Of the outpatients who returned the questionnaire (n = 165), almost one-quarter (24%) agreed that the physical environment of the hospital affected their mood or well-being. Patients who disagreed that the hospital was a comfortable temperature or agreed that waiting rooms were crowded had significantly higher odds of reporting that the treatment environment affected their mood or wellbeing. Implementing systems to reduce overcrowding in waiting rooms and increasing patient control over personal temperature in clinics may be the most effective strategies to improve patient wellbeing.
... Die Patient*innen in den Zimmern mit weniger Sonnenlicht benötigten durchschnittlich 28,3 Prozent mehr Analgetika pro Stunde über die gesamte Aufenthaltsdauer als Patient*innen in den Sonnenlichtzimmern. Gerade in den ersten 24 Stunden nach der Operation, konnte ein statistisch signifikanter Unterschied zwischen der Interventionsgruppe und der Kontrollgruppe festgestellt werden(Walch et al., 2005).Dies liefert einen Hinweis, dass anscheinend in den ersten 24 Stunden nach einer Operation Patient*innen auf Licht bzw. Beleuchtung im Zusammenhang mit Schmerzen reagieren. ...
Es ist was es ist – das Individuum als soziales Wesen im
Spannungsfeld zwischen Beziehung, Gemeinschaft,
Wirtschaft und Gesellschaft
Der verständige Mensch „Homo sapiens sapiens“ ist das Produkt von jahrtausendlanger Evolution und Entwicklung. Er lebt und agiert heute in einer hochkomplexen Lebens- und Arbeitswelt. Die Eigenschaften und Besonderheiten der menschlichen Entwicklung und des menschlichen Zusammenlebens beschäftigen Psycholog*innen, Psychotherapeut*innen, Anthropolog*innen und Soziolog*
innen seit Jahrhunderten. Im Zuge der menschlichen Entstehungsgeschichte und der soziokulturellen Evolution entwickelte der Mensch sozialisations- und kulturabhängige Eigenschaften. Der aufrechte Gang, die kindliche Entwicklung, das Erlernen der Sprache und das Eingehen besonders komplexer sozialer Bindungen. Das Individuum entsteht durch den Menschen, mit dem Menschen und entwickelt sich mit Hilfe des Menschen zum sozialen Lebewesen.
Today, the design of a healthcare facility is not just about designing a performance-based building. In contrast, it gradually shifts to a design that respects and considers human needs and shows admiration for the medical team and patients. The literature review revealed many physical and psychological environmental factors that affect the Patient's health and recovery. Since most studies have focused on the effects of a single physical or psychological environment factor, in this research, we intend to investigate the results of the previous works and categorize them to provide a list of those affecting factors. In this research, through a deep review and the scientific method, the environmental factors and processes for measuring them are provided in a table. This table could be applied as a guiding tool for environmental designers and is a checklist for controlling the utilization of all the factors in environmental designs.
Context:
Distraction therapies are widely used in emergency departments to manage pediatric pain and distress. Little is known about which distraction techniques would translate best into the prehospital environment.
Objective:
To identify emergency department-based distraction techniques for managing pain and/or distress in pediatric patients who may be suitable for the prehospital environment.
Data sources:
Ovid Medline, Embase, CINAHL, Cochrane library, World Health Organization Clinical Trials Registry and Google Scholar were searched from their beginning to May 2022.
Study selection:
Studies were included if they reported on: (1) distraction techniques, (2) pediatric ED patients, (3) with pain and/or distress, and (4) used interventional or observational study designs. Studies utilizing interventions not feasible in the prehospital setting were excluded.
Data extraction:
Three authors independently assessed eligibility and completed data extraction.
Results:
The search yielded 4516 records, and 29 studies were included. Risk of bias across all studies was moderate to high. Children were 3 months to 18 years old. Digital, nondigital, and environmental distractors were tested using 12 pain and 15 distress measurement tools. No significant negative outcomes were reported. Fifteen studies reported reductions in self-reported pain and/or distress. Active, nondigital distractors most consistently reduced pain. There was insufficient evidence to support a distraction type for distress.
Limitations:
The heterogeneity in study design, distractors, measurement tools, and reporting restricted statistical analysis.
Conclusions:
Distraction tools that effectively reduce pediatric pain and/or distress in the ED exist and could be adapted to the prehospital environment. Further research is required to determine feasibility and effectiveness.
Objectives:
To identify the impact of clinical risk adjustment models for evaluating pain medication consumption differences between private rooms and a multibed ward.
Background:
Views of nature are reported to reduce anxiety and pain for patients. This often leads to prioritizing large windows with views for patient rooms; however, it is not clear how other factors influencing pain (e.g., patient demographics) may confound evaluations of room design.
Methods:
We identified 1,284 patients at the University of Michigan undergoing thyroidectomy where patients recovered in one of the two locations: a private room with a view to nature or a multibed ward with no windows. We used pain medication data from the electronic medical record and risk adjustment models to evaluate pain medication consumption between the room types.
Results:
Private room patients did not use more pain medications when measured using unadjusted morphine milligram equivalents (18.3 vs. 15.3 mg, p = .06). Risk adjusting for age, gender, comorbidities, opioid history, and procedure subtype resulted in private room patients demonstrating higher consumption of morphine milliequivalents (17.5 vs. 15.5 mg, p < .01). In contrast, risk adjusting for age, gender, opioid history, and selected comorbidities estimated higher pain medication consumption for multibed ward patients relative to private rooms (16.27 vs. 15.51 mg, p < .05).
Conclusion:
Estimated differences of pain medication consumption for patients in differently designed rooms varied depending on the risk adjustment model. These findings underscore the importance of understanding appropriate clinical measurement and risk adjustment strategies to accurately estimate the impact of design, before applying research into practice.
Biyomimesis kavramından yola çıkarak, sağlık ünitelerinin eylem alanlarına yönelik mekân kurgulanmasında kullanılabilecek doğa-tasarım etkileşimli modüler sağlık ünitelerinin tasarlanması
In the context of epidemic normalization, it is particularly important to explore environmental health from the perspective of adaptation of patient pathological characteristics to achieve sustainable goals. Although recent studies have confirmed the effects of ventilation and sound on human health and revealed that improvement in the quality of patient recovery can be achieved by controlling the material exchange between people and the environment, it remains unclear in terms of the mutual drivers of intangible material (ventilation and sound) and patient recovery quality. This study establishes a link between the physical environment and the quality of rehabilitation by reporting on the ventilation and noise levels at a rehabilitation facility for people with cognitive disorders. Second, a successful design optimization technique based on the adaption of pathological traits is suggested. The Centre fails to fulfil the ventilation and acoustic criteria for indoor comfort, according to the findings of the real testing. The study procedure demonstrates that (1) enhancing the space's openness to unblock the airflow can only have its effect maximised if the layout is taken into account to accommodate the wind direction.; (2) the spatial scale is not the only factor affecting the sound quality of the environment; and (3) increasing the openness of the area can improve the quality of sound transmission and reduce noise in the area, but at the same time, it will have some impact on other areas.
Itch and pain are two closely related sensations that receiving similar encodings at multiple levels. Accumulated evidences suggest that activation of the ventral lateral geniculate nucleus and intergeniculate leaflet (vLGN/IGL)-to-lateral and ventrolateral periaqueductal gray (l/vlPAG) projections mediates the antinociceptive effects of bright light therapy. Clinical study showed that bright light therapy may ameliorate cholestasis-induced pruritus. However, the underlying mechanism and whether this circuit participates in itch modulation remains unclear. In this study, chloroquine and histamine were utilized to induce acute itch models in mice. Neuronal activities in vLGN/IGL nucleus were evaluated with c-fos immunostaining as well as fiber photometry. Optogenetic manipulations were performed to activate or inhibit GABAergic neurons in the vLGN/IGL nucleus. Our results showed that the expressions of c-fos in vLGN/IGL were significantly increased upon both chloroquine- and histamine-induced acute itch stimuli. GABAergic neurons in vLGN/IGL were activated during histamine and chloroquine-induced scratching. Optogenetic activation of the vLGN/IGL GABAergic neurons exerts antipruritic effect, while inhibiting these neurons exerts pruritic effect. Our results provide evidence that GABAergic neurons in vLGN/IGL nucleus might play a crucial role in modulating itch, which may provide clue for application of bright light as an antipruritic treatment in clinic.
A report to the Ministry of the Environment (Finland) on daylight regulation and assessment methods
This paper aims to contribute to the formulation of criteria for the design of inpatient spaces through the efficient use of natural light as a factor that greatly influences human health. Specifically, it concerns the development of a methodology to assess the quality of natural light in the operating phase and demonstrate how the morphological and material characteristics of the hospital rooms can affect natural lighting. All variables affecting light in indoor spaces have been evaluated, with a focus on the photometric characteristics of finishing materials and furnishings, aimed at determining their contribution in terms of reflectance. This evaluation was based on pre-occupancy evaluation methodologies, which allow comparing actual and simulated natural light conditions, and was tested on a sample of inpatient rooms located in a hospital in Rome. Improvement design solutions were proposed and simulated through the evaluation of physical variables including daylight factor, illuminance, color rendering index, etc., selecting the ones with appreciable improvements over ante operam natural light conditions. The methodology allows control over the effects of individual interventions, specific to each variable, highlighting their impact on visual comfort and their feasibility from an economic and operational point of view.
Daylight access in healthcare facilities is essential for creating comfortable ambiance conditions for the patients during their accommodation in a hospital. The aim of this paper is to investigate how the window size, the location (Paralimni in Cyprus and Brussels in Belgium), the room orientation and patients’ gaze direction have an impact on visual and non-visual effects. This research focuses on hospitals’ most typical patient room: the double room (3.50m * 5.50m). The building parameters under study arc eight orientations and three window sizes. Moreover, other parameters are the timing (season and hour in a day), the patient placement inside the room, and the patient gaze directions. For this study, computer simulations are used for daylight assessment using climatc-bascd daylight metrics and CIE S026 melanopic metrics for non-visual effects. Research findings show that it is possible to examine design options through a comprehensive investigation of climatc-bascd daylight metrics and CIE S 026 melanopic metrics for optimised performance for visual and non-visual effects.
This textbook is written as a comprehensive overview of acute pain management. It is designed to guide clinicians through an impressive array of different options available to them and to patients. There has been a flurry of interest in the extent to which acute pain can become chronic pain, and how we might reduce the incidence of such chronicity. This overview covers a wide range of treatments for pain management, including the anatomy of pain pathways, the pathophysiology of severe pain, pain assessment, therapeutic guidelines, analgesic options, organization of pain services, and the role of anesthesiologists, surgeons, pharmacists, and nurses in providing optimal care. It also discusses the use of patient-controlled analgesia and how this may or may not be effective and useful.
Children with a history of trauma or adverse childhood experiences may be at higher risk for poor psychological and physical responses to medical experiences aimed at enhancing their well-being. Health care institutions are aware of the need for integration of trauma-informed care (TIC) practices yet struggle to find frameworks that promote resiliency to medical stress. An approach called neuroprotective care buffers the effects of toxic stress negatively affecting child health and well-being. Although often used in neonatal and cardiac intensive care units, the development and broad implementation of universal neuroprotective care measures across age groups and hospital settings has not been previously explored. An expanded neuroprotective care protocol takes a prevention approach to TIC. It fits a TIC framework, accounts for children’s ecological, biological, and developmental needs, protects them against medical traumatic stress and retraumatization, and provides a tailored, measurable approach that systematically preserves child well-being within hospital settings.
Die Ökopsychosomatik beschreibt die Wirkung von stofflichen sowie nicht stofflichen Stimulanzien aus Ökosystemen auf die psychische und somatische Gesundheit des Menschen. Sie erforscht die pathogenen und salutogenen Umwelt- und Natureinflüsse, um die daraus gewonnenen Erkenntnisse für die öffentliche Gesundheit sowie für die Therapie von Krankheitszuständen nutzbar zu machen. Im ökopsychosomatischen Paradigma wird der menschliche Organismus als eingebunden in einen evolutionsbedingten Funktionskreis mit seinen natürlichen Lebensräumen betrachtet. Der Mensch ist Teil der Biodiversität. Nicht nur Umweltschadstoffe wirken sich ungünstig auf Gesundheit und Genesungsaussichten aus, sondern auch die Durchbrechung des Funktionskreises durch Trennung von den Einflüssen intakter Ökosysteme. Die „Waldmedizin“ ist als evidenzbasiertes Beispiel der angewandten Ökopsychosomatik und Ökoimmunologie zu betrachten. Der Artikel gibt einen Überblick über das interdisziplinäre Feld der Ökopsychosomatik und Ökoimmunologie.
Im Wintersemester 2020/21 haben sich 12 Architekturstudierende im Rahmen des ARCH4HEALTH Student Research Lab an der Professur für Sozial- und Gesundheitsbauten der TU Dresden mit der architektonischen Gestaltung von Notaufnahmen beschäftigt. Im Rahmen von eigenen Forschungsprojekten sind sie aktuellen Fragestellungen zu Nutzerbedürfnissen, der Gestaltung von einzelnen Bereichen einer Notaufnahme oder Planungsmethoden nachgegangen und haben aus ihren Erkenntnissen erste Ideen und Konzepte abgeleitet. In diesem Buch werden die Ergebnisse der studentischen Forschungsprojekte präsentiert.
Buildings are the primary human habitat and their health impacts can be far-reaching across time and space. Homes, workplaces, schools and other buildings can be designed not only as refuges from harsh weather, noise and other environmental harms but also as places that support social interaction and ontological security. This chapter introduces several ways of conceptualising healthy buildings before a detailed exploration of the planning and design goals in the outer ring of the THRIVES framework: acoustic and thermal comfort, affordability, tenure security, lighting and space. The Nightingale Housing model from Australia is provided as an example of sustainable and healthy housing that aims to meet the needs of climate change mitigation and adaptation. Emerging topics in healthy building design are discussed, such as how sleep is influenced by lighting, noise and thermal comfort.
Background:
Natural views are an important design strategy for the application of ecological resources in built environments. Numerous clinical studies have indicated that views of nature-for example, plants-can effectively promote patient recovery by relieving their postoperative pains and negative emotions during hospitalization.
Aims:
This study demonstrates an intelligent method that develops algorithms of using collision detection techniques in Building Information Modeling to evaluate outdoor plant visibility for patients.
Methods:
These algorithms are digitized into a Revit plug-in program, which can be viewed as a design-aided tool for architects with the purpose of informing healthcare environment design in the decision-making process.
Results:
Its acceptability and effectiveness are evaluated based on the consultations in beta tests.
Conclusions:
It is believed that this method can improve the work efficiency of evaluating natural views in wards and help architects implement an informed design of built environments for better health performance. All findings in this study can contribute to the development of computational intelligence and social sustainability in the near future.
Light is a powerful modulator of non-visual functions. Although accumulating evidence suggests an antinociceptive effect of bright light treatment, the precise circuits that mediate the effects of light on nocifensive behaviors remain unclear. Here, we show that bright light treatment suppresses mouse nocifensive behaviors through a visual circuit related to the lateral and ventral lateral parts of the periaqueductal gray area (l/vlPAG). Specifically, a subset of retinal ganglion cells (RGCs) innervates GABAergic neurons in the ventral lateral geniculate nucleus and intergeniculate leaflet (vLGN/IGL), which in turn inhibit GABAergic neurons in the l/vlPAG. The activation of vLGN/IGL-projecting RGCs, activation of l/vlPAG-projecting vLGN/IGL neurons, or inhibition of postsynaptic l/vlPAG neurons is sufficient to suppress nocifensive behaviors. Importantly, we demonstrate that the antinociceptive effects of bright light treatment are dependent on the activation of the retina-vLGN/IGL-l/vlPAG pathway. Together, our results delineate an l/vlPAG-related visual circuit underlying the antinociceptive effects of bright light treatment.
Planlama ve Tasarım konularını farklı ölçek ve bakış açılarıyla ele almak üzere Endüstriyel Tasarım, İçmimarlık, Mimarlık ve Şehir ve Bölge Planlama olmak üzere farklı disiplinler ve meslek grupları ortaya çıkmıştır. Her bir disiplinin planlama/tasarım sürecine olan yaklaşımı farklılık göstermektedir. Amacın, ölçeğin ve sürecin değişmesinin yanı sıra; kavramlar, alan tanımı/algılaması/anlayışı da değişiklik göstermektedir. Ancak, hangi ölçekte çalışılırsa çalışılsın üst ya da alt ölçekler birbiriyle ilişkili olmak durumundadır.
“Birimden Bütüne İnterdisipliner Tasarım Yaklaşımları” isimli bu kitapta da, ürün tasarımından, kentsel mekân tasarımına kadar geniş bir yelpazeye sahip tasarım fikirleri yer almakla beraber her bir disiplin birim-bütün anlayışını kendi meslek sınırları içinde de değerlendirerek ele almıştır. Bölüm yazarları, Türkiye’de yer alan farklı üniversitelerin endüstriyel tasarım, içmimarlık, mimarlık ve şehir ve bölge planlama bölümlerinde görev yapan değerli akademisyen ve paydaşlardan oluşmaktadır.
Background:
Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.
Methods:
This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.
Results:
Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220-3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125-0.805).
Conclusions:
Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.
Dante Alghieri died in 1321, there 2021 is the 700th Anniversary. His best known work is the Divine Comedy which explores Dante’s journey through the three realms of the Underworld. Each realm is associated with three different sensations: Inferno- bodily (Pain), Purgatorio – acoustic (Music) and Paradiso – visual (Light). The progression of the painful experiences and the resolution through music and light mirrors the modern understanding of pain and its management. Pain is a continuum from nociceptive to more severe neuropathic painful experiences. Music has both direct and indirect benefits, and can help with coping. Sunlight promotes wellbeing and self-awareness.
Sleep disruption is ubiquitous in patients admitted to the ICU. For survivors of critical illness, sleep disruption is often persistent and associated with an increased risk of functional impairment and reduced quality of life. Optimising sleep should be considered as a high priority in its own right and as a foundation for the success of other strategies aimed at improving recovery in survivors of critical illness. Routine measurement is a key first step in order to implement timely and appropriately targeted interventions. A holistic approach to optimising sleep requires consideration of patient, environmental, and staff factors, informed by the best available evidence.
A high-intensity fluorescent lighting system, tilted downward toward the head, and emitting negligible levels of ultraviolet radiation, was tested under two random crossover protocols in winter-depressed patients: 30-minute sessions at (a) 3,000 lux vs. 10,000 lux in early morning, and (b) morning vs. evening sessions at 10,000 lux. Judgment of clinical remission was based jointly on relative and absolute score improvements on a Structured Interview Guide for the Hamilton Depression Scale--Seasonal Affective Disorder Version (SIGH-SAD) and a set of supplementary atypical-vegetative items. Data are presented for 24 subjects who showed relapse upon withdrawal. An overall remission rate of 75 percent was found for morning light at 10,000 lux. The rates for evening light (25%) and 3,000 lux morning light (19%) were significantly lower. The remission rate for morning light treatment of 10,000 lux for 30 minutes approximately equalled 2,500 lux treatment for 2 hours (data from our earlier studies), suggesting a reciprocity between dosing dimensions of intensity and duration. No pathological changes were revealed by ophthalmological examinations given after 2 to 6 weeks of daily treatment.
Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined
to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three
surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays,
received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in
similar rooms with windows facing a brick building wall.
Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
Patients with seasonal affective disorder (SAD) were treated for 1 week either with a daily 1-h morning walk outdoors (natural light) or low-dose artificial light (0.5 h@2800 lux). The latter treatment (given under double-blind conditions) can be considered mainly placebo and did not improve any of the depression self-ratings, whereas natural light exposure improved all self-ratings. According to the Hamilton depression score, 25% remitted after low-dose artificial light and 50% after the walk. Sleep duration or timing were not crucial for the therapeutic response. The morning walk phase-advanced the onset and/or offset of salivary melatonin secretion, but individual clinical improvement could not be correlated with specific phase-shifts. Morning cortisol was decreased. Low-dose artificial light did not modify melatonin or cortisol patterns. This is the first study to provide evidence for the use of outdoor light exposure as a potential alternative or adjuvant to conventional artificial light therapy in SAD.
Bright light therapy is the recommended treatment for winter seasonal affective disorder (SAD). However, the studies with the best placebo controls have not been able to demonstrate that light treatment has a benefit beyond its placebo effect.
Ninety-six patients with SAD completed the study. Patients were randomly assigned to 1 of 3 treatments for 4 weeks, each 1.5 hours per day: morning light (average start time about 6 AM), evening light (average start about 9 PM), or morning placebo (average start about 6 AM). The bright light (approximately 6000 lux) was produced by light boxes, and the placebos were sham negative-ion generators. Depression ratings using the Structured Interview Guide for the Hamilton Depression Rating Scale, SAD version (SIGH-SAD) were performed weekly.
There were no differences among the 3 groups in expectation ratings or mean depression scores after 4 weeks of treatment. However, strict response criteria revealed statistically significant differences; after 3 weeks of treatment morning light produced more of the complete or almost complete remissions than placebo. By 1 criterion (24-item SIGH-SAD score <50% of baseline and < or =8), 61% of the patients responded to morning light, 50% to evening light, and 32% to placebo after 4 weeks of treatment.
Bright light therapy had a specific antidepressant effect beyond its placebo effect, but it took at least 3 weeks for a significant effect to develop. The benefit of light over placebo was in producing more of the full remissions.
This study was conducted to investigate the serum level of serotonin (S-5-HT) in patients with temporomandibular disorders (TMD) of muscular origin, i.e., localized myalgia, and to compare it to that found in healthy individuals and patients with fibromyalgia. A second aim was to investigate the association between S-5-HT and pain parameters.
Twenty patients with localized myalgia participated in the study. Twenty age- and gender-matched healthy individuals and twenty patients with fibromyalgia served as controls. The participants were examined clinically as to the condition of the temporomandibular region and S-5-HT.
The levels of S-5-HT did not differ significantly between the groups. However, in patients with localized myalgia there was a negative correlation between S-5-HT and tenderness of the temporomandibular muscles.
The results of this study indicate that allodynia of orofacial muscles in patients with TMD is significantly related to S-5-HT concentration.
About 5% of pregnant women meet criteria for major depression. No pharmacotherapy is specifically approved for antepartum depression; novel treatment approaches may be welcome. The authors explored the use of morning bright light therapy for antepartum depression.
An open trial of bright light therapy in an A-B-A design was conducted for 3-5 weeks in 16 pregnant patients with major depression. The Hamilton Depression Rating Scale, Seasonal Affective Disorders Version, was administered to assess changes in mood. A follow-up questionnaire was used to assess outcome after delivery.
After 3 weeks of treatment, mean depression ratings improved by 49%. Benefits were seen through 5 weeks of treatment. There was no evidence of adverse effects of light therapy on pregnancy.
These data provide evidence that morning light therapy has an antidepressant effect during pregnancy. A randomized controlled trial is warranted to test this alternative to medication.
To explore whether mortality from female breast, ovarian, colon, and prostate cancer were negatively associated with exposure to sunlight.
A death certificate based case-control study of mortality was conducted into five cancers: female breast, ovarian, colon, prostate, and non-melanoma skin cancer (as a positive control) to examine associations with residential and occupational exposure to sunlight. Cases were all deaths from these cancers between 1984 and 1995 in 24 states of the United States. Controls, which were age frequency matched to a series of cases, excluded deaths from cancer and certain neurological diseases. Multiple logistic regression was used in a model that included age, sex, race, residential exposure to sunlight (based on region), and socioeconomic status, occupational exposure to sunlight, and physical activity (the last three based on usual occupation).
Residential exposure to sunlight was negatively and significantly associated with mortality from female breast, ovarian, prostate, and colon cancer. Only female breast and colon cancer, however, also showed significant negative associations with jobs with the highest occupational exposure to sunlight (odds ratio (OR) 0.82 (95% confidence interval (95% CI) 0.70 to 0.97) for female breast cancer; OR 0.90 (95% CI 0.86 to 0.94) for colon cancer). For both cancers, the negative association with occupational sunlight was greatest in the geographical region of highest exposure to sunlight and was independent of physical activity on the job. Non-melanoma skin cancer, as expected, was positively associated with both residential and occupational sunlight.
In this exploratory study, unlike mortality from non-melanoma skin cancer, mortality from female breast cancer and colon cancer were negatively associated with both residential and occupational sunlight.
Seven hundred and twelve patients who received 10 mg of morphine sulfate or 20 mg of pentazocine or both for acute postoperative pain were studied for possible correlations between pain relief and patient characteristics. Age proved to be highly correlated with pain relief reports, in that the older age group reported more pain relief. These data are consistent with the results of earlier studies of experimental pain, as well as with the results of studies of the response of patients to placebos. We believe that it is more important to adjust dosage of a narcotic analgesic in relation to a patient's age than in relation to height, weight, or other patient characteristics.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Patients with seasonal affective disorder (SAD) were treated for 1 week either with a daily 1-h morning walk outdoors (natural light) or low-dose artificial light (0.5 h @ 2800 lux). The latter treatment (given under double-blind conditions) can be considered mainly placebo and did not improve any of the depression self-ratings, whereas natural light exposure improved all self-ratings. According to the Hamilton depression score, 25% remitted after low-dose artificial light and 50% after the walk. Sleep duration or timing were not crucial for the therapeutic response. The morning walk phase-advanced the onset and/or offset of salivary melatonin secretion, but individual clinical improvement could not be correlated with specific phase-shifts. Morning cortisol was decreased. Low-dose artificial light did not modify melatonin or cortisol patterns. This is the first study to provide evidence for the use of outdoor light exposure as a potential alternative or adjuvant to conventional artificial light therapy in SAD.
Seasonal variations of certain cerebrospinal fluid (CSF) parameters have been reported in several psychiatric patient groups, but there is little or no available information on such variations in normal individuals. To evaluate possible circannual variations in the major CSF monoamine metabolites and an array of neuropeptide measures, we analyzed data from 20 to 34 normal volunteers studied over a 3-year period. Data were analyzed for seasonal and cross-seasonal fluctuations by one-way analysis of variance (ANOVA) followed by Bonferroni t tests when appropriate. The only statistically significant findings by ANOVA were for CSF 5-hydroxyindoleacetic acid (5HIAA) and homovanillic acid (HVA), both of which were lowest during spring and highest during summer. These spring-summer differences were statistically significant following Bonferroni t tests. These data support a growing body of evidence indicating a substantial seasonal effect on the serotonin system and suggest that any group analysis of CSF 5HIAA, and perhaps HVA, should take into account circannual variability.
The density of platelet 3H-imipramine binding sites (Bmax) was investigated in seven inpatients with winter depression before and after incandescent light treatment and in seven healthy volunteers within a 7-day interval without light exposure. A significantly lower mean Bmax value was found in the depressed patients compared to the controls. After light treatment, parallel to a marked clinical improvement, Bmax increased in each patient and reached or even exceeded the mean values of the controls. These results indicate that in patients with winter depression the decreased Bmax value is state-dependent. The incandescent light treatment has beneficial effect in winter depressives and can influence Bmax values.
A cross-sectional sample of adults, ages 20-79, were administered an adjective rating scale instrument measuring multiple affective states, including items from the Profile of Mood States (POMS) instrument. Confirmatory item factor analysis supported, for the most part, a priori assignments of items to scales based upon prior research, but revealed a few small, additional item factors that were cross-validated in a second sample. Items measuring different aspects of psychological distress, including anxiety and depressive affect, showed appreciable skew and kurtosis, with a substantial proportion of respondents indicating no perceived distress. Items measuring psychological well-being tended to show more normal response distributions. Tests of age-related invariance in item factor structure indicated that the unstandardized factor pattern weights (loadings) were not fully equivalent across two age groups, but showed that the same configuration of items loading on factors was supported. The scales perform well enough to justify continued use in older populations, but further research on the contributions of item distributions to age differences in factor loadings is needed.
A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
Serotonin N-acetyltransferase (EC 2.3.1.5) activity in the rat pineal organ is enhanced 50-fold at night. Rats exposed to light at night or kept in darkness during the daytime do not show any elevation of enzyme activity. Treatment with reserpine, a compound that depletes norepinephrine from nerves, 1-propranolol, a beta-adrenergic blocking agent, or cycloheximide, an inhibitor of protein synthesis, abolishes the nocturnal increase in serotonin N-acetyltransferase activity, indicating that the enzyme activity is modulated by neural release of norepinephrine from sympathetic nerves via beta-adrenergic receptors, and that the increase in enzyme activity is due to synthesis of new enzyme molecules. When rats are exposed to light at night or injected with 1-propranolol, there is a precipitous fall in serotonin N-acetyltransferase activity (half-life 5 min). Cycloheximide administered at night results in a slow fall in enzyme activity (half-life 60 min). When rats are kept in darkness and then exposed to light for 10 min, L-isoproterenol rapidly initiates the elevation of serotonin N-acetyltransferase activity to the initial level in 60 min. On the other hand, when the rats are kept in continuous light, L-isoproterenol initiates an increase in serotonin N-acetyltransferase activity after a lag phase of 60 min. The results indicate that there are two types of changes in serotonin N-acetyltransferase activity; a rapid increase and decrease mediated by the beta-adrenergic receptor, and a slow increase and decrease in enzyme activity that appears to represent the turnover of the enzyme.
In the present investigation the brains of 56 humans (32 males and 24 females, age 26 to 91 years), in most of the cases dying from myocardial infarction or malignancies but in no case with any known neurological or psychiaric disorder have been analysed post mortem for monoamines and some of their precursors and metabolites. The analysis of post-mortem brain data is difficult. Great care must be taken to exclude false correlations owing to heterogeneity of the material with respect to various factors such as age, sex, diagnosis, agonal states and post-mortem delay. In the present investigation the authors tried to check for these factors. They cannot exclude that the shape of the biorhythmic curves presented here have been distorted by such heterogeneities, but the analyses indicate that circadian and seasonal fluctuations of biogenic amines and their metabolites do indeed occur in the human brain. The observations are supported by animal data, which like the human observations indicate marked regional differences.
An endogenous central nervous system pain-modulating network, with links in the mid brain, medulla, and spinal cord, has recently been discovered. This system produces analgesia by interfering with afferent transmission of neural messages produced by intense stimuli. Although other neurotransmitters are involved, the analgesia produced by this system depends on the release of endogenous opioid substances, generically referred to as endorphins. The system is set in motion by clinically significant pain--such as that resulting from bony fractures or postoperative pain. The analgesia network monitors the pain and controls it at the level of the spinal cord. Complex psychologic factors play an important role in the variability of perceived pain, partly because of their ability to trigger this pain-suppressing system. For example, this system contributes to the analgesic potency of placebo administration and is also activated by stress. Knowledge of this analgesia system has greatly expanded our understanding of the mechanisms underlying pain management. Opiates, like morphine and meperidine, produce analgesia by mimicking the action of endorphins in the pain. Tricyclic drugs may produce analgesia by enhancing the nonendorphin links of the same system. Future research on this system will provide new insights and, consequently, new approaches to the management of pain.
Light therapy (bright or dim light) was given at different times (morning or evening) to 27 unmedicated patients with nonseasonal depression (according to DSM-III-R criteria) and 16 normal volunteers. Circadian rhythms in body temperature were measured before and after light therapy. Bright light significantly improved clinical symptoms of depression, as measured by the Hamilton Rating Scale for Depression (HRSD), independent of the time of phototherapy. Dim light therapy had no effect on HRSD scores. Circadian rhythms of body temperatures in patients with affective disorder were more sensitive to the entraining effects of bright light than those of normal subjects, but these effects were not related to clinical improvement. Bright light exposure has an antidepressant effect on patients with nonseasonal depression, but the effect is unlikely to be mediated via the same circadian system that regulates body temperature.
In general, ovarian cancer incidence and mortality is higher in northern than southern latitudes. This ecologic study tests the hypothesis that vitamin D produced in the skin from sunlight exposure may be associated with a protective action in ovarian cancer mortality.
The association between average annual sunlight energy and age-specific ovarian cancer mortality rates in counties containing the 100 largest US cities was evaluated for 1979-1988. Simple linear regression was performed by decade using sunlight and ozone as independent variables and ovarian cancer rates as the dependent variable. Multiple regression was used to adjust for ozone and sulphur dioxide, since these atmospheric components may absorb ultraviolet light.
Fatal ovarian cancer in these areas was inversely proportional to mean annual intensity of local sunlight in a univariate analysis (P = 0.0001), and in a regression adjusted for air pollution (P = 0.04). The association was also seen when restricted to 27 major urban areas of the US; however, probably due to a small sample size, this statistic did not reach significance.
This ecologic study supports the hypothesis that sunlight may be a protective factor for ovarian cancer mortality.
Bright light therapy is an effective treatment for seasonal affective disorder, an uncommon condition marked by mild winter depression. Bright lights have been used as adjuncts in the pharmacological treatment of other types of depressive illness. The rooms in our psychiatric inpatient unit are so placed that half are bright and sunny and the rest are not. Reasoning that some patients were getting light therapy inadvertently, we compared the lengths of stay of depressed patients in sunny rooms with those of patients in dull rooms. Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05.
We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (MI). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU.
Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in MI, and that this natural experiment merits replication.
The relative shortage of light during the decreasing photoperiod may compromise well-being. Earlier studies suggest that bright-light exposure may be of help to alleviate winter-bound symptoms.
We carried out a field study with exposure to bright light on office employees during winter.
Repeated bright-light exposure improved vitality and reduced depressive symptoms. The benefit was observed not only in healthy subjects with season-dependent symptoms but also in those not having the seasonal variation.
Bright-light exposure during winter appears to be effective at improving the health-related quality of life and alleviating distress in healthy subjects.
Administration of bright light is a useful option to improve vitality and mood among subjects working indoors in wintertime. LIMITATIONS OF STUDY: Our field setting used self-reports, not interviews, for the assessment of outcome.
This review provides an overview of 59 randomized placebo-controlled trials that examined the analgesic effect of antidepressants. To summarize, there is significant evidence that the tricyclic group of antidepressants is analgesic and that trazodone is not; the data regarding selective serotonin reuptake inhibitors are conflicting. To date, there are no randomized controlled trials examining the potential analgesic action of nefazodone or venlafaxine, but on the basis of initial clinical reports and its structural similarity to other analgesics, venlafaxine shows promise as an analgesic.
Bright artificial light improves non-seasonal depression. Preliminary observations suggest that sunlight could share this effect.
Length of hospitalization was recorded for a sample of 415 unipolar and 187 bipolar depressed inpatients, assigned to rooms with eastern (E) or western (W) windows.
Bipolar inpatients in E rooms (exposed to direct sunlight in the morning) had a mean 3.67-day shorter hospital stay than patients in W rooms. No effect was found in unipolar inpatients.
Natural sunlight can be an underestimated and uncontrolled light therapy for bipolar depression.
This is a naturalistic retrospective observation, which needs to be confirmed by prospective studies.
For the first time in more than a decade, health care spending per capita rose at a double-digit rate in 2001, growing 10 percent. Spending on hospital services (both inpatient and outpatient) surged by 12 percent in 2001, reflecting increases in both hospital payment rates and use of hospital services. Hospital spending was the key driver of overall cost growth, accounting for more than half of the total increase. Prescription drug spending growth declined for the second straight year and was overtaken by spending on outpatient hospital services as the fastest-growing component of total spending. Driven by these cost trends and other factors, premiums for employment-based health insurance increased 12.7 percent in 2002--the largest increase since 1990. But taking account of the sizable amount of "benefit buy-down" in 2002, the true increase in the cost of health insurance for employers and employees was about 15 percent. Early evidence from 2002 suggests that health care cost trends are now beginning to slow, possibly setting the stage for more moderate premium growth in the future.
Little is known about risk factors that increase the risk of development of opioid side effects. Our objective was to evaluate the effect of the type of opioid, age, gender, and race on the incidence of side effects from short-term opioid use.
A secondary analysis of a retrospective cohort study in 35 community-based and tertiary hospitals was done. There were 8855 black or white subjects aged 16 years and older. Patients received meperidine (INN, pethidine), morphine, or fentanyl as part of their treatment. Measurements were made to assess the presence of nausea and vomiting and respiratory depression.
Of the patients, 26% had nausea and vomiting and 1.5% had respiratory depression after opioid administration. After adjustment for opioid dose, route of administration, age, gender, and race, meperidine produced less nausea and vomiting (odds ratio [OR] = 0.7; 95% confidence interval [CI], 0.5-0.8) and less respiratory depression (OR = 0.6; 95% CI, 0.2-0.9) than morphine. The risk of respiratory depression increased with age. Compared with patients aged between 16 and 45 years, those aged between 61 and 70 years had 2.8 times the risk of development of respiratory depression (95% CI, 1.2-6.6); those aged between 71 and 80 years had 5.4 times the risk (95% CI, 2.4-11.8); and those aged older than 80 years had 8.7 times the risk (95% CI, 3.8-20.0). Men had less nausea and vomiting than women (OR = 0.5; 95% CI, 0.4-0.6). White subjects had more nausea and vomiting than black subjects (OR = 1.4; 95% CI, 1.1-1.7).
Meperidine produced fewer side effects than morphine during short-term use. The risk of respiratory depression increases substantially after 60 years of age. Women have nausea and vomiting more often than men. The effect of race deserves further investigation.
A renewed interest in hospital design in the UK, prompted by the Private Finance Initiative, provides an opportunity to consider hospitals as 'therapeutic environments'. Noting that the therapeutic value of hospitals is related to their physical, social and symbolic design, this paper argues that 'expert' knowledges have encouraged the development of hospitals that all-too-rarely provide benign settings for promoting patient recovery and healing. The recent programme of hospital building in the UK, however, has been accompanied by a vigorous debate over what constitutes good hospital design, with four significant ideas emerging: hospitals should be clinically efficient, be integrated within the community, be accessible to consumers and the public, and encourage patient and staff well-being. Suggesting that all four goals demand careful consideration of the real and imagined spatiality of hospital environments, the paper concludes by suggesting ways that health geographers can contribute to debates surrounding PFI hospital design.
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