Article

The Effect of Sunlight on Postoperative Analgesic Medication Use: A Prospective Study of Patients Undergoing Spinal Surgery

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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.

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...  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). ...
Thesis
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.
... exposed to 46% higher-intensity sunlight on average. This study found that patients exposed to an increased intensity of sunlight experienced less perceived stress, marginally less pain, took 22% less analgesic medication per hour, and had 21% less pain medication costs [14]. Figure 1 and 2 shows the position of the pediatric nurse station for both the building types. ...
... . the historic wall of burns center A recent randomized prospective study assessed whether the amount of sunlight in a hospital room modifies a patient's psycho-social health, quantity of analgesic medication used, and pain medication cost [14]. Patients undergoing elective cervical and lumbar spinal surgeries were admitted to the bright or the dim side of the same hospital unit postoperatively. ...
... Patients staying on the bright side of the hospital unit were exposed to 46% higher-intensity sunlight on average. This study found that patients exposed to an increased intensity of sunlight experienced less perceived stress, marginally less pain, took 22% less analgesic medication per hour, and had 21% less pain medication costs [14]. ...
... Gardens in healthcare environments are calming in themselves. Views from Skylight have mechanisms such as fostering access to social support and providing opportunities for positive escape and sense of control with respect to stressful clinical settings [9][10][11][12][13]. A peaceful nature scene is superlative in inducing feelings of calmness and safety [9][10][11][12][13]. ...
... Views from Skylight have mechanisms such as fostering access to social support and providing opportunities for positive escape and sense of control with respect to stressful clinical settings [9][10][11][12][13]. A peaceful nature scene is superlative in inducing feelings of calmness and safety [9][10][11][12][13]. ...
... The psychological behavioral effects of natural light, on humans have been investigated in the fields of mood satisfaction. Human biology and psychology [13] studies indicate that: neuron hormonal mechanisms regulated by the appropriate environmental lighting can cause in elevated mood, alertness, and arousal, resulting an increased productivity and efficiency and reduced cognitive impairment and sleepiness. However, limited studies have carried out on the effect of daylight, and the presence of windows on healthcare employees' health and performance, for Asian countries, specially Pakistan (Table 1). ...
... 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. ...
Article
Full-text available
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.
... 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. ...
Conference Paper
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.
... 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. ...
Article
Full-text available
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.
... 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. ...
Article
Full-text available
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.
... 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]. ...
Conference Paper
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. ...
Article
Full-text available
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.
... (Zadeh et al., 2014), visual task performance (Figueiro et al., 2006), and medication dispensing errors (Buchanan et al., 1991). The existing studies also show the relationship between light exposure and patient outcomes including patient satisfaction (Gharaveis et al., 2016), length of stay (Beauchemin & Hays, 1996;Benedetti et al., 2001;Choi et al., 2012;Park et al., 2018), mood (Beauchemin & Hays, 1996;Walch et al., 2005), pain (Walch et al., 2005;Zadeh et al., 2014), and sleep (Hadi et al., 2019). Within the context of these studies, lighting has been measured through a variety of metrics such as: a. ...
... (Zadeh et al., 2014), visual task performance (Figueiro et al., 2006), and medication dispensing errors (Buchanan et al., 1991). The existing studies also show the relationship between light exposure and patient outcomes including patient satisfaction (Gharaveis et al., 2016), length of stay (Beauchemin & Hays, 1996;Benedetti et al., 2001;Choi et al., 2012;Park et al., 2018), mood (Beauchemin & Hays, 1996;Walch et al., 2005), pain (Walch et al., 2005;Zadeh et al., 2014), and sleep (Hadi et al., 2019). Within the context of these studies, lighting has been measured through a variety of metrics such as: a. ...
... ART asserts that spending time or viewing naturalistic environments can aid the user in recovering from negative emotions [46]. Prior studies conducted among hospitalized patients have demonstrated that various natural environments can help reduce their anxiety and stress [47][48][49]. ...
... Prior studies have identi¯ed that shades of blue and green associated with neutral earth tones help in creating a feeling of relaxing [51][52][53]. Additionally, it has been observed that sunlight invokes a pleasant feeling and relaxing mood [47]. Based on these data, a conceptual sketch was generated, as seen in Fig. 1, with various relaxation-inducing variables listed on the side. ...
Article
Pain and anxiety are common accompaniments of surgery, and opioids have been the mainstay of pain management for decades, with about 80% of the surgical population leaving the hospital with an opioid prescription. Moreover, patients receiving an opioid prescription after short-stay surgeries have a 44% increased risk of long-term opioid use, and about one in 16 surgical patients becomes a long-term user. Current opioid abuse and addiction now place the US in an “opioid epidemic,” and calls for alternative pain management mechanisms. To mitigate the preoperative anxiety and postoperative pain, we developed a virtual reality (VR) experience based on Attention Restoration Theory (ART) and integrated the user’s heart rate variability (HRV) biofeedback to create an adaptive environment. A randomized control trial among 16 Total Knee Arthroplasty (TKA) patients undergoing surgery at Patewood Memorial Hospital, Greenville, SC demonstrated that patients experiencing the adaptive VR environment reported a significant decrease in preoperative anxiety (p<0.01) and postoperative pain (p<0.01) after the VR intervention. These results were also supported by the physiological measures where there was a significant increase in RR Interval (RRI) (p<0.01) and a significant decrease in the low frequency (LF)/high frequency (HF) ratio (p<0.01) and respiration rate (RR) (p=0.01).
... Daylight incorporation in healing environments has a profound positive influence on the health and well-being of patients physiologically, mentally, and psychologically as found in numerous publications (Walch, et al., 2005). Daylight improvement could reduce stress and pain, improve alertness, regulate the circadian system, improve patient safety, and enhance the overall healthcare quality (Ulrich, 1991). ...
... There are several good reasons to minimize the use of electric lighting in residential spaces by utilizing more daylight to illuminate room interiors (Knoop et al. 2019). Firstly, it has long been shown that daylight has substantial healthcare effects (Beauchemin and Hays 1998;Ulrich 1991;Walch et al. 2005;Weiss et al. 2016). It is the most important among "zeitgebers" ("time givers", in German) that help brain neurons synchronize with the environment in a 24-hour rhythm that affects human physiology and behavior, ensuring health and well-being (Arendt and Middleton 2018;Kyriacou and Hastings 2010). ...
Article
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This paper examines the association between daytime electric lighting use and perceived indoor daylight availability in residential spaces. In addition, occupant preferences were evaluated, in particular which rooms are prioritized in terms of daylight availability. The study deployed a questionnaire survey that was carried out in typical multi-dwelling apartment blocks in Malmö, Sweden (Latitude: 55.6 °N). Occupants were asked to report how often they use electric lighting during daylight hours (EL) in their kitchen, living room and main bedroom, and how much of the floor area they perceive as adequately daylit (DA) throughout the year. Responses EL and DA were measured in seven-point semantic differential scales, and were correlated (Spearman) to evaluate their association for different room groups. Groups were based on age, room function, façade orientation, balcony obstruction and fenestration geometry. In addition, occupants were asked which room they would choose if there had to be one underlit room. Results indicate that EL is strongly associated with DA in the overall room sample (rS = −0.588, p < .01, n = 225). The association is persistent across room groups of different characteristics, with the Spearman rank correlation coefficient ranging between −0.4 and −0.8, and not differing significantly between groups. In terms of preferences, a significantly high proportion of participants would choose the bedroom if there had to be one underlit room (62%, p < .05), while the kitchen was selected by only 5 out of 108 respondents.
... Similarly, a study by Beauchemin and Hays (1998) indicates a positive impact of bright, sunny rooms on patients experiencing heart attacks. Researchers found evidence that lighter and brighter rooms in hospitals reduces the stress and pain levels, and results in shorter hospital stays for patients with depression or bipolar disorder (Beauchemin and Hays, 1998;Benedetti et al., 2001;Walch et al., 2005). ...
Article
Beyond resource efficiencies, green buildings aim to create healthy indoor environments for building occupants. In terms of improving occupant well-being, a unique case emerges for healthcare facilities, whose patients may be at a vulnerable state. In the U.S., the Leadership in Energy and Environmental Design (LEED) rating system has become the most widely recognized certification system for green buildings, including green healthcare facilities and buildings. Hospitals with high total scores in the LEED rating system are green buildings but may not necessarily be the optimal green healthcare environment from a patient’s wellbeing perspective. Certified health-care facilities were analyzed in terms of their credit valuation to assess whether health-care facilities prioritize specific criteria that influence patient wellbeing and recovery time. Analysis of results indicate hospitals may be valuing the level of certification more than those credits that were deemed relevant for patient wellbeing and rate of recovery, either due to lack of information or due to economic constraints. To consolidate the previous results and to compare the performance of LEED certified green hospitals to the national average, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was analyzed for patients’ perspectives on the healthcare facility. Results indicate higher satisfaction in green hospitals’ overall patient care performance as well as a greater tendency to recommend green hospitals to others compared to the national average. No statistical significance was found for hospital cleanliness and quietness between green hospitals and the national average. HIGHLIGHTS
... As many as 39 percent of individuals with PTSD have tried CAM approaches as their primary mode of treatment or as an adjunct to traditional forms of therapy (Libby, Pilver, & Desai, 2013). Many of these more holistic programs, not only for PTSD, but also for pain (Walch, et al., 2005), mood (Irvine & Warber, 2002), and recovery from surgery (Ulrich, 1984), have been based in the outdoors. ...
... Thus, the effect of indoor daylight levels on patient's clinical recovery process 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. ...
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Background Indoor daylight levels can directly affect people’s physical and psychological state. However, the effect of indoor daylight levels on patient’s clinical recovery process remains controversial.AimTo evaluate the effect of indoor daylight levels on hospital costs and average length of stay (LOS) of a large patient population in general surgery wards.Methods Data were collected retrospectively and analysed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured light levels in the patient rooms of general surgery and assessed their association with patients’ total hospital costs and LOS.ResultsA total of 2,998 patients were included in this study with 1,478 each assigned to two light level groups after matching. Overall comparison of hospital total costs and LOS among patients according to light 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 and shorter LOS as compared to those exposed to 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 healthcare facilities to enhance indoor environmental benefits of daylight for some specific population.
... Det finnes en stor mengde vitenskapelige artikler om sykehusarkitekturens innvirkning på pasienter og sykehuspersonell. Økt dagslyseksponering reduserer opplevd smerte/stress ved sykehusinnleggelser, begrenser bruk av smertestillende medikamenter og reduserer antall liggedøgn (13). Pasienter som visuelt eksponeres for ekte eller simulert natur, kan oppleve anselig lindring av smerte (14)(15)(16). ...
... 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. ...
Article
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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.
... Esiste evidenza scientifica che a pazienti ricoverati in stanze intensamente illuminate da luce naturale viene somministrata una percentuale significativamente inferiore di analgesici, rispetto a pazienti ricoverati in stanze meno illuminate (Walch et al., 2005), per effetto della minore percezione del dolore provato. La ricerca scientifica, inoltre, mostra che pazienti affetti da infarto miocardico hanno una permanenza più breve in ospedale ed un minore tasso di mortalità se degenti in ambienti ben illuminati naturalmente, rispetto a pazienti ricoverati in ambienti scarsamente illuminati (Beauchemin, Hays, 1996). ...
... 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]. ...
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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.
... Thus, the effect of indoor daylight levels on patient's clinical recovery process 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. ...
Preprint
Full-text available
Background Indoor daylight levels can directly affect people’s physical and psychological state. However, the effect of indoor daylight levels on patient’s clinical recovery process remains controversial. To evaluate the effect of indoor daylight levels on hospital costs and average length of stay (LOS) of a large patient population in general surgery wards.Methods Data were collected retrospectively and analysed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured light levels in the patient rooms of general surgery and assessed their association with patients’ total hospital costs and LOS.ResultsA total of 2,998 patients were included in this study with 1,478 each assigned to two light level groups after matching. Overall comparison of hospital total costs and LOS among patients according to light 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 and shorter LOS as compared to those exposed to 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 indoor environmental benefits of daylight for some specific population.
... 17,18 Quieter, more peaceful health care environments can improve pain, reduce need for medications, improve mental state, and lead to speedier discharge. 19,20 Finally, clinician and family collaboration increases quality and safety of health care, decreases associated costs, and increases parent satisfaction. 8 For Olivia, we taught her nonpharmacologic pain and stress management approaches, encouraged mobilization, protected her sleep through clustering nighttime vitals, and ensured her family was heavily involved in her care. ...
... [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. ...
Article
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.
... 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. ...
Article
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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.
... 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. ...
Chapter
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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.
... 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. ...
Article
Full-text available
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.
... /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). ...
Article
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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). ...
Technical Report
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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.
Article
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.
Article
Although previous studies have shown that both forest and natural light exposure can significantly affect psycho-physiological responses, how different natural light levels influence stress recovery efficacy in forest environments has not been discussed yet. A pretest-posttest design was used to explore the influence of varying brightness levels on stress recovery effect in a virtual forest environment. Six immersive virtual environments (IVE) stimuli were generated from the lightest to the darkest through virtual reality simulation software. A total of 120 participants viewed the IVE using head-mounted display. Physiological and psychological responses and perceived environmental features were evaluated. The results of the present study confirmed previous findings that bright sunlight scenes (i.e., the lightest, lighter, light) allay stress more effectively than the darkest night scenes in the virtual forest. Another noteworthy finding is that dark scenes, such as daybreak without sunlight but with a little brightness, also has this property. An unexpected finding was that exposure to the natural light of medium-brightness (i.e., lighter, light, dark) in the virtual forest could significantly reduce the stress of the participants, compared to overly bright (i.e., the lightest level) or overly dark (i.e., the darkest level) levels. In addition, this study also found that perceived environmental features (i.e., maintenance, visibility, accessibility, variety, and perceived safety) and stress recovery were associated with different levels of brightness in the simulated forest environment. The results of this study contribute to existing forest therapy theory and offer insights for follow-up research to explore forest therapy and bright light therapy.
Article
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.
Article
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Connection with nature has been considered beneficial for psychological wellbeing since times of evolution. Differences in Indian and Western thoughts have viewed natural elements in different lights, varying between eco-centrism to anthropocentrism. The intrusion of technology and digitalized lives as a result of globalization has decreased connectedness with nature. Ecotherapy is a novel form of psychotherapeutic technique based on explicit environmental or ecological interventions. Social and therapeutic horticulture, animal-assisted interventions, care farming, green exercise, environmental conservation and wilderness therapy are some of the ecosystem-based approaches used in mental health. Based on the principles of positive and client-centred psychology, ecotherapy-related techniques have been shown to be effective in medical disorders like hypertension, obesity, post-surgical recovery and psychosocial conditions like depression, stress reduction, post-traumatic stress disorder (PTSD), attention deficit hyperkinetic disorder (ADHD) and adjustment disorders. The principles of ecotherapy have been integrated into other psychotherapeutic techniques for better efficacy. This review attempts provides an overview of techniques, applications and challenges related to ecotherapy in psychology. The implications of its use during the ongoing Coronavirus 2019 (COVID-19) crisis, social isolation and consequent psychosocial aftermath are also discussed.
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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.
Background Fatigue-related errors that occur during patient care impose a tremendous socioeconomic impact on the health care system. Blue-enriched light has been shown to promote alertness and attention. The present study tested whether blue-enriched light can help to reduce medical errors in a university hospital adult ICU. Methods In this interventional study, a blue-enriched white light emitting diode was used to enhance traditional fluorescent light at the nurse workstation and common areas in the ICU. Medical errors were identified retrospectively using an established two-step surveillance process. Suspected incidents of potential errors detected on nurse chart review were subsequently reviewed by two physicians blinded to lighting conditions, who made final classifications. Error rates were compared between the preintervention fluorescent and postintervention blue-enriched lighting conditions using Poisson regression. Results The study included a total of 1,073 ICU admissions, 522 under traditional and 551 under interventional lighting (age range 17–97 years, mean age ± standard deviation 58.5 ± 15.8). No difference was found in overall medical error rate (harmful and non-harmful) pre- vs. postintervention, 45.5 vs. 42.7 per 1,000 patient-days (rate ratio: 0.94, 95% confidence interval = 0.71–1.23, p = 0.64). Conclusion Interventional lighting did not have an effect on overall medical error rate. The study was likely underpowered to detect the 25% error reduction predicted. Future studies are required that are powered to assess more modest effects for lighting to reduce the risk of fatigue-related medical errors and errors of differing severity.
Article
Hospitalized patients are frequently deprived of contact with natural light and constantly exposed to artificial lighting, losing biological synchronism. However, few studies have been conducted to assess the consequences of inadequate exposure to light in hospital environments, whether related to insufficient light in the period daytime, or to light peaks at night. This study assesses the effect of daytime exposure to different monochromatic lights on the excretion of 6-sulfatoxymelatonin (aMT6s), a hormone that reflects variations in the light/dark cycle. The light intensity was adjusted to 300 lx. Forty voluntary patients under transfusion were randomly assigned into five groups of light exposure for five hours, during the day. The concentration of aMT6s was determined in the urine samples collected at four intervals in a period of 24 hours during two days (before and at intervention). Exposure to green light resulted in significant acute melatonin reduction; blue light, in delay of night secretion; red, yellow and white light, kept it unaltered. These findings indicate that exposure to light during the day can lead to changes in the pattern of melatonin secretion. This research can be useful in artificial lighting environments, such as hospitals, to maintain adequate lighting and preserve the sleep/wake cycle.
Chapter
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.
Article
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.
Article
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.
Article
Objectives This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior. Background Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important. Methods Physical environment measurements, observations, and questionnaire surveys were employed. Results The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors ( R ² = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors ( R ² = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (β = −.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants’ behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window. Conclusions The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.
Article
Architectural design of a facade, both at the aesthetic point of view and from the point of view of internal daylighting performance of the building, can be considered as a complex task. In this study, we implement a multi-objective evolutionary algorithm to formally exploration the process of reconstruction of the education building’s facade. The purpose of this research is to create a facade configuration by considering the size and location of elements and their materials when creating a suitable internal daylight distribution. The total construction cost of the building’s exterior and the daylight performance of the building’s interior are considered as objectives. The problem formulation includes two conflicting objectives, which are to increase daylighting aspect on each floor and reduce the total construction cost of the facade. To detect the approximation of Pareto fronts, including non-dominated solutions, we used a fast and elitist multi-objective genetic algorithm (NSGA-II). Computational and architectural results show that NSGA-II is efficient enough to demonstrate eligible facade design alternatives.
Article
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.
Article
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
Article
Light can impact human health via the visual and non-visual systems originating in the retina of the eye or as optical radiation falling on eye or skin. This paper provides a summary of what is known about these impacts. Topics covered include aspects of lighting likely to cause eyestrain and headaches; increase the risk of falls; induce circadian disruption; enhance sleep; mitigate Alzheimer’s disease and depression; produce tissue damage; alleviate diseases through phototherapy and inactivate viruses through germicidal irradiation. It is concluded that human health is undoubtedly influenced by lighting, but there are four conditions that should be attached to such a simple assertion. First, the impact of lighting on human health can be either positive or negative. Second, human health is affected by many factors other than lighting. Third, the severity of the effects of light exposure can vary widely from the short-lived and trivial to the long-term and fatal. Fourth, the same lighting conditions can have very different health impacts for different individuals depending on their age and medical status. Taken together, these conditions imply that care is required when judging the veracity and relevance of broad assertions about the benefits of lighting for human health.
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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.
Article
The farm holiday has the potential to rebound faster following the COVID-19 pandemic than many other forms of tourism. This potential is due to two elements that are abundant in the location of holiday farms: fresh air and sunlight. This conceptual paper synthesizes various streams of research that illustrate how fresh air and sunlight can improve both actual and perceived salutogenesis. This paper then offers a series of recommendations that farm stay venues can adopt in order to, explicitly and implicitly, infuse fresh air and sunshine elements in their marketing messages. Furthermore, there is potential in designing marketing messages for farm holidays that demand further research activities, continuous information and awareness raising.
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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.
Chapter
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Identification, assessment, and treatment of seasonality in mood disorders
  • Mc Blehar
  • Rosenthal
  • M Terman
  • Wehr
Blehar MC, Rosenthal N, Terman M, Wehr T. Identification, assessment, and treatment of seasonality in mood disorders. Psychopharmacol Bull 1990;26:3–11
The anatomy of ascending serotonergic pathways possibly involved in pain modulation
  • A Beitz
Beitz A. The anatomy of ascending serotonergic pathways possibly involved in pain modulation. In: Besson, ed. Serotonin and Pain. Elsevier Science Publishers; 1990:31–46
Chartbook on Trends in the Health of Americans. Health, United States
  • Vm Freid
  • K Prager
  • Mackay
  • Xia
Freid VM, Prager K, MacKay AP, Xia H. Chartbook on Trends in the Health of Americans. Health, United States 2003. Hyattsville, MD: National Center for Health Statistics; 2003:10
Measurement of affective states in adults
  • Pd Usala
  • Hertzog
Usala PD, Hertzog C. Measurement of affective states in adults. Res Aging 1989;11:403–426
Sunlight, vitamin D, and ovarian cancer mortality rates in US women
  • Es Lefkowitz
  • Cf Garland
Lefkowitz ES, Garland CF. Sunlight, vitamin D, and ovarian cancer mortality rates in US women. Int J Epidemiol 1994;23:1133– 6.
Side effects of opioids during short-term administration: effect of age, gender, and race
  • Ms Cepeda
  • Jt Farrar
  • M Baumgarten
  • R Boston
  • Db Carr
  • Bl Strom
Cepeda MS, Farrar JT, Baumgarten M, Boston R, Carr DB, Strom BL. Side effects of opioids during short-term administration: effect of age, gender, and race. Clin Pharmacol Ther 2003;74:102–12.
Achieving Excellence Design Evaluation Toolkit. A toolkit for evaluating the design of healthcare buildings from initial proposals through to post project evaluation: Instructions. NHS Estates
NHS Estates, 2001. Achieving Excellence Design Evaluation Toolkit. A toolkit for evaluating the design of healthcare buildings from initial proposals through to post project evaluation: Instructions. NHS Estates. Available at: http://195.92.246.148/nhsestates/chad/chad_content/ publications_guidance/introduction.asp#sub_3.
Pain: Clinical Manual
  • M Mccaffery
  • C Pasero
McCaffery M, Pasero C. Pain: Clinical Manual. 1999:241– 43.
Data trends— direct expense percentage by department
Data trends— direct expense percentage by department. Healthc Financ Manage 2001;55– 84.
Clinical and chronobiological effects of light therapy on nonseasonal affective disorders
Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol Psychiatry 1995;37:866 –73.
  • Scheier