Human responses to nature- and culture-based non-clinical interventions: a systematised review

AIMS

A wide range of non-clinical nature- and culture-based interventions for the treatment of health issues have been evaluated in evidence and systematic reviews. However, common outcomes of these interventions have not been identified and neuro-bio-psychosocial mechanisms underlying how these interventions impact health are not well understood. We conducted a systematised review and compared the evidence for human responses to nature- and culture-based non-clinical interventions for a range of health issues and assessed the proposed mechanisms and conceptual frameworks underlying these interventions.

METHODS

Comprehensive searches were conducted up to May 2018 in six bibliographic databases: Campbell Collaboration, Cochrane Library, Embase, Medline, Scopus and Web of Science. Studies included were evidence reviews or systematic reviews on any nature- or culture-based non-clinical intervention to improve the health of individuals.

RESULTS

A total of 60 reviews were included (33 of nature, 26 of culture, 1 of both) covering 1480 individual studies and trials. The most common review types were systematic (32), literature (22) and meta-analyses (6). Positive effects on mental health were reported for the majority of interventions, while other health outcomes such as immunity were not well represented in the review literature. A range of secondary outcomes were common to both nature- and culture-based interventions including psychological and emotional impacts, social interaction and relationship development, skills development, physical health benefits, and positive impact of the intervention environment. Only two reviews proposed conceptual frameworks, and the neuro-bio-psychosocial mechanisms that underpin the health changes were not clarified.

CONCLUSION

Future research should focus on reviewing the evidence gaps for non-clinical nature- and culture-based interventions with an emphasis on implementing larger sample sizes, cohort and longitudinal studies, which deploy a wider range of mixed-methods, quasi-experimental and randomised control trials. There should also be agreement on terminology and developing conceptual frameworks to better understand the neuro-bio-psychosocial mechanisms underlying interventions.

Social, cultural and community engagement and mental health: cross-disciplinary, co-produced research agenda

BACKGROUND

There is increasing cross-disciplinary research on the relationship between individuals' social, cultural and community engagement (SCCE) and mental health. SCCE includes engagement in the arts, culture and heritage, libraries and literature, sports and nature activities, volunteering, and community groups. Research has demonstrated the effects of these activities both on the prevention and management of mental illness. However, it remains unclear whether current research is focusing on the research questions that are of most immediate urgency and relevance to policy and practice.

AIMS

The current project was funded as part of the UK Research and Innovation cross-disciplinary mental health network programme to develop and co-produce a new cross-disciplinary research agenda on SCCE and mental health.

METHOD

Established processes and principles for developing health research agendas were followed, with a six-phase design including engagement with over 1000 key stakeholders, consultations, integration of findings and collective prioritisation of key questions.

RESULTS

We identified four core themes: the mode of engagement, process of engagement, impact of engagement and infrastructure required to facilitate engagement. There were many points of agreement across all stakeholder groups on the priority questions within these themes, but also some specific questions of relevance to different sectors.

CONCLUSIONS

This agenda is particularly timely given the extreme pressure on mental health services predicted to follow the current COVID-19 pandemic. It is important to identify how resources from other sectors can be mobilised, and what research questions are going to be most important to fund to support SCCE for mental health.

Museums, health and wellbeing research: co-developing a new observational method for people with dementia in hospital contexts

AIMS

The aim of this article is to present a new observational tool for assessing the impacts of museum object handling for people with moderate-to-severe dementia in hospital settings, focusing on wellbeing, social interaction, level of engagement and agitation. This article presents a four-step approach to collaboration towards co-developing the tool, which involved a range of academics, museums professionals, and health and social care partners, and describes the process of integrating multiple perspectives towards common research methodologies.

METHODS

The research team organised a series of meetings and workshops with museum and healthcare partners to identify commonly used assessments and their perspectives on the objectives and possible outcomes of museum object handling activities. These were integrated with findings from a review of current conceptualisations of engagement in people with dementia (PWD) to produce a fit-for-purpose video evaluation method of the health and wellbeing impacts of the museum object handling programmes.

RESULTS

This article presents the Museum Engagement Observation Tool for use in hospital settings for people with moderate-to-severe dementia.

CONCLUSION

This article suggests that collaborative approaches can inform the development of future methods for creative health research and evaluation initiatives and to support this, it outlines the process of development of a new observational tool for people with dementia.

Investigating the therapeutic potential of a heritage-object focused intervention: a qualitative study

This study explores the therapeutic potential of heritage-object handling in nurse-patient encounters with women facing cancer. Ten women participated in an object-focused conversation with a nurse specialist. Sessions were audio-tape recorded and transcribed. Kleinian theory framed the analysis to reveal the individual ways women 'used' the object in the session. Professionally observed heritage-object handling provides an aid to discussion with patients and has potential as an assessment platform for therapeutic work or as an intervention approach in its own right. Further longitudinal controlled trials are needed to evaluate such benefits, particularly given the depth of the talk revealed in this study.

Pattern of nontyphoid ileal perforation over three decades in Pondicherry

Two hundred and twelve cases of ileal perforation due to different causes (excluding typhoid) were treated in 3 phases in the Department of Surgery, JIPMER Hospital, Pondicherry, during the periods 1966-78 (phase I), 1981-88 (phase II) and 1990-1998 (Phase III). Forty per cent of the patients were in the second and third decades of life. Male-to-female ratio was 2.2:1. The majority of the perforations (52.8%) were due to non-specific causes. Trauma (19.3%) and mechanical factors (12.7%) were the other principal aetiologies. Pain abdomen (92.3%), constipation (63.6%) and fever (44.3%) were the principal presenting features. Abdominal guarding and rigidity (89%) were the main physical signs. Pneumoperitoneum was present in 66.8% of cases on plain X-ray abdomen. Widal and blood culture for Salmonella typhi were negative in all. Laparotomy was done in most of the cases after adequate resuscitation. Simple closure of the perforation, wedge resection and resection anastomosis were the different procedures of management. Histology of the margin of perforation/excised gut gave added evidence of a non-typhoid etiology. Broad-spectrum antibiotics in different combinations with metronidazole were administered postoperatively. Mortality was 28.2% in Phase I, and 9.4% and 11.9% in phases II and III respectively. The lag period (advent of symptoms and hospitalization) showed definite relationship with mortality and morbidity. Wound infection, wound dehiscence, enterocutaneous fistula and septicaemia were the principal postoperative complications.

Herniation through triple defects of the diaphragm with gastric volvulus

A rare case of herniation through triple defects in the diaphragm with volvulus of the stomach is reported. Herniation with gastric volvulus was diagnosed preoperatively. Three diaphragmatic defects were detected at surgery. Repair of the defects after reduction of the abdominal contents resulted in an uneventful recovery.

Changing trends in outcome of typhoid ileal perforations over three decades in Pondicherry

Two hundred and forty eight cases of proved typhoid ileal perforation were admitted and treated in three phases in the department of surgery during 1966-1998. Of these, 71% patients belonged to second and third decades of life. Male female ratio was 4:1. Abdominal pain (100%) fever (95%) and constipation (87%) were the main presenting symptoms. Abdominal guarding and rigidity (84%) were the principal physical signs. Plain radiograph of abdomen showed evidence of pneumoperitoneum in 57% of cases. The Widal test was positive for S. typhi in 74% of cases. Blood and bone marrow culture were positive for S. typhi in 9% and 30% respectively. Histology of the excised edges of perforation confirmed typhoid pathology in 62% of specimens. Many of the patients were treated conservatively in the first phase. In phase two and three vigorous resuscitation and early surgery was resorted to. Simple closure in two layers and wedge resection were the treatment of choice in most of the cases. Bypass, ileostomy and resection were done on few occasions. Chloramphenicol was the only drug used in the first phase. Other broad spectrum antibiotics were added to chloramphenicol with metranidazole in the second phase. Ciprofloxacin and metronidazole were the drugs of choice in the third phase. The mortality rate showed a dramatic improvement from 47.2% (first phase) to 17.7% (second phase) and as low as 7% in the last phase. The lag period (advent of symptoms to time of admission to hospital) showed definite correlation with mortality. Septicemia, wound infection, dehiscence, enterocutaneous fistula were the principal postoperative complications.

Volvulus of stomach in childhood

Six children, aged upto one year, with volvulus of the stomach are reported. Vomiting and regurgitation of feeds were the main presenting symptoms. Eventration of the left hemidiaphragm was present in four cases. Barium meal confirmed the diagnosis. Five cases were operated on through an abdominal approach. Plication of the diaphragm (3 cases), colonic displacement (2) and gastrostomy (3) were resorted to. One child needed reoperation for a missed Ladd's band. There was no operative mortality.

Intrauterine perineal tear: a rare birth injury

A rare case of birth injury having intrauterine complete perineal tear is presented. Defunctioning sigmoid colostomy was undertaken because of bad perineal condition. The baby died of Pseudomonas septicemia on the 15th day before definitive surgical procedure could be undertaken.

Intestinal injuries in childhood: analysis of 32 cases

This is a retrospective study of 32 cases of intestinal injuries sustained among 135 children admitted from cases of abdominal trauma in 1976 till 1989. Falls from height or bullock cart and bull-gore injury formed the majority of the cases (21/32; 65%). Clinical thermometer accounted for perforating injuries in 2 neonates. Penetrating injury accounted for 10 cases and blunt trauma was responsible in 19. The site of injury was duodenum 1, jejunum 8, ileum 17, colon 3, rectum 4, and multiple sites 1. Associated injuries included diaphragmatic rupture 1, liver 1, mesentery 4, retroperitoneal hematoma 4, head injury 2, and loss of hand due to blast 1. Diagnosis was made on history, physical examination, pneumoperitoneum in plain x-ray, and diagnostic four-quadrant peritoneal tap. Closure of perforations was done in 21 cases, wedge resection in 3, and resection anastomosis in 5. Protective colostomy had to be done in 5 cases. Four patients died of septicemia (2) and head injury (2).

A new technique of prolapse-free transverse colostomy

With this technique, the colostomy loop emerges in the space between the linea alba and the right rectus muscle. These two tough structures act as gatekeepers and prevent prolapse of the intestine when there is a rise in the intra-abdominal pressure. The stoma is matured immediately. Small incisions and precision with the technique are essential in neonates.

Single layer abdominal wound closure in children

A single layer closure of abdominal incisions was done, including the skin, musculo-aponeurotic layer and peritoneum, with a modified 'figure-of-eight' technique, using thick monofilament nylon interrupted sutures. This technique leaves no suture material in the wound after suture removal on the 14th postoperative day. One hundred and fifty-two transverse incisions of the abdomen in children of all ages were analysed. Easy closure in difficult cases, no wound dehiscence and a greatly reduced infection rate are the advantages. We recommend this technique as a routine, particularly in poor risk patients, contaminated wounds and closure of colostomy wounds.

Subcutaneous phycomycosis from Pondicherry, South India

Four cases of subcutaneous phycomycosis diagnosed by isolating Basidiobolus meristosorus from affected tissue, are reported along with the growth characters and morphological features of this fungus. This is the first report from Pondicherry, South India where it was it was possible to isolate the causative fungus from each case.