Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study

Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.

Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey

OBJECTIVE

The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized.

BACKGROUND

Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction.

METHODS

A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA.

RESULTS

The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important.

CONCLUSIONS

Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools

Background

The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards.

Study Design

The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation.

Methods

A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project.

Results

Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed.

Conclusions

Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.

Rethinking the Healthcare Facilities: The Role of the Buffer Space

OBJECTIVES

A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design.

BACKGROUND

The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients.

METHODS

The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents.

RESULTS

102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds.

CONCLUSIONS

Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context

BACKGROUND AND AIM

Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital -Facilities (Mega-hospitals) but their site sustainability is questioned.

METHODS

The paper focuses on a comparison -between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for -Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country.

RESULTS

This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures.

CONCLUSIONS

The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are -suggested.

Health and well-being key performance indicators in corporate sustainability disclosure. A review of sustainability reports from a sample of major European companies

BACKGROUND AND AIM

Health and Well-Being (HWB) measurement represents a key issue for companies in all sectors and a core element of social sustainability, according to the Sustainable Development Goals (SDGs). Despite its importance for companies and in sustainability reporting, the topic has not been investigated yet from a cross-sectoral perspective. Therefore, this research aims to assess if health and well-being are disclosed in sustainability reports of the largest European companies.

METHODS

The disclosure of Key Performance Indicators (KPIs) has been investigated and compared according to the main international frameworks of sustainability. The research focused on sustainability reporting from a sample of the 30 largest companies in three methodological steps. First, the inclusion of HWB issues has been analyzed, identifying references to the SDGs and ISO 45001 within the documents. A second level of analysis considered the adoption of the Global Reporting Initiatives (GRI) Standards, with particular attention to Health metrics (GRI:403). The third level of analysis aimed at researching health and well-being performances, linked to specific KPIs from two selected case studies.

RESULTS

The review highlighted that all 30 companies generally refer to SDG 3 and SDG 8 in their sustainability reporting while 83%(n=25) of them also apply either Occupational Health and Safety ISO 45001 or Health metrics in GRI Standards; 22 (73%) companies adopted both GRI as the sustainability reporting standard and disclosed the adoption of ISO 45001 management system. Only in two cases, an additional structured framework for HWB is reported highlighting the need for more comprehensive KPIs, especially for employee's well-being.

CONCLUSIONS

The study highlighted that health indicators disclosure is generally limited to GRI Standards disclosure. To achieve greater transparency in sustainability reporting, there is a need to further investigate the issue. (www.actabiomedica.it).

The meta-projects of the new community health centers, community hospitals and local operative centers for the Italian country

BACKGROUND AND AIM

COVID-19 highlighted significant criticalities of the Italian National Healthcare System (NHS) and recently the Italian Government approved the National Recovery and Resilience Plan (NRRP) to relaunch its economy and at the same time to promote health, sustainability and digital innovation. Specifically, M6C1 (Mission 6 Component 1) wants to introduce Community Health Centers (CHCs), Community Hospitals (CHs) and Local Operative Centers (LOCs) to strength territorial healthcare services. Starting from the Italian Ministerial Decree n. 77 (2022), AGENAS (National Agency for Regional Healthcare System) and POLIMI (Politecnico di Milano) working group developed the meta-design guidelines for CHCs, CHs and LOCs facilities with the aim of supporting decision-makers to define spatial features and building performances in order to be responsive to functional issues.

METHODS

The spatial strategies of these facilities have been elicited through three different steps: a) a survey about the current national and international scenario regarding the territorial healthcare; b) a review of all national and regional regulations; c) the development of the meta-design guidelines have been elaborated from the analysis of the a) and b) steps.

RESULTS

The regulatory instructions and scientific indications collected through the literature have been translated into spatial and functional layouts. The services have been organized by homogeneous macro-areas and defined in a synoptic framework which shows the performance approach and their features. Each macro-area, sorted by type of functions, has been subdivided into a list of all its specific spatial units.

CONCLUSIONS

The study conducted aims at supporting the planning of these facilities in relation to the catchment area and their sizing. It will be necessary to define the location by evaluating the possibility of setting them up within existing hospitals, as well as to guarantee a sustainable approach in the realization of these infrastructures.

Bridging therapeutic landscapes to architecture. International experience-based design strategies for healthcare infrastructures

BACKGROUND AND AIM

in Italy, many cases studies of therapeutic green spaces are built into healthcare infrastructures, but only some of these follow the principles of healing gardens. Scientific literature and international case studies offer many contributions of evidence relating to how therapeutic green spaces can support traditional treatments. The paper analyze the relationship between indoor and outdoor spaces and healing gardens' features; the main research questions were: "Can we synthetize experience-based design strategies for therapeutic green spaces and healing gardens? How can we prioritize the most relevant ones for the healthcare infrastructures?"

METHODS

Research Method is divided into three different steps: 1st case studies' selection; 2nd case studies' analysis, and 3rd quali-quantitative comparative matrix.

RESULTS

ten case studies were identifiedfour of them have the therapeutic green space on the ground floor,despite of the other six having the healing garden on the rooftop.The best experience-based design strategies for the therapeutic green spaces or healing gardens development were identified from the previous comparison matrix, and divided into A.Safety, Security and Privacy; B.Accessibility; C.Physical and Emotional Comfort; D.Positive distraction; E.Engagement with Nature; F.Maintenance and Aesthetics; and G.Sustainability.

CONCLUSIONS

The results obtained from the comparative matrix are qualitative and quantitative design elements in terms of type of element / space, percentage, perimeter, area, number, materiality, shape, color, among others. The quali-quantitative matrix is a useful and practical tool that allows the designer to have a base of design guidelines that can be later applied to the proposal of new therapeutic gardens.

Structural accreditation of healthcare facilities: comparison of the requirements by Italian Presidential Decree 14/01/1997 and regional regulations. A proposal for updating the minimum environmental units at national level

BACKGROUND AND AIM

The Decree of the President of the Italian Republic 14/01/1997 is the reference norm related to the accreditation of public and private healthcare structures. This guideline establishes the minimum structural, technological and organizational requirements that each structure operating in the Italian territory must comply with.

METHODS

In occasion of the project work for the postgraduate training course in healthcare management by ALTEMS School, a team of researchers conducted a survey on the state of updating of the minimum structural requirements indicated in the norm-in particular those relating to hospital facilities- with those adopted by the individual regions through the analysis of the most up-to-date regional regulations.

RESULTS

Precisely starting from the comparison of regional references and from the regulations on the subject of structural accreditation which suggest strategic environmental units and which address some key-aspects relating to the contemporary design of healing environments (i.e. semi-intensive care units, hybrid operating theatres, etc.), the outcome of the project work is to define a proposal to update the national reference document, also in the light of the currently changing needs in terms of hospital design.

CONCLUSIONS

The research aims to become a starting milestone for future investigations. The team investigated - in this first phase - the functional areas listed in the norm, and the next step aims to extend the analysis also to the innovative functions (i.e. buffer spaces, hybrid operating theatres, sub-intensive care units, etc.) and/or introduced only the last years which have only been regulated in some regions.

Design for all A.U.D.I.T. (Assessment Universal Design & Inclusion Tool). A tool to evaluate physical, sensory-cognitive and social quality in healthcare facilities

BACKGROUND AND AIM

Universal Design (UD) is the design of environments equally accessible and usable to the wider range of people regardless their abilities or disabilities. Various studies highlight the lack of evaluation tools to support decision makers to enhance inclusive environments, especially complex constructions with various users as healthcare facilities. The research proposes a tool to evaluate the quality of building according to UD through a new set of objective indicators with a performance-based approach.

METHODS

the tool has been developed through three main phases: 1. Analysis of the state of the art through a systematic literature review and workshops with stakeholders and experts; 2. Elaboration of the evaluation framework following the Multicriteria analysis methodology; 3. Application, to test and validate the tool in hospitals.

RESULTS

the tool, named Design for All A.U.D.I.T., evaluates the level of UD analyzing Physical, Sensory-cognitive, and Social quality through a set of criteria specified by indicators and measurable requirements. The tool assesses the different healthcare environments through criteria and indicators to verify the level of appropriateness in terms of UD. The tool provides report with quantitative, qualitative and graphical information in plan of the facility status and design strategies.

CONCLUSIONS

The study proposes an innovative evaluation system to determine the inclusion of hospitals, both for projects and for existing buildings. The flexible structure allows the tool to beapplied in different building typologies, currently adopted to identify hospital's weaknesses and setting priorities of intervention on inclusion.

Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19

Background and aim Hospital facilities are one of the most stressful environments and there is evidence that during Covid-19 having outdoor and green spaces helped medical staff and nurses to decrease the stress and anxiety level. Nevertheless, knowledge about the type of green space is limited. The aim of the study is to systematize the existing scientific literature on the topic in a specific time period.     Methods Scopus, Pubmed, and Cochrane library databases have been explored in a systematic way. Following the Prysma diagram 25 studies have been included. Descriptive statistics and content analysis have been performed to highlight green typologies, users and functional area involved, spatial focus, relationship between users and space and vegetation typology. The different topics have been clustered according to Kellert's biophilic framework.     Results Articles reviewed included studies from the 2000 to 2020. The selection led to the analysis of 25 documents; it was significant to understand the major areas of application (pediatrics, ma-ternity, oncology, hospitalization, etc) and forms of green (images, furniture, healing gardens, vegetable gardens, etc).   Conclusions The present review highlight the main characteristics of green space in hospital built environment with specific focus on pre-pandemic situation.

Evaluation of stakeholder opinion about Long Term Care Facilities for People with Dementia perceived quality: a web-based survey in the Italian context

BACKGROUND AND AIM

Italy is a country where the percentage of elderly population is very high (23% over 65). The aim of the investigation is to bring out which aspects of the spaces intended to accommodate elderly People with Dementia pathologies should be most present and potentially interested in becoming cornerstones of a new model of Long-Term Care facilities (LTC).

METHODS

This research uses a case studies analysis followed by a web based survey as methodological tools. The questions were identified following an analysis of recent European case studies. The survey has been submitted to a panel of stakeholders (users, pratictioner, designer and manager in the healthcare sector). It is articulated in eight items touching on functional, configurational, and perceptual aspects of the LTC.

RESULTS

The 210 responses received provided a basis for comparison with the trend lines detected by the case study analysis, establishing continuity on some configurational aspects and providing divergent views for others. The research found a strong need to introduce new service activities and technologies aimed at the care and assistance of guests with dementia. These specific needs often involve the introduction of new spaces and environments or the redefinition of the same, where already present.

CONCLUSIONS

The results highlights that a new model of residence must incorporate new technological applications, outdoor spaces, that are perceived significantly by both patients and practitioners, and improve well-being of all users.

Covid-19 emergency management and preparedness in cross-border territories. Collection of experiences, needs and public health strategies in the framework of interreg GESTI.S.CO. project

BACKGROUND AND AIM

The Covid-19 pandemic highlighted management difficulties in neighboring territories. The aim of the paper is to report the needs of different stakeholders during, before and after Covid-19 emergency with specific regard to challenges faced by public administrators in confined territories.

METHODS

In the framework of Interreg GESTI.S.CO. project the study has been designed with two methodological steps: i) a co-design workshop and ii) a web-based survey. The workshop includes both an audience interaction session and focus groups. Then, starting from the focus group results, the survey has been designed with 30 questions and submitted to the 227 municipalities located between Italy and Switzerland to understand the implementation of Public Health strategies in local emergency planning.

RESULTS

The interactive session highlighted that most of the critical issues are related to the lack of communication and planning in Public Health policies. The survey highlighted that the local emergency plans rarely integrate a section on health emergencies (30% Italy and 50% Switzerland). Only 20% of the respondents dedicated a section for Covid-19 emergency management. Most of them did not activate initiatives to support mental health. 90% of the municipalities did not cooperate with the neighboring country, but half of them think that it would have been much more useful. The 55% of the Italian respondents are currently updating their emergency plan and will implement it with some Public Health input.

CONCLUSIONS

The study provides insights that can support policy makers in improving their strategy in responding to future pandemic. (www.actabiomedica.it).

Built environment impact on people with dementia (PwD) health and well-being outcomes: a systematic review of the literature

BACKGROUND AND AIM

The number of People with Dementia (PwD) is rising worldwide and represents a complex figure because of the changes in the cognitive sphere, altering perceptions of the Built Environment (BE). Even though the role of the built environment in the health and well-being of people it's nowadays well known, few studies analyze and evaluate the impact of specific Architectural Features. To this end, this contribution provides a systematic review that will underline the impacts of BE on the Health and Well-being of PwD and set a matrix of the relationship with measurable outcomes.

METHODS

A literature review has been conducted on scientific databases. 40 studies that relate health outcomes and aspects of the built environment have been identified and organized on a comparison matrix that clearly shows the relationships between Architectural Features of BE and Health and Wellbeing Outcome. This matrix allows to identify which are the aspects that can impact on PwD as well as possible lacks.

RESULTS

Many aspects appear to be widely explored, such as BPSD or wandering. In addition, significant gaps in the relationship between recognized aspects of the built environment recognized as relevant to the well-being of people with dementia and the real impacts on health outcomes such as the location and personalization of spaces.

CONCLUSIONS

This study collected the most recent studies to underline the relationship between BE and dementia, providing a set of outcomes and architectural features that can be analyzed to assess the quality of BE for PwD.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities

OBJECTIVES

This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies.

STUDY DESIGN

A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed.

METHODS

Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals.

RESULTS

Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psychological well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines.

CONCLUSIONS

The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Can Homes Affect Well-Being? A Scoping Review among Housing Conditions, Indoor Environmental Quality, and Mental Health Outcomes

The purpose of the scoping review is to explore the relationship between housing conditions, indoor environmental quality (IEQ), and mental health implications on human well-being. In fact, time spent at home increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. This scoping review, conducted on the electronic database Scopus, led to the identification of 366 articles. This, after the screening processes based on the inclusion criteria, led to the final inclusion of 31 papers related specifically to the OECD area. The review allowed the identification of five housing conditions [house type, age, and floor level; housing qualities; household composition; neighborhood; green spaces] that, by influencing the IEQ parameters, had impacts on the mental health outcomes addressed. By synthesizing the contributions of the review, a list of design recommendations has been provided. These will serve as a basis for future researchers, from which to develop measures to reduce inequalities in housing by making them healthier, more resilient, and salutogenic.

Let's not forget those who forget! Participatory design in the context of dementia built environment

 

Dementia is a major cause of disability and dependency among older people worldwide. Eco-bio-psychosocially supportive design can significantly reduce agitation and depression while improving mobility and daily activities. For this we need to include dementia patients as experts while understanding the neurological changes and functional impairments associated with the progression of the disease over time. How can we support dementia patients to participate? What tools/processes can we use to involve them in the design process? The aim of this project was to map and evaluate co-design methods for dementia and neurodiversity, in order to create an eco-bio-psychosocially supportive environment. Mixed methods were used comprising a systematic literature review on co-design techniques for spaces for dementia, three workshops: a 3-day one with seven early career researchers translating patient involving methodologies to the dementia context, a round table Patient and Public Involvement and Engagement with six service providers and stakeholders cross three countries and a cross-sectoral international day conference with four academics, four early career researchers and eight stakeholders and a series of co-design workshops for dementia and neurodiversity, which were then classified according to applicability so as to generate co-production methods for living environments for dementia. This transdisciplinary project highlighted the challenges of participatory design in the context of dementia built environment. The importance of the topic was highlighted by clinicians and staff but there are still significant limitations in terms of research and methodologies. The workshops outcome was an inclusive code of conduct for participatory design and research for dementia patients, which will help to improve home and care environments for people with dementia. The framework involved aspects such as time, space, equipment in relation to people involved (carers, patients, proxies).

Key messages

• The project created a framework to support dementia patients’ involvement for built environment decision making that considers aspects such as time, space and equipment to foster communication.

• The framework described the phases and the tools/methods in order to build trust and enable fluidity to accommodate dementia patients’ needs.

(Re)thinking the city of proximity for Salutogenic purposes

As centres of population and human activities, nowadays urban environments are simultaneously the main cause of and solution to a growing number of health-related challenges. In this setting, COVID-19 pandemic has helped reiterate this and serves as a wake-up call and an opportunity to rethink the way we approach cities. Aim of this paper is to research what today seems the most promising urban model for long-term individual and global resilience: the “city of proximity”, namely about inclusive walkable and cycling environments where people can access all basic destinations within reasonable times and distances from home. Therefore, urban proximity dimension, methodological approach and urban features and functions become the main subject of a quanti-qualitative matrix of comparison of five international case studies centred on the topic, by which it is possible to set out general criteria for such model, along with a methodology to measure all cities in its respect. As a result, residential density, functional mix, pedestrian surface, cycle routes, public transport stops, green areas, schools, cultural facilities, sport facilities, retail services and urban gardens make up the fix components of a comprehensive set of 11+n urban features, whose occurrence is investigated through GIS-based analysis within designated distance ranges, creating a comprehensive assessment framework that is adjustable to all urban contexts worldwide. In the end, the application of such framework to the city of Milan finally helps to validate its effectiveness in providing a picture of city-wide accessibility to proximity services, and in highlighting the value of integrated analysis in view of shaping public policies and informed planning choices which put health and sustainability at the centre.

Bridging Epidemiological Data with Features of the Urban Context: An experience of Urban Public Health within the City of Milan, Italy

Referring to the Research Project “Enhancing Healthcare and Well-Being Through the Potential of Big Data: An Integration of Survey, Administrative, and Open Data to Assess Health Risk in the City of Milan with Data Science” the Authors present preliminary results regarding a survey distributed to a sample of citizens across all neighborhoods of Milano city. This survey sought to collect data regarding health risk factors of this population, including both individual (e.g. socio-demographic characteristics, behaviors, etc.) and community (e.g. environmental/morphological features, available social services, etc.) data. A digital survey was designed to collect information on the health conditions, risk factors, and lifestyle characteristics of a representative sample of the Milanese population at the neighborhood level, with reference to the census tracts and Local Identity Units (NIL). Collected survey data are entered into a system containing corresponding individual health information acquired from the Local Health Authority databases, creating a synthesized information profile with each respondent's state of health, including existing conditions, health services used, and drug therapies. The disseminated survey was developed from comparisons with similar experiences at the national/international level and divided into 60 multiple choice questions (6 for Sociodemographic profile; 8 for Context of residence; 12 for Functional limitations; 25 for Behaviors and lifestyles; 9 for Access to health services). The data from urban analysis conducted on the NIL of the City of Milan are assessed with particular reference to the theme of bicycle-pedestrian accessibility (Walkability) in the urban context and repercussions on the adoption of Healthy Lifestyles. The models developed through this research are expected to provide critical insight for designing health promotion, health protection, and disease prevention interventions aimed both at individual and community level.

How breaks in nature can affect the users’ wellbeing: an experience based survey during the lockdown

Background

In the occasion of COVID-19 pandemic in Italy, the life of citizens was greatly disrupted - from healthcare professionals to the smart workers - and consequently also the state of mood. On the basis of the scientific evidences in relation to the relationship between the built environment and health, a research group has promoted an investigation on the benefits that greenery can have on the psychophysical state of the users, especially healthcare staff and users at home.

Objectives

The methodology adopted is the Profile of Mood States, which provides experiential activity in nature - without any technological distraction- to evaluate the benefits on mood. The methodology adopted refer to the shorter version (34 items) designed by prof. Grove at the University of Western Australia. In relation to the COVID-19 pandemic, the experience based questionnaire is differentiated for healthcare staff and general users. The questionnaire is composed of a few questions, to be completed before and after an experience in nature of 20/30 minutes. The investigation requires to be carried out in private gardens, balcony and/or terrace with greenery, public green areas, etc.

Results

300 participants (subdivided into 225 general users and 75 healthcare professionals) took part in the investigations. Data analysis highlighted the higher performances in anxiety, depression, anger, force, fatigue and confusion, in particular for users who had the experience in garden (-50/70%), and among the healthcare staff the best outcomes are related to who did the investigation during or after the workshift (-60/-90%).

Conclusions

Although it is well-known the benefits that nature affects positively on well-being and stress level of users, the investigation underlines that brief breaks in the nature - especially in period of great stress such as pandemic - can influence the well-being and mental health of users.

Challenges of the next generation hospitals: Rethinking the Emergency Department

The COVID 19 outbreak dramatically highlighted the inadequacy of the Emergency Department (ED) settings in dealing with events that can acutely affect a wide range of population. The immediate urgency to create strictly distinct pathways became also a strategic aspect for reducing possible sources of contagion inside the hospital.1 This need has often clashed with inadequate structural conditions of the hospital: in fact, the rigidity of many EDs is due to the hospital typology and its localization (affected by functional program);2,3 and it prevents them from being quickly adapted to new needs in the case of maxi-emergencies.4 In several recent international projects, the presence of a multifunctional space and/or a buffer area guarantees different scenarios in relation to the healthcare/emergency needs.5 [...]

Healthcare Facilities and Dementia Development of a Framework to Assess Design Quality

In recent years, thanks to advances in medicine and the role of prevention, life expectancy has experienced rapid growth (from 77.6 to 81.3 years), resulting in an increase in Non-Communicable Diseases (NCDs) and years lived with disability. One of these is dementia, with about 7 million people currently affected in Europe while the number is set to double by 2050. These patients are complex due to the serious changes in their cognitive sphere, altering perceptions of their physical space. Because of age and multimorbidity, they are the most frequent users of healthcare facilities, but these structures often are not suitable to them. For example, during the COVID-19 pandemic, healthcare facilities demonstrated criticalities in structural and social issues. To this end, a rethinking of these spaces is urgent, and the use of Evidence-Based Design (EBD, the design based on findings from scientific research) can be a method to create safe and suitable environments. This study aims to develop an evaluation framework to assess the design quality of healthcare facilities for people with dementia. A systematic literature review was conducted to define a set of requirements that the space must have to be prosthetic for the patient. The framework consists of three macro areas (i.e., physical, social, and cognitive aspects), seven criteria, and 24 sub criteria. The proposed framework is a starting point for the development of inclusive projects for people with dementia and cognitive disabilities. Architecture has recently begun to approach the topic of dementia, especially in Italy. Therefore, it is urgent to investigate which are the main aspects to be considered in the design and renovations of facilities to make them as therapeutic and prosthetic as possible, creating places where the wellbeing of patients is the priority, both physical and psychological. To this end, EBD needs to become a habit for designers to create facilities suitable for people with both cognitive impairments and for every user, in line with the principles of Universal Design.

Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities

Various studies highlight a gap on reliable methods to measure the quality of projects and environments in terms of Universal Design (UD) and Design for All (DfA). In particular, healthcare facilities need decision support systems to improve the well-being of as many users as possible through a systematic approach. The present research proposes an evaluation tool to support designers and decision makers in the adoption of UD to develop healthcare facilities suitable for a wide range of users. Several methodologies have been adopted: an in-depth literature review on the current state of knowledge on UD evaluation, workshops and focus groups with both users and experts, and the analysis of four hospital case studies. The result was an evaluation framework built by using a Multi-criteria Analysis (MCA) methodology. The first version of the tool was applied to an American hospital and validated d in an Italian pilot case study. The research outlines a tool called Design for All A.U.D.I.T., able to evaluate Physical, Sensory-cognitive, and Social qualities based on a hierarchical framework with criteria and indicators based on UD and DfA. The framework evaluates the different areas of the hospital from outdoor to indoor spaces, allowing hospital administrators to act to improve the well-being of users according to the critical aspects of UD identified by the tool. The analysis provides a report of the facility status and design strategies to support designers for new projects or buildings renovations. The application shows that DfA A.U.D.I.T. can assess hospitals by examining both spatial qualities and DfA criteria. The tool could represent a decision support system in the national and international context, where many hospitals are not newly built. Further research will include application in different facilities and building typologies, aided by the flexible structure of the tool, which allows measurement of the environment's quality in terms of DfA and UD.

Communities, Sport, Inclusion. Strategies for Parish Complexes Social Reactivation Through Sport Practice Promotion

The following contribution presents some findings deriving from the research project "Sport is Society" by Politecnico di Milano. The research reflects on the built heritage and its ability to be accessible and usable for different users with different needs in its structures and offer of services, focusing on sports activities and spaces. The study refers to collective ecclesiastical structures in the contemporary city. The research in this area demonstrates the possible degrees of innovation regarding the increase in the inclusiveness of private facilities with a public vocation, where sport represents a driver of social inclusion for the community. The research proposes advice to guarantee inclusive sports facilities for the community, highlighting the strict relationship between the inclusive city and the ecclesiastical heritage, as an emerging issue to be investigated and solved. Starting from its relevance and the potential of the structures to become a truly "accessible patrimony", the tool suggests strategies for policymakers and ecclesiastical administrations to make them become "open services" - usable and accessible by all - for and inside the urban community.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities

OBJECTIVES

This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies.

STUDY DESIGN

A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed.

METHODS

Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals.

RESULTS

Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psycho-logical well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines.

CONCLUSIONS

The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Community Health Centers for Resilient Communities in the post-COVID-19 era

Background

The synergy between territorial services and hospital organizations plays a crucial role for health promotion. Starting from the recent pandemic, the Community Health Centers (CHCs) could turn out particularly efficient in cases of high emergencies, avoiding the overflow of users in the hospital thanks to health home care management or low and medium-care facilities. The aim of the research is to identify evidence based experiences that supports the efficacy of design and management of CHCs, also during pandemics.

Methods

The methodology is based on the analysis of several European case studies, selected by an extensive analysis of the main EU countries, through a comparative matrix with different criteria related to: a) general information; b) urban relationship with the healthcare territorial network; c) number of inhabitants and population basins; d) building typology, dimensions, flexibility and layout issues; e) healthcare staff involved, the number of workers and volumes of activities; f) sanitary and not sanitary functions before and during the COVID-19 pandemic, and transformations applied.

Results

The analysis gives rise to several correlations due the localization of CHCs and the healthcare territorial network, dimensions and staff involved, sanitary and not sanitary functions -before and during the pandemic- and the flexibility of the CHCs, that permits to list experience based best practices for the design and management of resilient CHCs, as useful strategic lines for professionals in public health and healthcare design. The survey highlights the strategic role of CHCs for the healthcare territorial network with particular evidence during pandemics.

Conclusions

The strategies aim to encourage the introduction of CHCs for the access to care for the population. The outcomes of the analysis are related to the research project Cities and Health Community Centers for Resilient Communities funded by PoliSocial Award 2020 of Politecnico di Milano.

Key messages

definition of design and organizational strategies for Community Health Centers for Resilient Communities in the post-COVID-19 era. qualitative and quantitative data analysis of European Community Health Centers before and during the COVID-19 pandemic.

Urban Green Spaces and Public Health Outcomes: a systematic review of literature

Background

As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity.

Methods

In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included.

Results

Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects.

Conclusions

To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity.

Key messages

Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.

Evidence-informed health care infrastructures: test of SustHealthv2 tool on hospital pilot cases

Background

Healthcare facilities are important node of health systems and several scholars from Public Health and health service field highlighted that high quality and sustainable built environment is fundamental in providing high quality health care services. Nevertheless, most hospital buildings are obsolete, not adequate to contemporary organizational models; additionally, none of the existing quality improvement tools systematically evaluate the built environment. Therefore, the study develops an evidence-informed weighted multicriteria tool and tested it on two pilot case study.

Methods

Starting from previous literature reviews and scenario analysis, different indicators for hospital quality assessment have been grouped in 17 criteria and 3 macro areas, validated through semi-structured interviews and weighted with Multicriteria Simon Roy Figueras (MCDA-SRF) and Deck Card Method (DCM). The weighted tool SustHealthv2 has been tested on two medium sized hospital pilot case studies (H1 and H2) in northern Italy.

Results

The tool is composed by three macro areas: Social, Environmental and Organizational qualities respectively accounting for 22%, 29% and 49%. The application and test of the tool highlighted transversal criticalities such as Sustainable Accessibility (H1=0.04/0.16; H2=0.11/0.16), Sensitization and Education (H1=0.06/0.18; H2=0.10/0.18). The most recent case study (H1) was able to achieve higher scores in energy (0.15/0.0.19), waste management (0.07/0.07), as well as future proofing characteristics (0.20/0.23) compared to the older one. Overall H1 scored higher in all the macro areas reaching a total fulfillment of 72/100, while H2 scored 52/100.

Conclusions

The application of SustHealth v2 on operating health care facilities can support hospital management in defining strategic area of improvements and investments for hospital building renovation providing higher level of services to patients, users and staff.

Key messages

Built environment for healthcare needs systematic evaluation frameworks to improve and contribute to health service quality. SustHealth v2 is an evidence-informed multicriteria framework for hospital built environment sustainability and quality assessment from social, environmental and organizational perspective.

The city of proximity as an Urban Health strategy for the post pandemic neighborhood’s needs

The lockdown due to the pandemic has prevented travels, forcing many people to work at home and reducing the possibility of accessing services in the territory. This condition has further highlighted the importance of urban living areas capable of satisfying basic needs within a reasonably easy range of accessibility. The concept of the “15 minutes city” is a useful vision to represent the city of proximity, where it is possible to meet the needs for sustainable, fair, quality, and healthy living. However, even if the objectives represented are fundamental, the model it proposes - accessibility within 15 minutes - is not always applicable in all urban contexts, mostly peripheral, peri-urban, or low-density ones. This dimension of proximity - to be defined from time to time according to urban contexts - can be central to formulating strategies to improve the quality of urban life. Still, it can also play a role in constructing forms of intervention to improve public health and in ordinary conditions, both in extraordinary and emergency conditions. From this point of view, a proximity area can be an area to be defined with a variety of tools typical of urban analysis but fed by overlapping layers that also refer to the health dimension. A place of proximity, therefore not only defined based on the physical characteristics and people's uses, but also based on the data collected from a public health perspective in which it is also possible to try to test different types of information and build the conditions to suggest suitable policies and projects. Aim of the authors is to illustrate a survey about several case studies considered virtuous at the international level, analyzed in detail to highlight the main urban and architectural features of those healthy experiences and the related health outcomes, such as sedentary lifestyle reduction, increase of the attractiveness of places, reduction of air and noise pollution.

Can hospitals impact users’ experience? Application of an evaluation tool to enhance Design for All

Background

Design for All (DfA) strategy addressing human diversity, social inclusion and equality, can have an impact on users' well-being in healthcare facilities. However, evaluation tools are needed to identify the extent to which DfA influences users' experience and service quality. This study explores the application of the Design for All A.U.D.I.T. (Assessment Usability Design & Inclusion Tool).

Methods

The tool's structure is based on a multicriteria framework that evaluate hospital areas through a rating system. The hierarchical framework includes three Categories of DfA outcomes (Physical-spatial quality; Sensorial-cognitive quality and Social quality) with related criteria, indicators and requirements. The tool has been applied in the evaluation of two private hospitals, one in Buffalo (US) and one in Milan (Italy).

Results

The analysis of findings addressed both spatial and DfA qualities. For spaces, Horizontal circulation had the best scores in both hospitals (76% Italy, 88% US). The Italian hospital Vertical circulation had the lowest score (46%), while in the Buffalo facility Outdoor spaces had the lowest scores. Regarding DfA qualities, the Italian hospital obtained the highest score in Environmental Factors (84%), due to a sustainable design approach, while Social Inclusion got the lowest score (54%). The Buffalo facility scored higher on Social Inclusion (87%) because it provides diverse services for users. Both the hospitals had problems with Wayfinding due to layout and signs, scoring low on this criterion (59% Italy, 39% US).

Conclusions

The analysis of the hospitals demonstrated that the tool can evaluate spaces and DfA outcomes along dimensions of health and well-being. The system can be used to identify critical aspects and suggest design strategies, defining priorities for interventions. Further research directions will consider applications in different hospitals to ensure the tool scalability and application to new building projects.

Key messages

The evaluation tool enhances Public Health by measuring hospital quality in terms of Design for All and user needs. The tool can be applied in the decision-making process during design and renovation of specific areas of hospitals to implement Inclusive Design.

Healthy Design and Urban Planning Strategies framing the SDG 11 Sustainable Cities and Communities

According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Public Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of health protection and promotion, but an individual and collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health doesn't depend only on the supply of the healthcare services, but also, on the quality of outdoor and indoor living environments. Aim of the Presentation 3 is the share the findings of a literature review about the link between the urban contexts' morphological and functional features; the results are divided into: 14 Health Outcomes, representing the main Non-Communicable Diseases (NCDs) whose come from the urban environment's quality and by the adoption of healthy lifestyles; 8 types of Environmental Risk Factors (Urban Heat Island Effect; soil/air/acoustic/light pollution; vehicular traffic; Safety & Security; weak attractiveness of places); and 14 Healthy Urban Planning Strategies (green/blue/grey infrastructures; biodiversity protection; adverse meteoric events management; public transport systems; vehicular traffic reduction; pedestrian and cycling paths; social and functional mix; urban solid waste's management; renewable energy and efficiency; outdoor spaces lighting; Design for All).

Towards an update of the Italian Ministerial Decree July 5th, 1975

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

Covid-19 Massive Vaccination Center Layouts

BACKGROUND AND AIM OF THE WORK

The rapid evolution of Covid-19 and the availability of numerous vaccines led countries to set up Massive Vaccination campaign in a very short time. Since December 2020, due to the lack of specific guidelines, multidisciplinary groups started to investigate the minimum requirements for Massive Vaccination Centers (MVC). The aim of the paper is to shed light on the process of development of a scalable model for MVC layout design and implementation.

METHODS

The methodology included two phases and six steps: 1)Study of MVC with i) acquisition of process data from experimental study on an early set up vaccination hub; ii) review of scientific literature on MVC; iii) review of existing available guidelines and international examples; 2) Design proposal with iv) functional and space requirements collection; v) standard MVC layout design and vi) scalable model definition.

RESULTS

The resulting layout is compact, has a good wayfinding and address safety reducing cross-contamination risks. Different vaccine lines have been designed with a central dilution area for process efficiency. Healthcare staff wellbeing is guaranteed by the provision of resting spaces, short distances, and the correct sizing of space for the different activities. To ensure optimal vaccination capacity at the peak of vaccination, a modular and scalable model of different sizes has been designed ranging from 400 to 12000 m2.

CONCLUSIONS

The modular layout has been used as basic model in the regional legislation, disclosed with the Deliberation n° XI / 4353 of 24/02/2021. Further research is encouraged to compare different national and international layouts.

Hospital Construction Cost Affecting Their Lifecycle: An Italian Overview

The need for 24/7 operation, and the increasing requests of high-quality healthcare services contribute to framing healthcare facilities as a complex topic, also due to the changing and challenging environment and huge impact on the community. Due to its complexity, it is difficult to properly estimate the construction cost in a preliminary phase where easy-to-use parameters are often necessary. Therefore, this paper aims to provide an overview of the issue with reference to the Italian context and proposes an estimation framework for analyzing hospital facilities' construction cost. First, contributions from literature reviews and 14 case studies were analyzed to identify specific cost components. Then, a questionnaire was administered to construction companies and experts in the field to obtain data coming from practical and real cases. The results obtained from all of the contributions are an overview of the construction cost components. Starting from the data collected and analyzed, a preliminary estimation tool is proposed to identify the minimum and maximum variation in the cost when programming the construction of a hospital, starting from the feasibility phase or the early design stage. The framework involves different factors, such as the number of beds, complexity, typology, localization, technology degree and the type of maintenance and management techniques. This study explores the several elements that compose the cost of a hospital facility and highlights future developments including maintenance and management costs during hospital facilities' lifecycle.

Validation Checklist for Massive Vaccination Centers

Abstract

Starting from the minimum requirements indicated by Lombardy Region, a validation checklist has been developed by experts in design, healthcare layout planning, hygiene and public health, planning and compliance, in order to provide managers of COVID-19 massive vaccination centers with a useful and easy-to-use tool to ensure quality, safety and efficiency of the different activities performed.

Influence of Nature at the Time of the Pandemic: An Experience-Based Survey at the Time of SARS-CoV-2 to Demonstrate How Even a Short Break in Nature Can Reduce Stress for Healthcare Staff

AIM

The current COVID-19 pandemic has been causing significant upheavals in the daily lives of citizens and consequently also their mood (stress, distraction, anxiety, etc.), especially during the lockdown phase. The aim of the investigation is to evaluate the benefits of 20-30 minutes in contact with nature.

BACKGROUND

The Scientific Community, also through the evidence-based design approach, has already demonstrated the importance of greenery and nature on the psychophysical well-being of people and, in a moment of emergency, contact with the nature can be therapeutic and quite influential on the mental health of staff subject to stress.

METHOD

During the lockdown, an Italian multidisciplinary working group promoted an experience-based survey, based on the Profile of Mood States methodology, for measuring the psychophysical well-being of hospital staff.

RESULTS

The author collected 77 questionnaires. The benefits that users have obtained from the experience in nature have been investigated by comparing the type of stresses they were subjected to and highlighting various peculiarities in the data analysis associated with the type of green in which they carried out the survey, the healthcare areas in which they worked during the pandemic emergency, and the moment in which the survey was conducted.

CONCLUSIONS

The study has highlighted that a short break in green spaces strongly influenced the mental and psychophysical well-being of hospital staff, emphasizing the importance of nearby green spaces in architectures for health. Even a brief break in nature can regenerate users, especially in times of a stressful health emergency.

Hospital Architecture in Spain and Italy: Gaps Between Education and Practice

AIM

The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice.

BACKGROUND

Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems.

METHOD

A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted.

RESULTS

Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners' survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners.

CONCLUSIONS

Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.

Gender Differences in COVID-19 Lockdown Impact on Mental Health of Undergraduate Students

Background: Prolonged university closures and social distancing-imposed measures due to the COVID-19 pandemic obliged students to at-home learning with online lectures and educational programs promoting potential social isolation, loneliness, hopelessness, and episodes of clinical decompensation. Methods: A web-based cross-sectional survey was carried out in a university institute in Milan, Northern Italy, to assess the COVID-19 lockdown impact on the mental health of the undergraduate students. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) using adjusted logistic regression models. Results: Of the 8,177 students, 12.8% reported depressive symptoms, 25.6% anxiety, 8.7% insomnia, and 10.6% reported impulsive tracts, with higher proportions among females than males. Mental health symptoms were positively associated with caring for a person at home, a poor housing quality, and a worsening in working performance. Among males compared with females, a poor housing quality showed a stronger positive association with depressive symptoms and impulsivity, and a worsening in the working performance was positively associated with depressive and anxiety symptoms. In addition, the absence of private space was positively associated with depression and anxiety, stronger among males than females. Conclusions: To our knowledge, this is the first multidisciplinary consortium study, involving public mental health, environmental health, and architectural design. Further studies are needed to confirm or refute our findings and consequent recommendations to implement well-being interventions in pandemic conditions.

SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities

Abstract

Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach

BACKGROUND

World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues.

METHODS

The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects.

RESULTS

The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc.

CONCLUSION

The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

A proposal of hygienic and sanitary standards for the new Building Code in Italy

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

COVID-19 lockdown: housing built environment’s effects on mental health

Background

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on March 11th, severe 'lockdown' measures have been adopted by the Italian Government. For over two months of stay-at-home, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures had on mental health and wellbeing.

Methods

We conducted a large web-based survey on 9261 subjects in Northern Italy, one of the Regions most heavily hit by the pandemic in Europe. Participants were recruited among university staff, faculty and students. The questions included socio-demographic features of the participants; international evaluation scales designed to recognize depressive-, anxiety- and sleep-related symptoms, impulsivity, quality of life; architectural parameters investigating housing physical characteristics.

Results

As emerges from our analysis poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments < 60 m2, with poor quality view and indoor area is associated with, respectively, 1.31 (95CI), 1.368 (95CI), and 2.253 (95CI) time the risk of moderate/severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95%CI).

Conclusions

Our findings suggest housing played a major role in influencing people mental health and wellbeing during COVID-19 pandemic. We argue strengthened multi-interdisciplinary approach involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to inform the planning implementation and monitoring of housing policies centered on population health.

Key messages

COVID-19 lockdown mitigation measures strongly impacted on Mental Health. Living in apartments < 60 m2, with poor quality view and indoor area significatively increase the risk of moderate and severe depressive symptoms.

Validation of a multiple criteria tool for healthcare facilities quality evaluation

Purpose

Several healthcare quality assessment tools measure the processes and outcomes of the care system. The actual physical infrastructure (buildings and organizational) aspects are, however, rarely considered. The purpose of this paper is to describe the process of validation and weighting of an evidence-informed framework for the quality assessment of hospital facilities from social, environmental and organizational perspectives to complement other assessments.

Design/methodology/approach

Sustainable High-quality Healthcare version 2 (SustHealth v2) is the updated version of an existing framework composed of three domains (social, environmental and organizational quality). To validate and establish a relevant weighting, interviews were conducted with 15 professionals within the field of healthcare planning, design, research and management. The study has been conducted through semi-structured interviews and the application of the Simon Roy Figueras (SRF) procedure for the elicitation of weights criteria. The data collected have been processed through the DecSpace web platform.

Findings

Among the three domains, the organizational qualities appear to be the most important (W = 49%), followed by the environmental (W = 29%) and social aspects (W = 22%). Relevant indicators such as future-proofing, wayfinding and users’ space control emerged as the most important within each macro-area. Those results are confirmed by the outcome of the interviews that highlight user/patient-centeredness, wayfinding strategies and space functionality as the most important concepts to foster in existing healthcare facilities improvement.

Practical implications

The study highlights important structural and organizational aspects that hospital managers and planners can consider when dealing with healthcare facilities’ quality improvement.

Originality/value

The use of the SRF multicriteria method is novel in this context when used to weight an assessment tool with a focus on hospital built environment.

New competences to manage Urban Health: Health City Manager core curriculum

Health as a common good is a prior essential objective to be pursued by an alliance including citizens and local administrations. Role of cities in health promotion is emphasized by urbanization, entailing 70% of the global population living in urban areas. Cities are therefore perfect laboratories within which to act: studying and monitoring dimensions that determine the level of quality of life in cities, improving their sustainability and capacity for growth, is fundamental for a new governance model able of managing this complexity. Under the premises, the Health City Manager (HCM) has been launched, a professional gaining skills in PH management, sociology of communities, urban design and control in reducing health inequalities. A course lasting 80 hours gives then the opportunity to put into practice, at municipal level, knowledge, competences and abilities achieved. In the background, both the former EU Commissioner for Health and the Committee of the Regions warmly supported the establishment of HCMs, who would coordinate a process ensuring alignment of policies on a macro and micro scale. During G7 in 2017, Ministry for Health and Presidency of Italian Municipalities signed the Urban Health Rome Declaration, underlining the need for a stronger synergy facilitated by HCMs. In 2019, Ministry of Youth and Sport approved and financed the project. On the basis of a core curriculum, validated by a group of experts, the course is starting in 2020 for the first 120 HCMs. Innovation lies in the holistic approach, a multidisciplinary project managing method overcoming silos logic. Customization of public policies and participatory process make the figure ideal to be applied in all countries. Sustainability is ensured by a relatively high return on investment. Main impact relates to improvement of the quality of life through a full involvement and accountability of local administrations; contrast of climate change identifying strategies of urban resilience.

Key messages

Improvement of the quality of life through a full involvement and accountability of local administrations. Contrast of climate change identifying strategies of urban resilience.

How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies

Background

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

Methods

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.

Results

Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.

Conclusions

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments.

Key messages

The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs.

The physical distancing imposed, may have amplified population's social and health inequalities.

Urban health and Physical Activity: how urban design can improve cycling

Introduction

It is well-known that physical inactivity is among the main risk factors that increases chronic degenerative diseases. The emergency is relevant in urban contexts, where, most transfers have a distance of less than 5 km, easily done by foot or bicycle. They would ensure an adequate daily physical activity. An increase of cycling would also lead to several other positive effects on the urban environment (air quality, less traffic, noise, etc.). Therefore, it is necessary to investigate which characteristics of the cycling and walking infrastructures encourage or not adequate lifestyles.

Methods

Starting from an analysis of the State of the Art related to the correlation among active transport, physical activity and health, a questionnaire was handed out to collect data on the current level of urban cycling and to quantify the expected increase in case of the improvement of the bicycle path network. The questionnaire was circulated through on-line and paper forms (1675 users), for a period of 3 months in the city of Milan. The aim was to quantify the increase in physical activity related to a provisional improvement of the infrastructures.

Results

The data collected subdivided into 9 districts show that the choice to use the bicycle, as an active means of transport, would significantly increase both in frequency and in duration: for example in the expected scenario 76.5% of the sample (over 21% more than the current one) would reach 150 minutes of physical activity per week, as WHO suggests. The main reasons for daily use or non-use of the bicycle were also identified.

Conclusions

The survey conducted highlighted the direct correlation between urban planning and active mobility. Actions related to mobility redesign, especially small-scale ones, could play a key-role in reducing physical inactivity with positive effects on health. The methodology could be replicated in other realities in order to highlight the specific strategies to be adopted.

Key messages

Questionnaires for improving cycling in urban contexts. Data analysis on citizens’ lifestyles for encouraging active mobility.

Measuring health outcomes of OECD countries’ urban greenspace, with a special focus on Milan (Italy)

Background

Urban world population has raised to 4.2 billion in 2018, with 2.5 billion more forecasted by 2050. Cities are places of opportunities but, at the same time, sites of environmental and social risk factors. Scientific evidence about urban green's environmental benefits is abundant, but Public Health outcomes are seldom carefully defined. The project aims at assessing the Public, Urban and Mental Health outcomes of urban green areas in Organisation for Economic Co-operation and Development (OECD) countries, and at exploring citizen urban greenspace perception in Milan, Italy.

Methods

A systematic review of literature was conducted according to the 2015 PRISMA statement. Two online databases (Medline and Embase), were consulted, and inclusion criteria were set, ruling in all OECD countries-based, English-written studies from 2000 to December 2019. Only objectively measurable health outcomes were deemed suitable for analysis. Based on the main review findings, a community-based survey was created, targeting residents of Milan and its suburban area to understand better how they benefit from the urban green areas in their city. The study is being carried out by an interdisciplinary team of medical doctors and architects.

Results

We grouped health outcomes into five separate domains, namely cardiovascular, obesity, respiratory, neoplasia and mental health. We found negative associations between disease prevalence and urban greenspace overall quantity. Size, perceived quality and accessibility were powerfully explanatory variables. Milan community-based survey drafting is underway. Results are still preliminary and will be presented by tables, graphs and plots.

Conclusions

Cities are increasingly becoming critical points for many emerging Public Health challenges. The results of our study may help urban planners, key stakeholders, policymakers and communities to preserve and increase existing green spaces, and to improve Urban Public Health.

Key messages

Urban greenspace is paramount to OECD cities’ current and future sustainability because of its significant impact on Public, Urban and Mental Health. Milan citizens show remarkable care for urban greenspaces integrity and development.