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Patient-centred improvements in health-care built environments: perspectives and design indicators.

OBJECTIVE: To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. DESIGN: Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. SETTING AND PARTICIPANTS: The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. RESULTS: The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space around the bed area, supportive of privacy and dignity, ward noise and other disturbances. CONCLUSIONS: Patients perceived sustainable health-care environments to be supportive of their health and recovery. The design indicators developed from their perspectives and from their considerations for improvements to the health-care built environment were based on their visions of the role of the health-care facilities. These were homely environments that supported normal lifestyle and family functioning and designs that were supportive of accessibility and travel movements through transitional spaces.

Focus Groups↗

Independent coding of connected environments by place cells.

Place cells are hippocampal neurons that have a strong location-specific firing activity in the rat's current environment. Collectively, place cells also provide a signature of the rat's environment as their ensemble activity is markedly different when recorded in distinct apparatuses. This phenomenon, referred to as 'remapping', suggests that each environment activates a different hippocampal map. In this study, we sought to determine the independence of such maps. In Experiment 1, we used a cylinder apparatus that was divided into two equal halves by a central barrier with an aperture allowing the rat to freely commute between the two sides. A local change in one side failed to induce field remapping in the changed side, thus precluding any significant conclusion to be drawn. We therefore designed Experiment 2 in which place cells were first recorded while rats explored three distinct high-walled boxes. Most cells had distinctive firing fields in each box. A runway was then added to connect two initially unrelated boxes. This manipulation altered the firing of some cells but the fields in each box were still clearly distinguishable. The final manipulation consisted of changing one box and allowing the rat to commute freely between the changed and unchanged boxes. While the firing fields remapped in the changed box, they were most usually unaltered in the unchanged box. These results suggest that the hippocampus holds a set of independent maps for each box, and that each specific map is activated mainly according to the rat's current sensory environment.

Animals↗

The effect of population structure on the adaptive radiation of microbial populations evolving in spatially structured environments.

Spatial structure is thought to be an important factor influencing the emergence and maintenance of genetic diversity. Previous studies have demonstrated that environmental heterogeneity, provided by spatial structure, leads to adaptive radiation of populations. In the present study, we investigate not only the impact of environmental heterogeneity on adaptive radiation, but also of population fragmentation and niche construction. Replicate populations founded by a single genotype of Escherichia coli were allowed to evolve for 900 generations by serial transfer in either a homogeneous environment, or a spatially structured environment that was either kept intact or destroyed with each daily transfer. Only populations evolving in the structured environment with intact population structure diversified: clones are significantly divergent in sugar catabolism, and show frequency-dependent fitness interactions indicative of stable coexistence. These findings demonstrate an important role for population fragmentation, a consequence of population structure in spatially structured environments, on the diversification of populations.

Adaptation, Physiological↗

Early environment, emotions, responses to stress, and health.

A harsh early family environment is related to mental and physical health in adulthood. An important question is why family environment in childhood is associated with these outcomes so long after its initial occurrence. We describe a program of research that evaluates a model linking these variables to each other. Specifically, we hypothesize that low social competence and negative emotional states may mediate relations between a harsh early family environment and physiological/neuroendocrine responses to stress, as well as long-term health outcomes. We report evidence that the model characterizes self-rated health, cortisol responses to stress, and, in males only, elevated cardiovascular responses to stress. We discuss how the social context of early life (such as SES) may affect the family environment in ways that precipitate adverse health consequences. Perspectives on comorbidities in physical and mental health are discussed.

Adult↗

Gene-environment interplay and psychopathology: multiple varieties but real effects.

Gene-environment interplay is a general term that covers several divergent concepts with different meanings and different implications. In this review, we evaluate research evidence on four varieties of gene-environment interplay. First, we consider epigenetic mechanisms by which environmental influences alter the effects of genes. Second, we focus on variations in heritability according to environmental circumstances. Third, we discuss what is known about gene-environment correlations. Finally, we assess concepts and findings on the interaction between specific identified genes and specific measured environmental risks. In order to provide an understanding of what may be involved in gene-environment interplay, we begin our presentation with a brief historical review of prevailing views about the role of genetic and environmental factors in the causation of mental disorders, and we provide a simplified account of some of the key features of how genes 'work'.

Alleles↗

Perceptions of family environment among psychiatric patients and their wives.

This study compared the perceived family environments of former psychiatric inpatients with thought, affective, and substance abuse disorders to those of normative comparison couples using the Family Environment Scale. Family environment was assessed among patients and wives separately at hospital discharge and at three- and twelve-month follow-ups. Patients and their wives were consistently more incongruent in their perceptions of their shared environment than normative couples. In addition, low-functioning patient couples reported less family cohesion, expressiveness, and recreational emphasis than their higher functioning counterparts; the high-functioning patient couples more closely resembled the norm. The paper discusses possible relationships between positive family contact and better patient functioning.

Bipolar Disorder↗

Protist genetic diversity in the acidic hydrothermal environments of Lassen Volcanic National Park, USA.

We examined eukaryote genetic diversity in the hydrothermal environments of Lassen Volcanic National Park (LVNP), Northern California. We sampled hydrothermal areas of the Bumpass Hell, Sulfur Works, Devil's Kitchen, and Boiling Springs Lake sites, all of which included diverse acidic pools, mud pots, and streams with visible algal mats and biofilms. Temperatures varied from 15 to 85 degrees C and pH from 1.7 to 5.8. DNA extraction methods compared by denaturing gradient gel electrophoresis fingerprinting exhibited similar patterns, and showed limited diversity of eukaryotic small subunit (SSU) rRNA genes compared with prokaryotes. We successfully amplified eukaryotic SSU rRNA genes from most environments up to 68 degrees C. Cloned rDNA sequences reveal acidophilic protists dominate eukaryotes in LVNP hydrothermal environments. Most sites showed phototrophic assemblages dominated by chlorophytes and stramenopiles (diatoms and chrysophytes). Heterotrophic taxa, though less abundant, included diverse alveolates (ciliates), amoebae, and flagellates. Fungi were also found at most sites, and metazoans (hexapods, nematodes, platyhelminths) were sometimes detected in less acidic environments, especially in algal mats. While many cloned rDNA sequences showed 95%-99% identity to known acidophilic isolates or environmental clones from other acidic sites (Rio Tinto), sequence diversity generally declined both with decreasing pH and increasing temperature, and both were controlling physical variables on the abundance and distribution of organisms at our sites. However, a pool at 68 degrees C with pH 1.7 yielded the greatest number of distinct sequences. While some were likely contaminants from nearby cooler sites, we suggest that Lassen's acidic hydrothermal features may harbor novel protists.

Acids↗

Family environments of depressed outpatients.

The present study assessed the family environments of 43 depressed patients treated in an outpatient clinic. All family members 11+ years of age were administered the Family Environment Scale. Results showed that perceptions of the family environment were not statistically different from a normative sample. Differences among unipolar, bipolar and secondary affective disorder groups also did not attain statistical significance. On the other hand, current symptomatology among patients was associated with negative perceptions of the family environment.

Adult↗

Family environment predictors of outcome in schizophrenic patients in Spain: a nine-month follow-up study.

This study investigates the effects of perceived family environment on clinical outcome among patients in Spain who suffer from schizophrenia. Forty-five consecutively admitted DSM-III-R schizophrenic patients were assessed monthly with the Brief Psychiatric Rating Scale during a 9-month period. Patients and parents rated the family environment through the Family Environment Scale (FES). FES factors were considered separately for each family member, since parents' and patient's perceptions of the family environment were weakly correlated. Stepwise multiple regression analysis showed that patients' perceptions of family control and intellectual-cultural orientation predicted rehospitalization. Patients' and mothers' ratings of family control and fathers' scores of conflict and moral religious emphasis predicted psychotic relapse. However, fathers' scores of family cohesion predicted higher negative symptoms. Prior admissions, age of onset and use of depot medication tended to predict outcome in conjunction with the family variables.

Adolescent↗

Age, environment, and lymphocyte immunization influence the spontaneous resorption rate in the CBA/J x DBA/2J mouse model.

PROBLEM: This study was designed to examine the influence of age, environment, and lymphocyte immunotherapy on fetal resorption rates in the CBA/J x DBA/2J mouse model. METHODS: After weaning, CBA/J female mice were randomly allocated to two different environments: room A was a conventional housing facility, and room B was a specific pathogen-free room. They were further divided into two groups in each room according to age (> three months and < or = three months), and mated with CBA/J, DBA/2J, or BALB/c males. The fetal resorption rates were observed. The immunization study was conducted using CBA/J females greater than three months old in room B. Preimmunization with various preparations and dosages of lymphocytes was performed 1 wk before mating with DBA/2J males, and fetal resorption rates were measured to investigate the effect of immunotherapy. RESULTS: In room A, the fetal resorption rates (9.4 to 11.8%) were not significantly different among the various mating combinations using CBA/J females greater or less than three months of age. In room B, CBA/J females older than three months and mated with DBA/2J males had a higher rate of fetal resorption than those younger than three months (28.9 versus 14.2%) and had higher rate of fetal resorption than those housed and mated in room A (28.9 versus 10.9%). This fetal resorption rate was also higher than those seen with other mating combinations. Preimmunization with male BALB/c splenic lymphocytes (optimal dose 1 x 10(7) cells) was effective in decreasing fetal resorption rate (7.9%), whereas administration of normal saline, or immunization with male CBA/J or DBA/2J lymphocytes was not (20.7 to 27.0%). CONCLUSION: Age and environment influence the spontaneous resorption rate in the CBA/J x DBA/2J mouse model. The high fetal resorption rate of older CBA/J females mated with DBA/2J males in a pathogen-free environment can be reduced by immunization with BALB/c splenic lymphocytes. These results suggested that a variety of mechanisms might initiate early pregnancy failure and that immunological modulation during implantation might be a nonspecific factor.

Abortion, Spontaneous↗

Correlations among size-related traits affected by chromosome inversions in Drosophila buzzatii: the comparison within and across environments.

Genetic variation in correlations among size-related traits of head, thorax, and wings was examined in Drosophila buzzatii, by comparing the pattern of the Phenotypic Correlation Matrix (Rp) between inversion karyotypes of the second chromosome. No similarity in Rp was observed between some karyotypes in a natural population. The pattern of Rp in wild-reared heterokaryotypes, but not in homokaryotypes, was similar to the whole population represented by laboratory-reared flies. While phenotypic correlations in wild-reared flies were found to be larger than in laboratory-reared flies, similarity in the pattern of Rp was very high for one homokaryotype reared in both environments: the relatively homogeneous lab environment and the more variable field environment. While no such a similarity across environments was detected between different karyotypes, the pattern of Rp was similar for a same homokaryotype in different populations. Thus, the lack of karyotypic similarity in Rp is, at least partially, genetic. These results indicate that chromosomal inversions are factors affecting genetic correlations among traits known to be phenotypically correlated with adult fitness components in this species.

Animals↗

The social/sexual environment of gay men residing in a rural frontier state: implications for the development of HIV prevention programs.

CONTEXT: The incidence and prevalence of HIV/AIDS is increasing among rural men who have sex with men (MSM). Yet little is known about the social/ sexual environment of rural frontier areas. PURPOSE: The purpose of this study was to assess the social/sexual environment of gay men living in rural areas and how this environment contributes to the development of HIV/AIDS prevention programs. METHODS: A qualitative study was conducted in Wyoming. In-depth guided interviews were conducted with 39 self-identified gay men. Data were analyzed for emergent themes using constant comparative analysis. FINDINGS: Four broadly related themes emerged. Participants perceive that they live in a hostile social environment in which the potential for becoming a target of violence is present. In order to cope with this social reality, men adopt strategies to assimilate into the predominant heterosexual culture and to look for sex partners. These, in turn, are related to their attitudes about HIV/AIDS and prevention activities. Notably, the Internet was discussed by participants as a means for men to connect to a larger gay society and look for sex partners and as a potential venue to HIV/AIDS prevention programs. CONCLUSIONS: Data provided a number of implications for developing HIV/AIDS prevention programs targeting rural MSM. Especially apparent was the need for programs to be mindful of the desire to keep one's sexual preferences shielded from public knowledge and the effect this may have on recruiting rural MSM to participate in prevention activities. The Internet, because men can access it privately, might provide a venue for prevention projects.

Adult↗

Vygotsky and Papert: social-cognitive interactions within Logo environments.

The purpose of this study was to examine the effects of co-operative and individualised Logo environments on creativity and interpersonal relationships regarding academic recognition and social acceptance. Participants were 83 students who studied in three eighth grade classrooms: one was exposed to a co-operative Logo environment (N = 30), the other to an individualised Logo environment (N = 24), and the third served as a non-treatment control group (N = 29). Results showed that students in the cooperative Logo environment outperformed their counterparts in the other two groups on certain measures of creativity (figurative-originality, verbal-flexibility, and verbal-originality). In addition, the co-operative Logo group developed more positive interpersonal relationships than the students in the other two settings. The results are discussed from three perspectives: the social-cognitive approach emphasising the roles of co-operation and metacognition in developing advanced thinking skills; the educational-technology viewpoint demonstrating the potential use of computers; and the pedagogical view pointing out the implications of the study to school situations and heterogeneous classrooms.

Child↗

The importance of self-efficacy as a mediating variable between learning environments and achievement.

The purpose of this research was to investigate the extent to which self-efficacy acts as a mediating variable between the learning environment and achievement. Seven year 5 classes (N = 179 students aged 9 to 10 years) were allocated randomly to cooperative, competitive or individualistic environments for twice-weekly social studies lessons, changing environments after five weeks. Data collected on self-efficacy and achievement in weeks 5 and 10 indicated that co-operative environments led to higher self-efficacy and achievement as well as more appropriate behaviour. The performance of particular tasks under competition appears to be enhanced when students have previously worked co-operatively, but may be difficult to sustain as self-efficacy and behaviour standards decline.

Child↗

Sources of stress and dissatisfaction among nurses in four hospital environments.

A study was designed to examine the hypothesis that occupational stress in nurses is a function of how they perceive their work environment. Sixty-five nurses on four mixed-sex wards were interviewed using a nursing stress and work environment scale. Demographic data including age, sex and nursing status were also collected. 'Work overload' and the 'death and dying' of patients were identified as the major sources of stress for all the nurses. In general, although there was little difference between the specialized and non-specialized groups of nurses in the degree of stress experienced, the work environments were found to be dissimilar. The reported level of dissatisfaction with their work environment combined with certain demographic characteristics were found significantly to predict the degree of stress experienced. These findings have implications for the organization of the ward and for the skills taught to nurses by which stress may be managed or alleviated.

Female↗

Measuring the influence of built neighborhood environments on walking in older adults.

There is a need for greater understanding of how perceptions and objective measures of the physical environment influence physical activity among seniors. The goal of this study was to examine the degree of association between perceived and objective characteristics of the neighborhood environment and the relation of each type of measurement to neighborhood walking in older adults. Data on self-reported frequency of walking in the neighborhood and perceived measures of neighborhood environment from 105 older adults were linked to objective measures assessed by geographic information systems and an audit instrument. Perceived and objective measurements of the built environment exhibited a low degree of agreement (kappas: <.20). After adjustment for education, age, and gender, presence of a mall was positively associated with neighborhood walking in both the objective and perceived models.

Aged↗

Response of terrestrial microorganisms to a simulated Martian environment.

Soil samples from Cape Canaveral were subjected to a simulated Martian environment and assayed periodically over 45 days to determine the effect of various environmental parameters on bacterial populations. The simulated environment was based on the most recent available data, prior to the Viking spacecraft, describing Martian conditions and consisted of a pressure of 7 millibars, an atmosphere of 99.9% CO2 and 0.1% O2, a freeze-thaw cycle of -65 degrees C for 16 h and 24 degrees C for 8 h, and variable moisture and nutrients. Reduced pressure had a significant effect, reducing growth under these conditions. Slight variations in gaseous composition of the simulated atmosphere had negligible effect on growth. The freeze-thaw cycle did not inhibit growth but did result in a slower rate of decline after growth had occurred. Dry samples exhibited no change during the 45-day experiment, indicating that the simulated Martian environment was not toxic to bacterial populations. Psychotrophic organisms responded more favorably to this environment than mesophiles, although both types exhibited increases of approximately 3 logs in 7 to 14 days when moisture and nutrients were available.

Atmosphere↗

Bacillus endospores isolated from granite: close molecular relationships to globally distributed Bacillus spp. from endolithic and extreme environments.

As part of an ongoing effort to catalog spore-forming bacterial populations in environments conducive to interplanetary transfer by natural impacts or by human spaceflight activities, spores of Bacillus spp. were isolated and characterized from the interior of near-subsurface granite rock collected from the Santa Catalina Mountains, AZ. Granite was found to contain approximately 500 cultivable Bacillus spores and approximately 10(4) total cultivable bacteria per gram. Many of the Bacillus isolates produced a previously unreported diffusible blue fluorescent compound. Two strains of eight tested exhibited increased spore UV resistance relative to a standard Bacillus subtilis UV biodosimetry strain. Fifty-six isolates were identified by repetitive extragenic palindromic PCR (rep-PCR) and 16S rRNA gene analysis as most closely related to B. megaterium (15 isolates), B. simplex (23 isolates), B. drentensis (6 isolates), B. niacini (7 isolates), and, likely, a new species related to B. barbaricus (5 isolates). Granite isolates were very closely related to a limited number of Bacillus spp. previously found to inhabit (i) globally distributed endolithic sites such as biodeteriorated murals, stone tombs, underground caverns, and rock concretions and (ii) extreme environments such as Antarctic soils, deep sea floor sediments, and spacecraft assembly facilities. Thus, it appears that the occurrence of Bacillus spp. in endolithic or extreme environments is not accidental but that these environments create unique niches excluding most Bacillus spp. but to which a limited number of Bacillus spp. are specifically adapted.

Bacillus↗