Elements that contribute to healthy building design

Studying the factors that affect urban road noise-case study: El-Tahrir Street, Al-Dokki Cairo, Egypt

Expanding road networks to accommodate various activities has significantly increased urban noise pollution, adversely affecting human health and quality of life. Numerous factors influence the noise level in urban areas, including road characteristics, traffic characteristics, surrounding buildings, and weather conditions. While previous studies have considered many of these factors individually, this study aims to integrate all relevant variables to comprehensively monitor and analyze their combined effects on noise levels. The objective is to determine the most influential factors that could be incorporated into effective noise reduction strategies. This research focuses on Cairo, one of the most densely populated cities in the world, where high noise levels are a persistent issue. A detailed case study of Tahrir Street in Dokki, Cairo, provides the basis for this investigation. One of the most crowded areas is El-Tahrir Street in Al-Dokki, which was selected as a case study in this research. This area experiences high traffic volume, with up to 1700 vehicles passing through within a 15-min interval. This significant traffic volume is the primary driver of the elevated noise levels in the area. Traffic and noise level monitoring was conducted using a field survey using the sound level meter. Consequently, a statistical analysis was conducted to investigate the correlation between different factors and the noise level and determine the most influential factors. The study revealed that traffic volume and congestion are the most significant factors influencing noise levels on Tahrir Street, exhibiting strong positive correlations (R = 0.38). Additionally, the study found an inverse relationship between vehicle speed and noise level due to high traffic volumes and identified that building characteristics and wind direction also play roles, albeit to a lesser extent.

Developing a WELL building model for office environments

Many reported cases of occupants in modern office buildings suffer from severe health risks, negative impacts on well-being, and productivity loss. Existing building standards often prioritize energy performance and green environments over human sustainability. Moreover, office buildings have a distinct group of occupants that require extra attention. Hence, the study aims to develop a WELL building model specifically for office buildings to support occupants' well-being, health, and productivity (i.e., WELL). To achieve that objective, this study developed a list of physical indoor building features through a systematic literature review and semi-structured interviews. Then, the features were inserted into a survey and sent to office building occupants and built environment professionals. The collected data was analyzed using the analytic hierarchy process (AHP) and confirmatory factor analysis (CFA). The findings suggest twelve new features applicable for supporting WELL in office buildings: workspace privacy, sufficient space, office layout, cleanliness, efficiency in building services, individual control, building automation system, Information Technology (IT) infrastructure, Wireless Fidelity (WiFi) risk, security system, safety at parking lots, and safe design. Also, three new concepts for supporting WELL in office buildings were established: office space, building services and maintenance, and smart systems. The new concepts and features lay a foundation for designing office buildings that comprehensively target occupants' WELL. Finally, this study is unique as it accentuates the development of a WELL building model specifically for office buildings.

What is the "DNA" of healthy buildings? A critical review and future directions

Since the outbreak of COVID-19, buildings that provide improved performance have aroused extensive discussion. Nowadays, the connotation of healthy building is becoming complex, performance metrics for healthy buildings vary significantly from different regions in the world and there may be information asymmetry among stakeholders. Consequently, building health performance cannot be effectively achieved. However, previous studies have launched extensive reviews on green building, and there remains a lack of comprehensive and systematic reviews on healthy buildings. To address the above issues, therefore, this research aims to (1) conduct a thorough review of healthy building research and reveal its nature; and (2) identify the current research gaps and propose possible future research directions. Content analysis using NVivo were applied to review 238 relevant publications. A DNA framework of healthy buildings, which clarifies the characteristics, triggers, guides and actions, was then constructed for better understanding of the nature of them. Subsequently, the application of DNA framework and the directions of future research were discussed. Six future research directions were finally recommended, including life-cycle thinking, standard systems improvement, policies & regulations, awareness increase, healthy building examination, and multidisciplinary integration. This research differs from previous ones because it painted a panorama of previous healthy building research. Findings of this research contribute to reveal knowledge map of healthy buildings, guide researchers to fill existing knowledge gaps, provide a standardized platform for healthy building stakeholders, and promote high-quality development of healthy buildings.

Relationship of Healthy Building Determinants With Musculoskeletal Disorders of the Extremities: A Systematic Review

Musculoskeletal disorders (MSDs) are a substantial societal burden and various factors affect their causation, recovery, and prognosis. Management of MSDs is complex and requires multifaceted interventions. Given the challenges of MSDs and their continued burden, it is possible that additional elements could impact these disorders that have not been fully researched, for example, indoor environmental quality. Our previous review provided preliminary evidence that healthy building determinants (HBDs) are associated with the risk of back and neck pain. However, the relationship of HBDs with extremity MSDs and general MSDs (i.e., MSDs involving multiple body regions or in which body regions were unspecified in the original reports) has not been formally studied. The purpose of this review was to conduct a systematic literature review to assess the relationship of HBDs with extremity and general MSDs (PROSPERO ID: CRD42022314832). PubMed, CINAHL, Embase, and PEDRo databases were searched through April 2022. Inclusion criteria for study eligibility were as follows: humans of ages ≥18 years, reported on one or more of eight HBDs (1. air quality and ventilation, 2. dust and pests, 3. lighting and views, 4. moisture, 5. noise, 6. safety and security, 7. thermal health, 8. water quality), and compared these HBDs with extremity MSDs or general MSDs, original research, English. Exclusion criteria were as follows: articles not published in peer-reviewed journals, full-text articles unavailable. Review procedures were conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Empirical evidence statements were developed for 33 pairwise comparisons of HBDs with MSDs. The search uncovered 53 eligible studies with 178,532 participants. A total of 74.6% (39/53) of the studies were cross-sectional and 81.1% (43/53) were fair quality. Overall, the majority of uncovered evidence indicates that HBDs are related to risk of extremity and general MSDs. Nineteen comparisons support that as HBDs worsen, the risk of MSDs increases. Six comparisons had conflicting evidence. Three comparisons support that poor HBDs are not related to increased risk of extremity and general MSDs. Five comparisons had no evidence. This systematic review builds upon previous work to provide useful starting points to enhance awareness about the HBD-MSD relationship. These findings can help inform research and public health efforts aimed at addressing suboptimal HBDs through appropriate interventions to improve the lives of those suffering from MSDs.

Relationship of Healthy Building Determinants With Back and Neck Pain: A Systematic Review

OBJECTIVE

Back pain and neck pain are very common, costly, and disabling. Healthy building determinants within the built environment have not been adequately assessed as contributors to these conditions. The objective of this study was to systematically review the literature on the relationship of healthy building determinants with back and neck pain.

DATA SOURCE

PubMed, CINAHL, EMBASE, Google Scholar, and PEDRo. Study Inclusion and Exclusion Criteria: Studies were included if they met the following criteria: Adults, comparison of healthy building determinants (air quality, ventilation, dust and pests, lighting and views, moisture, noise, safety/security, thermal health, water quality) with back and neck pain, original research, English. Studies were excluded if full text articles were unavailable and if the focus was patient and materials handling or ergonomics.

DATA EXTRACTION

Data extraction and other review procedures were elaborated according to PRISMA guidelines. Data Synthesis: Data were synthesized with an approach adapted from Oxford Centre for Evidence-Based Medicine and American Physical Therapy Association.

RESULTS

37 articles enrolling 46,223 participants were eligible. Most articles were cross-sectional (31/37) and fair quality (28/37). None were interventional. Evidence was found to generally support a relationship indicating that as healthy building determinants worsen, the risk of back and neck pain increases.

CONCLUSION

Although the available evidence precludes interpretations about causality, the study's findings are starting points to guide future research, knowledge creation, and health promotion initiatives about the relationships of the built environment with back and neck pain.

Invigorating Health Strategy in an Integrated Design Process

Healthy buildings are gaining crucial significance in construction and one health setting for promoting occupants’ health. However, the traditional design process for healthy buildings presents limitations with no specific guidelines. In contrast, the integrated design process (IDP) has proven to be effective in realizing high-performance buildings. However, the IDP shortfall of not having robust health strategy (HS) capability is a concern of interest. Thus, we posit further advancement of IDP in the context of incorporating HS in the prevailing IDP guidelines with a sequential iterative procedure. Moreover, a conceptual framework aimed at invigorating the implementation of HS in all IDP stages is proposed. The strategies within IDP that would reinforce achieving healthy building by addressing building process implementation are highlighted. The (IDP + HS) iterative framework herein advanced is intended to aid neophyte and experienced building professionals to reflect about the process of achieving healthy building while optimizing IDP for one’s health invigoration in construction industry.

In-home environmental exposures predicted from geospatial characteristics of the built environment and electronic health records of children with asthma

PURPOSE

Children may be exposed to numerous in-home environmental exposures (IHEE) that trigger asthma exacerbations. Spatially linking social and environmental exposures to electronic health records (EHR) can aid exposure assessment, epidemiology, and clinical treatment, but EHR data on exposures are missing for many children with asthma. To address the issue, we predicted presence of indoor asthma trigger allergens, and estimated effects of their key geospatial predictors.

METHODS

Our study samples were comprised of children with asthma who provided self-reported IHEE data in EHR at a safety-net hospital in New England during 2004-2015. We used an ensemble machine learning algorithm and 86 multilevel features (e.g., individual, housing, neighborhood) to predict presence of cockroaches, rodents (mice or rats), mold, and bedroom carpeting/rugs in homes. We reduced dimensionality via elastic net regression and estimated effects by the G-computation causal inference method.

RESULTS

Our models reasonably predicted presence of cockroaches (area under receiver operating curves [AUC] = 0.65), rodents (AUC = 0.64), and bedroom carpeting/rugs (AUC = 0.64), but not mold (AUC = 0.54). In models adjusted for confounders, higher average household sizes in census tracts were associated with more reports of pests (cockroaches and rodents). Tax-exempt parcels were associated with more reports of cockroaches in homes. Living in a White-segregated neighborhood was linked with lower reported rodent presence, and mixed residential/commercial housing and newer buildings were associated with more reports of bedroom carpeting/rugs in bedrooms.

CONCLUSIONS

We innovatively applied a machine learning and causal inference mixture methodology to detail IHEE among children with asthma using EHR and geospatial data, which could have wide applicability and utility.

Integration of Indoor Air Quality Prediction into Healthy Building Design

Healthy building design is an emerging field of architecture and building engineering. Indoor air quality (IAQ) is an inevitable factor that should be considered in healthy building design due to its demonstrated links with human health and well-being. This paper proposes to integrate IAQ prediction into healthy building design by developing a simulation toolbox, termed i-IAQ, using MATLAB App Designer. Within the i-IAQ, users can input information of building layout and wall-openings and select air pollutant sources from the database. As an output, the toolbox simulates indoor levels of carbon dioxide (CO2), total volatile organic compounds (TVOC), inhalable particles (PM10), fine particles (PM2.5), nitrogen dioxide (NO2), and ozone (O3) during the occupied periods. Based on the simulation results, the toolbox also offers diagnosis and recommendations to improve the design. The accuracy of the toolbox was validated by a case study in an apartment where physical measurements of air pollutants took place. The results suggest that designers can integrate the i-IAQ toolbox in building design, so that the potential IAQ issues can be resolved at the early design stage at a low cost. The paper outcomes have the potential to pave a way towards more holistic healthy building design, and novel and cost-effective IAQ management.

Best Fit for Common Purpose: A Multi-Stakeholder Design Optimization Methodology for Construction Management

Within traditional design processes, decisions are often made based on individualistic values and late-stage assessments conducted on a predefined set of design alternatives potentially leading to suboptimal design decisions and conflicts. The issues are further amplified by the growing complexity of construction project management where an increasing number of stakeholders are involved. To address those issues, a shift is needed towards a collaborative early stage optimization-based design process. The current optimization-based design approaches are not appropriately integrating stakeholders and their preferences in the optimization process and thereby not reflecting the real-life design and construction process. In this study, we present a pioneering multi-stakeholder design methodology combining preference function modeling theory and a priori optimization enabling stakeholders to find the group-optimal design fairly representing their preferences. The application of the developed methodology is demonstrated on a real-life multi-storey building design case. The study provides a novel approach for managing design and construction projects for academic and industry stakeholders. It also sets the foundation for the further development of stakeholder-oriented optimization-based design.

Indoor exposure to phthalates and its burden of disease in China

China's profoundly rapid modernization in the past two decades has resulted in dramatic changes in indoor environmental exposures. Among these changes, exposure to phthalates has attracted increasing attention. We aimed to characterize indoor phthalate exposure and to estimate the disease burden attributable to indoor phthalate pollution from 2000 to 2017 in China. We integrated the national exposure level of indoor phthalates from literature through systematic review and Monte Carlo simulation. Dose-response relationships between phthalate exposure and health outcomes were obtained by systematic review and meta-analysis. Based on existing models for assessing probabilities of causation and a comprehensive review of available data, we calculated the disability-adjusted life years (DALYs) among the general Chinese population resulting from exposure to indoor phthalate pollution. We found that DnBP, DiBP, and DEHP were the most abundant phthalates in indoor environments of residences, offices, and schools with medians of national dust phase concentration from 74.5 µg/g to 96.3 µg/g, 39.6 µg/g to 162.5 µg/g, 634.2 µg/g to 1,394.7 µg/g, respectively. The national equivalent exposure for children to phthalates in settled dust was higher than that of adults except for DiBP and DnOP. Dose-response relationships associated with DEP, DiBP, DnBP, BBzP, and DEHP exposures were established. Between 2000 and 2017, indoor phthalate exposure in China has led to 3.32 million DALYs per year, accounting for 0.90% of total DALYs across China. The annual DALY associated with indoor phthalate pollution in China was over 2000 people per million, which is about 2~3 times of the DALY loss due to secondhand smoke (SHS) in six European countries or the sum of the DALY loss caused by indoor radon and formaldehyde in American homes. Our study indicates a considerable socioeconomic impact of indoor phthalate exposure for a modernizing human society. This suggest the need for relevant national standard and actions to reduce indoor phthalate exposure.

Does improving indoor air quality lessen symptoms associated with chemical intolerance?

Aim:

To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI).

Background:

Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI.

Methods:

Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effects, and provided guidance for reducing exposures.

Findings:

Homes where recommendations were followed showed the greatest improvements in IAQ. The improvements were based upon decreased airborne VOCs associated with reduced use of cleaning chemicals, personal care products, and fragrances, and reduction in the index patients’ symptoms. Symptom improvement generally was not reported among those whose homes showed no VOC improvement.

Conclusion:

Improvements in both IAQ and patients’ symptoms occur when families implement an action plan developed and shared with them by a trained EHC team. Indoor air problems simply are not part of most doctors’ differential diagnoses, despite relatively high prevalence rates of CI in primary care clinics. Our three-question screening questionnaire – the BREESI – can help physicians identify which patients should complete the QEESI. After identifying patients with CI, the practitioner can help by counseling them regarding their home exposures to VOCs. The future of clinical medicine could include environmental house calls as standard of practice for susceptible patients.

Identification and characterization of odorous volatile organic compounds emitted from wood-based panels

In studying indoor air quality, the concentration of volatile organic compounds (VOCs) emitted from wood-based panels and products is considered a main influencing factor. VOCs with low concentrations, even below the detection limit, can also have negative effects. Herein, VOCs emitted from particleboards and laminated boards were collected and analysed by GC-MS, and key odorous VOCs were identified using the odor activity value. Compared with laminated boards, particleboards showed higher concentration of total volatile organic compound (TVOC). Halogenated compounds, esters, and aromatic hydrocarbons were main contributors to total VOC emissions, which could relate to the addition of additives used during panel manufacturing. Eleven VOCs were identified that listed as hazardous air pollutants in the US Clean Air Act. Aldehydes were the major contributor to the OAV; most aldehydes have unpleasant odors, such as fatty acids, which contribute to the smell of surrounding air. Octanal was the dominant odorant in the aldehyde compounds.

The NOx Degradation Performance of Nano-TiO2 Coating for Asphalt Pavement

The NO_x degradation performance of nano-TiO₂ as a coating material for the road environment was evaluated in this research. The nano-TiO₂ coating materials for both road surface and roadside were prepared by using anatase nano-TiO₂, activated carbon powder, silane coupling agent and deionized water. The impact of varying amounts of coating material and silane coupling agent were evaluated. The road environment of NO_x degradation was simulated by the photocatalytic test system designed by the research team. For the road surface coating, the photocatalytic degradation experiments of NO under different radiation intensities were carried out. The results show that the material has good photocatalytic degradation performance, and the proper amount of silane coupling agent can enhance the bonding performance of the material and asphalt mixture. For the roadside coating, sodium dodecylbenzene sulfonate was selected as the surfactant to carry out the photocatalytic degradation experiment of NO₂ with different dosages of surfactant. The results showed that when the mass ratio of nano-TiO₂ and surfactant was about 1:2, the catalytic degradation effect of the material was the best.

Effects of biophilic interventions in office on stress reaction and cognitive function: A randomized crossover study in virtual reality

Biophilia hypothesis suggests humans have an innate connection to nature which may affect our health and productivity. Yet we currently live in a world that is rapidly urbanizing with people spending most of their time indoors. We designed a randomized crossover study to let 30 participants experience three versions of biophilic design in simulated open and enclosed office spaces in virtual reality (VR). Throughout the VR session, we measured blood pressure, heart rate, heart rate variability, and skin conductance level and administered cognitive tests to measure their reaction time and creativity. Compared to the base case, participants in three spaces with biophilic elements had consistently lower level of physiological stress indicators and higher creativity scores. In addition, we captured the variation in the intensity of virtual exposure to biophilic elements by using eye-tracking technology. These results suggest that biophilic interventions could help reduce stress and improve creativity. Moreover, those effects are related to both the types of biophilic elements and may be different based on the workspace type (open vs enclosed). This research demonstrates that VR-simulated office spaces are useful in differentiating responses to two configurations and among biophilic elements.

Impact of Low-Income Home Energy-Efficiency Retrofits on Building Air Tightness and Healthy Home Indicators

We studied 226 low-income households as a part of the Colorado Home Energy Efficiency and Respiratory Health (CHEER) study to investigate the relationship between energy-efficiency retrofits (EERs) specific to air sealing of residential building envelopes, annual average infiltration rates (AAIR), and qualitative indicators of “healthy” homes. Blower door tests quantified the leakage area in each home, which was used to estimate the AAIR. Walk-through inspections were used to record observations of air-sealing retrofits conducted as part of Colorado’s Weatherization Assistance Program and indirect indicators of poor indoor environmental quality (IEQ) in the homes, such as visible mold or stains, visible dust on hard surfaces, vapor condensation on windows, dampness, and perceived air quality. Results showed that building characteristics like age and volume affected AAIR more significantly than air-sealing EERs. Among the air-sealing EERs, homes with the air-handler ductwork sealed and windows weather-stripped were found to have significantly lower AAIR compared to the homes without these features. Mold growth, wall stains, notably higher levels of dust, and unacceptable odor levels were more frequently reported in homes with higher AAIR, showing that leakier homes do not necessarily have better IEQ.

Healthy-Sustainable Housing Index: A Pilot Study to Link Architecture and Public Health in a Semi-Urban Community in Mexico

The aim of this pilot study was to evaluate the link between housing and children´s respiratory symptoms, through the construction of an index (HSHI) based on the definition of healthy-sustainable housing criteria, in a semi-urban community from Morelos, Mexico. A general and household questionnaire, and respiratory symptoms diary were applied in 60 households to gather information about schoolchildren, respiratory health, housing and lifestyle characteristics. HSHI was constructed using principal component analysis. The association between HSHI and the presence and duration of respiratory symptoms was assessed using logistic and Poisson regression models. HSHI had five components, which accounted for 63% of variance, and were classified into poor and sufficient quality. It was observed that schoolchildren who inhabit a sufficient-quality house, showed a reduction in nose irritation duration and in the allergic symptoms probability regarding component 1 (ventilation, lighting and cloth washing) and presented three times less duration of common cold by component 2 (construction material, painted walls inside the house and type of bathroom) compared to poor-quality house inhabitants. Our results suggest that living in a sufficient-quality house, as described by the HSHI, reduced the prevalence of wheezing episodes and the probability of ear pain, providing evidence about the positive association of a healthy-sustainable housing on the respiratory health of schoolchildren.

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities.

VOCs Emissions from Multiple Wood Pellet Types and Concentrations in Indoor Air

Wood pellet storage safety is an important aspect for implementing woody biomass as a renewable energy source. When wood pellets are stored indoors in large quantities (tons) in poorly ventilated spaces in buildings, such as in basements, off-gassing of volatile organic compounds (VOCs) can significantly affect indoor air quality. To determine the emission rates and potential impact of VOC emissions, a series of laboratory and field measurements were conducted using softwood, hardwood, and blended wood pellets manufactured in New York. Evacuated canisters were used to collect air samples from the headspace of drums containing pellets and then in basements and pellet storage areas of homes and small businesses. Multiple peaks were identified during GC/MS and GC/FID analysis, and four primary VOCs were characterized and quantified: methanol, pentane, pentanal, and hexanal. Laboratory results show that total VOCs (TVOCs) concentrations for softwood (SW) were statistically (p < 0.02) higher than blended or hardwood (HW) (SW: 412 ± 25; blended: 203 ± 4; HW: 99 ± 8, ppb). The emission rate from HW was the fastest, followed by blended and SW, respectively. Emissions rates were found to range from 10^-1 to 10^-5 units, depending upon environmental factors. Field measurements resulted in airborne concentrations ranging from 67 ± 8 to 5000 ± 3000 ppb of TVOCs and 12 to 1500 ppb of aldehydes, with higher concentrations found in a basement with a large fabric bag storage unit after fresh pellet delivery and lower concentrations for aged pellets. These results suggest that large fabric bag storage units resulted in a substantial release of VOCs into the building air. Occupants of the buildings tested discussed concerns about odor and sensory irritation when new pellets were delivered. The sensory response was likely due to the aldehydes.

A predictive model of apartment-living based on socio-economic and demographic factors with health-based approach in Iran

Objective:

Due to importance and progressive growth of apartment-living phenomenon in the world today, it is essential to survey the different dimensions of this modern lifestyle. The aim of this study is to predict rate of apartment-living based on the different predicted variables of socio-economic and demographic factors with approach to different health aspects.

Methods:

A descriptive- analytic study was carried out between 600 apartment and 800 non-apartment residents in the Shiraz (Southern Region of Iran) through multi-stage cluster sampling during the year 2011. The statistical analysis was performed on the obtained data using multi-variable logistic regression as well as ANOVA analysis.

Result:

The rate for apartment-living in above 30 years old age group was 8.31 times more than 15-30 years old, 9.6 times more in employed vs. unemployed; 6.57 and 9.49 times more in families with average and high monthly incomes, respectively, vs. family with low monthly income; 8.73 times more in owner sub-group vs. renter sub-group; and 1.30 times more in people living lonely than those living with family. People living in an apartment are in poor health status considering physical, mental and social aspects.

Conclusion:

Based on the results, it is very important that policy makers in urban areas consider the determinative role of socio-economic and demographic factors, which are involved in selecting apartment-living lifestyle by urban residents and also are effective on health.

A cottage model for eldercare

OBJECTIVE

An overview of medical, cognitive, and affective changes experienced by geriatric long-term care residents during a migration from traditional healthcare delivery to a cottage-based model.

BACKGROUND

New architectural models hold great promise for improving health and social outcomes for residents. New studies must explore the resident, family, and staff outcomes across transformations, as well as the business case for change.

METHODS

A longitudinal, quasi-experimental design was employed, with an emphasis on regularly acquired institutional data, including the Minimum Data Set, as well as commonly available survey instruments including the MOSES, the 2005 NSWHN, and Castle's Job Satisfaction Questionnaire. Descriptive statistics, McNemar's Exact Test, repeated measures ANOVA, and t-tests were used as well as narratives from families, staff, and management.

RESULTS

Staff perceived enhanced institutional respect (t(72) = 2.38, p = 0.02) and work environment, and families perceived more staff cooperation and a better bond between staff and residents. No changes were discerned in a resident's prevalence of pain (odds ratio 0.43, p = .34, 95% CI [0.07, 1.88]), mobility (odds ratio 0.50, p =.19, 95% CI [0.17, 1.32]), range of motion(odds ratio 0.57, p = .55, 95% CI [0.12, 2.25]), or depression and anxiety (odds ratio 2.33, p =.11,95% CI [0.84, 7.41]). A modest decline in residents' systolic (t(101) = 3.74, p < .001) and diastolic (t(101) = 2.870, p < .01) blood pressures was demonstrated. The rate at which a resident's Activities of Daily Living score declined was attenuated (t(57) = 3.37, p < .001). Operational costs remained constant across the move.

CONCLUSIONS

Cottage settings were aesthetically appealing to residents, family, and staff. Modest improvements in health outcomes were observed, and operational costs remained stable.

Disparities in risk communication: a pilot study of asthmatic children, their parents, and home environments

Parents' knowledge and control of asthma triggers in home environments can help reduce risks associated with asthmatic children's respiratory health. This pilot study used both qualitative and quantitative methods to determine parental knowledge of their children's asthma triggers in home environments, control of those triggers, and information received and trusted. Twelve parents of asthmatic children in the greater Pittsburgh area--8 white and 4 African American--participated in one-on-one interviews about home exposures to asthma triggers. All parents described the link between asthma symptoms and both environmental tobacco smoke (ETS) and pet dander exposures. House dust mites and mold were also commonly identified asthma triggers. All 8 white parents reported receiving information from physicians about controlling home environmental triggers of asthma, but the 4 African American parents reported having received no such information. However, all 12 parents reported having greater trust in information received from physicians than from other sources. White parents were significantly more aware of potential asthma triggers and performed significantly more actions to control the triggers in their homes. African American parents noted stressful experiences with primary and secondary care, less recall of information sharing about asthma triggers, and a focus on symptom management vs trigger avoidance.

Assessment of microbiological indoor air quality in an Italian office building equipped with an HVAC system

The purpose of this study was to evaluate the level and composition of bacteria and fungi in the indoor air of an Italian office building equipped with a heating, ventilation and air conditioning (HVAC) system. Airborne bacteria and fungi were collected in three open-space offices during different seasons. The microbial levels in the outdoor air, supply air diffusers, fan coil air flow and air treatment unit humidification water tank were used to evaluate the influence of the HVAC system on indoor air quality (IAQ). A medium-low level of bacterial contamination (50-500 CFU/m(3)) was found in indoor air. Staphylococcus and Micrococcus were the most commonly found genera, probably due to human presence. A high fungal concentration was measured due to a flood that occurred during the winter. The indoor seasonal distribution of fungal genera was related to the fungal outdoor distribution. Significant seasonal and daily variation in airborne microorganisms was found, underlining a relationship with the frequency of HVAC system switching on/off. The results of this monitoring highlight the role of the HVAC system on IAQ and could be useful to better characterise bacterial and fungal population in the indoor air of office buildings.

Characterisation of urban inhalation exposures to benzene, formaldehyde and acetaldehyde in the European Union: comparison of measured and modelled exposure data

BACKGROUND, AIM AND SCOPE

All across Europe, people live and work in indoor environments. On average, people spend around 90% of their time indoors (homes, workplaces, cars and public transport means, etc.) and are exposed to a complex mixture of pollutants at concentration levels that are often several times higher than outdoors. These pollutants are emitted by different sources indoors and outdoors and include volatile organic compounds (VOCs), carbonyls (aldehydes and ketones) and other chemical substances often adsorbed on particles. Moreover, legal obligations opposed by legislations, such as the European Union's General Product Safety Directive (GPSD) and Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), increasingly require detailed understanding of where and how chemical substances are used throughout their life-cycle and require better characterisation of their emissions and exposure. This information is essential to be able to control emissions from sources aiming at a reduction of adverse health effects. Scientifically sound human risk assessment procedures based on qualitative and quantitative human exposure information allows a better characterisation of population exposures to chemical substances. In this context, the current paper compares inhalation exposures to three health-based EU priority substances, i.e. benzene, formaldehyde and acetaldehyde.

MATERIALS AND METHODS

Distributions of urban population inhalation exposures, indoor and outdoor concentrations were created on the basis of measured AIRMEX data in 12 European cities and compared to results from existing European population exposure studies published within the scientific literature. By pooling all EU city personal exposure, indoor and outdoor concentration means, representative EU city cumulative frequency distributions were created. Population exposures were modelled with a microenvironment model using the time spent and concentrations in four microenvironments, i.e. indoors at home and at work, outdoors at work and in transit, as input parameters. Pooled EU city inhalation exposures were compared to modelled population exposures. The contributions of these microenvironments to the total daily inhalation exposure of formaldehyde, benzene and acetaldehyde were estimated. Inhalation exposures were compared to the EU annual ambient benzene air quality guideline (5 microg/m3-to be met by 2010) and the recommended (based on the INDEX project) 30-min average formaldehyde limit value (30 microg/m3).

RESULTS

Indoor inhalation exposure contributions are much higher compared to the outdoor or in-transit microenvironment contributions, accounting for almost 99% in the case of formaldehyde. The highest in-transit exposure contribution was found for benzene; 29.4% of the total inhalation exposure contribution. Comparing the pooled AIRMEX EU city inhalation exposures with the modelled exposures, benzene, formaldehyde and acetaldehyde exposures are 5.1, 17.3 and 11.8 microg/m3 vs. 5.1, 20.1 and 10.2 microg/m3, respectively. Together with the fact that a dominating fraction of time is spent indoors (>90%), the total inhalation exposure is mostly driven by the time spent indoors.

DISCUSSION

The approach used in this paper faced three challenges concerning exposure and time-activity data, comparability and scarce or missing in-transit data inducing careful interpretation of the results. The results obtained by AIRMEX underline that many European urban populations are still exposed to elevated levels of benzene and formaldehyde in the inhaled air. It is still likely that the annual ambient benzene air quality guideline of 5 microg/m3 in the EU and recommended formaldehyde 30-min average limit value of 30 microg/m3 are exceeded by a substantial part of populations living in urban areas. Considering multimedia and multi-pathway exposure to acetaldehyde, the biggest exposure contribution was found to be related to dietary behaviour rather than to inhalation.

CONCLUSIONS

In the present study, inhalation exposures of urban populations were assessed on the basis of novel and existing exposure data. The indoor residential microenvironment contributed most to the total daily urban population inhalation exposure. The results presented in this paper suggest that a significant part of the populations living in European cities exceed the annual ambient benzene air quality guideline of 5 microg/m3 in the EU and recommended (INDEX project) formaldehyde 30-min average limit value of 30 microg/m3.

RECOMMENDATIONS AND PERSPECTIVES

To reduce exposures and consequent health effects, adequate measures must be taken to diminish emissions from sources such as materials and products that especially emit benzene and formaldehyde in indoor air. In parallel, measures can be taken aiming at reducing the outdoor pollution contribution indoors. Besides emission reduction, mechanisms to effectively monitor and manage the indoor air quality should be established. These mechanisms could be developed by setting up appropriate EU indoor air guidelines.