BackgroundIn a global effort to design better hospital buildings for people and organizations, some design principles are still surrounded by great mystery. The aim of this online study was to compare anxiety in an existing single-bed inpatient hospital room with three redesigns of this room in accordance with the principles of Golden Ratio, Feng Shui, and Evidence-Based Design.MethodsIn this online multi-arm parallel-group randomized trial participants were randomly assigned (1:1:1:1) to one of four conditions, namely Golden Ratio condition, Feng Shui condition, Evidence-Based Design condition, or the control condition. The primary outcomes were anxiety, sense of control, social support, positive distraction, and pleasantness of the room.FindingsBetween June 24, 2022, and August 22, 2022, 558 individuals were randomly assigned to one of the four conditions, 137 participants to the control condition, 138 participants to the Golden Ratio condition, 140 participants to the Feng Shui condition, and 143 participants to the Evidence-Based Design condition. Compared with baseline, participants assigned to the Evidence-Based Design condition experienced less anxiety (mean difference -1.35, 95% CI -2.15 to -0.55, Cohen’s d = 0.40, p < 0.001). Results also showed a significant indirect effect of the Feng Shui condition on anxiety through the pleasantness of the room (B = -0.85, CI = -1.29 to -0.45) and social support (B = -0.33, CI = -0.56 to -0.13). Pleasantness of the room and social support were mediators of change in anxiety in the Evidence-Based Design and Feng Shui conditions. In contrast, application of the design principle Golden Ratio showed no effect on anxiety and remains a myth.InterpretationTo our knowledge, this is the first randomized controlled trial linking design principles directly to anxiety in hospital rooms. The findings of our study suggest that Feng Shui and Evidence-Based Design hospital rooms can mitigate anxiety by creating a pleasant looking hospital room that fosters access to social support.
Objectives: Decline in the performance of instrumental activities of daily living (IADL) and mobility may be preceded by symptoms the patient experiences, such as fatigue. The aim of this study is to investigate whether self-reported non-task-specific fatigue is a long-term risk factor for IADL-limitations and/or mobility performance in older adults after 10 years. Methods: A prospective study from two previously conducted cross-sectional studies with 10-year follow-up was conducted among 285 males and 249 females aged 40–79 years at baseline. Fatigue was measured by asking “Did you feel tired within the past 4 weeks?” (males) and “Do you feel tired?” (females). Self-reported IADLs were assessed at baseline and follow-up. Mobility was assessed by the 6-minute walk test. Gender-specific associations between fatigue and IADL-limitations and mobility were estimated by multivariable logistic and linear regression models. Results: A total of 18.6% of males and 28.1% of females were fatigued. After adjustment, the odds ratio for fatigued versus non-fatigued males affected by IADL-limitations was 3.3 (P=0.023). In females, the association was weaker and not statistically significant, with odds ratio being 1.7 (P=0.154). Fatigued males walked 39.1 m shorter distance than those non-fatigued (P=0.048). For fatigued females, the distance was 17.5 m shorter compared to those non-fatigued (P=0.479). Conclusion: Our data suggest that self-reported fatigue may be a long-term risk factor for IADL-limitations and mobility performance in middle-aged and elderly males but possibly not in females.
Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
De koraalriffen van de Caribisch Nederlandse eilanden St. Eustatius en Saba zijn van groot ecologisch en economisch belang. Door een opeenstapeling van bedreigingen is de hoeveelheid driedimensionale structuur op het rif afgenomen en zijn herbivore sleutelsoorten verdwenen. Het rif wordt overwoekerd met algen, die nieuwe koraalaanwas bemoeilijken. Lokale natuurbeheerorganisaties STENAPA en SCF willen artificiële riffen inzetten, om het ecosysteem door middel van “Building with Nature” te herstellen. Artificiële riffen worden wereldwijd in toenemende mate gebruikt, maar de doeltreffendheid hangt in sterke mate af van hoe er rekening is gehouden met de lokale omstandigheden en doelstellingen. Als de riffen goed functioneren kunnen sleutelsoorten herstellen en kan koraal zich weer vestigen. De natuurbeheerorganisaties willen weten hoe artificiële riffen optimaal bij kunnen dragen aan het herstel van het koraalrif ecosysteem bij St. Eustatius en op de Saba bank. Van Hall Larenstein, STENAPA, SCF, IMARES, CNSI en Golden Rock Dive Centre werken samen in het AROSSTA (Artificial Reefs on Saba and Statia) project om deze vraag te beantwoorden. Hiervoor worden verschillende soorten artificiële riffen gebouwd van lokaal natuursteen en van veelgebruikte “reef balls”. De functionaliteit van de verschillende soorten artificiële riffen wordt bepaald door gedurende 1,5 jaar de vestiging van zee-egels, vissen en koraal te onderzoeken. Na afloop van dit project zal duidelijk zijn welk type artificieel rif het meest geschikt is voor beide onderzoeklocaties. Daarnaast is bekend wat het effect is van het gebruikte materiaal en het aanbrengen van extra schuilplaatsen op de functie van artificiële riffen. Tenslotte wordt inzicht gegeven in hoeverre artificiële riffen een bijdrage leveren aan het herstel van aangrenzende gebieden. Omdat het onderzoek uitgevoerd wordt op twee locaties, met contrasterende omstandigheden, zullen de resultaten van regionaal belang zijn om bestaande en toekomstige artificiële riffen optimaal te laten functioneren.
