Can pre-visit exposure to virtual tours of healthcare facilities help reduce child and parent anxiety during outpatient surgical procedures?

AIM: The study aims to evaluate the impact of exposure to a highly realistic virtual facility tour prior to the on-site visit on patients and their parent/care partner's self-reported anxiety and physiological measures on the day of the procedure. BACKGROUND: Preoperative anxiety impacts pediatric surgical outcomes; therefore, it is important for healthcare providers to address and manage preoperative anxiety in pediatric patients to promote better outcomes and overall wellbeing. Providing patients with a preview of the care setting before the actual procedure can be highly beneficial in mitigating preoperative anxiety. METHODOLOGY: In this pilot randomized experimental study, sixteen patient-care partner dyads scheduled to undergo a gastrointestinal procedure either received a virtual tour identical to the places experienced on the day of the procedure (experimental group) or received no virtual tour (control group). Self-reported measures of anxiety were collected from participants before and on the day of the procedure. Physiological measures of heart rate variability and skin conductance were collected on the day of the procedure from both groups. RESULTS: There were no significant differences between the self-reported and physiological measures of anxiety between the child groups. However, parents in the control group reported lower levels of anxiety and demonstrated lower levels of stress based on their physiological measures. CONCLUSION: Exposure to virtual facility tours days before the surgery was not helpful in positively impacting the psychological measures related to preoperative anxiety levels for the participants.

A Rapid Review of the Role of Virtual Reality in Care Delivery of Palliative Care and Hospice.

Virtual reality (VR) is an emerging technology that can provide a nonpharmacological approach to symptom management for those with serious illnesses. The VR platform offers a unique perspective to connect patients with places and experiences they might otherwise miss. This rapid review aims to present the current literature on the uses and benefits of VR for palliative care and hospice patients. Through a systematic process, we identified 14 articles published between 2018 and 2023 that used VR as an interventional strategy for symptom management. The VR equipment includes a head-mounted display, such as the Oculus Go, and sometimes requires hand controllers or joysticks. Virtual reality software was contained exclusively in the head-mounted displays or required a laptop. Nature scenes, memorable locations, and the solar system are examples of options patients could select for the VR experience. Assessments of the intervention were measured before, during, after, and several hours afterward to evaluate benefits and potential adverse effects. Pain was the predominant symptom assessed in the studies. Overall, most of the studies focused on establishing the safety, efficacy, and feasibility of VR using a single-arm interventional method. Future research should implement randomized controlled trials, increase sample size, and expand to pediatric populations.

Home gardens and distances to nature associated with behavior problems in alpine schoolchildren: Role of secondhand smoke exposure and biomarkers.

BACKGROUND: Behavior problems in children are shaped by a complex intertwining of environmental, social, and biological factors. This study investigated whether more nature exposure was associated with less behavior problems and whether these associations were mediated by differences in secondhand smoke in the home, sleep problems, adiposity, and inflammation. METHODS: We used cross-sectional data collected from 1251 schoolchildren (8-12 years old) in the Tyrol region of Austria and Italy. Information on sociodemographics, lifestyle, perinatal data, and housing conditions was obtained by questionnaire. Behavior problems in the past school year were rated by teachers using the Needleman questionnaire for classroom performance. We estimated nature exposure using a comprehensive naturalness index called "distance to nature" (D2N). This was calculated in several buffer sizes around the child's home and school. Presence of a home garden was assessed by self-report. Data on potential mediators including parental smoking in the home, child's urinary cotinine concentrations, sleep problems, body mass index, and urinary neopterin concentrations were also collected. Structural equation modeling was used to examine the multiple pathways between nature exposure and behavior problems. RESULTS: Children who lived in a home with a garden and those whose school was closer to nature exhibited less school behavior problems. The effect of proximity to nature from the school was directly associated with less behavior problems, and the effect of a home garden on behavior problems acted indirectly through a lower likelihood of secondhand smoke exposure. Associations were in unexpected directions between behavior problems and residential proximity to nature and depended on the outcome and context. CONCLUSIONS: Natural environments in school and home surroundings might be beneficial for school conduct and performance. Lower secondhand smoke exposure at home might be a pathway between home gardens and children's behavioral problems. Associations with residential proximity to nature in this study were in unexpected directions and warrant further investigation. These findings serve as a point of departure for investigating how proximal nature might activate health supportive pathways in children and simultaneously confer childhood health benefits via positive behavioral changes in their parents.

Do sex and gender modify the association between green space and physical health? A systematic review.

A growing literature shows that green space can have protective effects on human health. As a marginalized group, women often have worse life outcomes than men, including disparities in some health outcomes. Given their marginalization, women might have "more to gain" than men from living near green spaces. Yet, limited research has deliberately studied whether green space-health associations are stronger for women or men. We conducted a systematic review to synthesize empirical evidence on whether sex or gender modifies the protective associations between green space and seven physical health outcomes (cardiovascular disease, cancer, diabetes, general physical health, non-malignant respiratory disease, mortality, and obesity-related health outcomes). After searching five databases, we identified 62 articles (including 81 relevant analyses) examining whether such effect modification existed. We classified analyses based on whether green space-health were stronger for women, no sex/gender differences were detected, or such associations were stronger for men. Most analyses found that green space-physical health associations were stronger for women than for men when considering study results across all selected health outcomes. Also, women showed stronger protective associations with green space than men for obesity-related outcomes and mortality. Additionally, the protective green space-health associations were slightly stronger among women for green land cover (greenness, NDVI) than for public green space (parks), and women were also favored over men when green space was measured very close to one's home (0-500 m). Further, the green space-health associations were stronger for women than for men in Europe and North America, but not in other continents. As many government agencies and nongovernmental organizations worldwide work to advance gender equity, our review shows that green space could help reduce some gender-based health disparities. More robust empirical studies (e.g., experimental) are needed to contribute to this body of evidence.

Greenspace and human health: An umbrella review.

Multiple systematic reviews on greenspace and health outcomes exist, but the overall evidence base remains unclear. Therefore, we performed an umbrella review to collect and appraise all relevant systematic reviews of epidemiological studies on greenness exposure and health. We searched PubMed, Embase, and Web of Science from inception to June 28, 2021, and screened references of relevant articles. Systematic reviews with or without meta-analyses of epidemiological studies that examined the associations of greenness with any health outcome were included. Two independent investigators performed study selection and data extraction. We also evaluated the methodological quality of the included systematic reviews using the "Assessing the Methodological Quality of Systematic Reviews 2" checklist. A total of 40 systematic reviews and meta-analyses were included, of which most were cross-sectional studies conducted in high-income countries. Greenspace exposure was estimated with various objective and subjective parameters. Beneficial associations of greenspace with all-cause and stroke-specific mortality, CVD morbidity, cardiometabolic factors, mental health, low birth weight, physical activity, sleep quality, and urban crime were observed. No consistent associations between greenspace and other health outcomes (e.g., cancers) were observed. Most of the included systematic reviews and meta-analyses had one or more limitations in methodology. Our findings provide supportive evidence regarding the beneficial effects of greenspace exposure on some aspects of human health. However, the credibility of such evidence was compromised by methodological limitations. Better performed systematic reviews and meta-analyses as well as longitudinal designed primary studies are needed to validate this conclusion.

Association between residential greenness and exposure to volatile organic compounds.

Residential proximity to vegetation and plants is associated with many health benefits, including reduced risk of cardiovascular disease, diabetes and mental stress. Although the mechanisms by which proximity to greenness affects health remain unclear, plants have been shown to remove particulate air pollution. However, the association between residential-area vegetation and exposure to volatile organic chemicals (VOCs) has not been investigated. We recruited a cohort of 213 non-smoking individuals and estimated peak, cumulative, and contemporaneous greenery using satellite-derived normalized difference vegetation index (NDVI) near their residence. We found that the urinary metabolites of exposure to VOCs - acrolein, acrylamide, acrylonitrile, benzene, 1-bromopropane, propylene oxide were inversely associated (7-31% lower) with 0.1 higher peak NDVI values within 100 m radius of the participants' home. These associations were significant at radii ranging from 25 to 300 m. Strongest associations were observed within a 200 m radius, where VOC metabolites were 22% lower per 0.1 unit higher NDVI. Of the 18 measured urinary metabolites, 7 were positively associated with variation of greenness within a 200 m radius of homes. The percent of tree canopy and street trees around participants' residence were less strongly associated with metabolite levels. The associations between urinary VOC metabolites and residential NDVI values were stronger in winter than in summer, and in participants who were more educated, White, and those who lived close to areas of high traffic. These findings suggest high levels of residential greenness are associated with lower VOC exposure, particularly in winter.