Relocating to a New OR Suite: Practical Observations.

Operating room renovation projects usually involve updated technology and processes that can create challenges for administrative leaders (eg, maintaining a surgery schedule during a move) and require staff member adjustments. The perioperative team of a large tertiary care and trauma center relocated from a 35-year-old suite to a new suite, which required years of planning, months of training, and weeks of organizing. This article discusses the processes and observations that helped ensure a smooth transition to the new space. Early planning allowed time for leaders to make equipment decisions, develop and test new processes, and train staff members. The actual move required detailed planning, thorough execution, patience, and flexibility to ensure a safe transition. Perioperative leaders balanced operational needs with relocation plans to maintain patient and staff member safety. Open, multidisciplinary communication combined with staff member participation and buy-in contributed to an efficient, safe move at this facility.

Documentary analysis in the study of architectural designs of a hospital in the city of São Paulo / El análisis documental en el estudio de proyectos arquitectónicos de un hospital de la ciudad de São Paulo / A análise documental no estudo de projetos arquitetônicos de um hospital paulistano

ABSTRACT Objectives: to report the experience of using architectural designs of a hospital for a historical documentary research. Methods: report of the experience of the methodological route of using architectural designs of a model hospital from 1974 to 2002. Results: after being spread on a worksheet, the projects of interest were selected, enabling the data arrangement, where the analytical chart was applied, containing: context; authorship; authenticity/ reliability; nature of the text and preliminary analysis. The findings were grouped by pertinence and similarity, resulting in the construction of categories of analysis. Final Considerations: architectural design is a challenging source, both for its pursuit, since it took two and a half years until it was legally licensed, as well as for involving specific terminologies and symbology of its own. A special attention should be given to the selection criteria, organization and analysis of the document, and sharing the access of unusual sources with the health area, like this one, so as to stimulate the development of research.

RESUMEN Objetivos: informar la experiencia del uso de proyectos arquitectónicos de un hospital, en una investigación histórica y documental. Métodos: reporte de experiencia del recorrido metodológico del uso de proyectos arquitectónicos de 1974 a 2002 de un hospital modelar. Resultados: después de insertar los proyectos en planillas, se seleccionaron los proyectos de interés, creando un arreglo de datos en que se aplicó la ficha analítica que contenía: contexto; autoría; autenticidad/fiabilidad; naturaleza del texto y análisis preliminar. Los hallazgos fueron agrupados por pertinencia y semejanza, resultando en la construcción de categorías de análisis. Consideraciones Finales: el proyecto arquitectónico es una fuente desafiante, tanto para su búsqueda, ya que fueron necesarios dos años y medio hasta que recibieron la licencia legal, como por involucrar terminologías específicas y simbologías propias. Se debe prestar atención a los criterios de selección, organización y análisis del documento y compartir el manejo de fuentes inusuales en el área de la salud, como ésta, a fin de favorecer el desarrollo de la investigación.

RESUMO Objetivos: relatar a experiência do uso de projetos arquitetônicos de um hospital para uma pesquisa histórico-documental. Métodos: relato de experiência do percurso metodológico do uso de projetos arquitetônicos de 1974 a 2002 de um hospital modelar. Resultados: após planilhados, os projetos de interesse foram selecionados, criando um arranjo de dados em que foi aplicada a ficha analítica contendo: contexto; autoria; autenticidade/confiabilidade; natureza do texto e análise preliminar. Os achados foram agrupados por pertinência e similaridade, resultando na construção de categorias de análise. Considerações Finais: o projeto arquitetônico é uma fonte desafiadora, tanto em sua busca, visto que foram necessários dois anos e meio até que fossem licenciados legalmente, como por envolver terminologias específicas e simbologias próprias. Deve-se ter atenção aos critérios de seleção, à organização e à análise do documento, e compartilhar o manejo de fontes incomuns na área da saúde, como esta, a fim de favorecer o desenvolvimento da pesquisa.

Shelter housing for cats: Principles of design for health, welfare and rehoming.

Practical relevance: Shelters and rehoming centres are a valuable tool in the population management and rehoming of cats. However, housing large numbers of a relatively asocial species in close proximity poses significant challenges. Well-designed accommodation enables improved standards of husbandry, as well as a better working environment for staff. This can have a significant benefit in expediting rehoming, as cats are healthier, and more likely to display natural behaviors and have positive interactions with potential adopters. Global importance: As cat overpopulation is such a widespread issue, cat shelters are common in many countries. This review will be of interest to those involved in the design and construction of cat shelters, and to those caring for the cats within them. The principles discussed also apply to boarding, breeding, research and hospitalization facilities. Challenges: Shelter housing poses substantial challenges in terms of maintaining positive health and wellbeing while sustaining adoption at an optimum rate. Disease control and biosecurity are typically facilitated by having a relatively barren, easily cleanable environment. However, this must be weighed against the provision of opportunities for cats to perform natural behaviors such as hiding, perching and interacting if they wish. A more enriched environment has also been shown to expedite adoption. AIMS: This review, the first in a two-part series, discusses practical aspects of housing and shelter design for the health, welfare and adoption of shelter cats. Evidence base: There is a relatively small body of empirical evidence to inform shelter design recommendations. The recommendations in this article are based on a careful review of the available evidence, some of which has come from allied fields such as the care of experimental animals. Where evidence is not yet available, recommendations have been based on field experience and collective expert opinion.

Shelter housing for cats: Practical aspects of design and construction, and adaptation of existing accommodation.

Practical relevance: Not every cat shelter will have purpose-built accommodation but housing designed with the basic needs of cats in mind, whether purpose-built or adapted from existing housing, will improve the experience of cats passing through the facility. Challenges: Designing and building accommodation for cats in shelters should be a thoughtful process. There is a range of different housing types available. A variety of factors, such as expected length of stay, type of cat, cost and disease risk, will influence which design is most appropriate. AIMS: This review, the second in a two-part series, provides an overview of some of the essential requirements for housing shelter cats, either singly or in groups. Specific practical aspects of housing, including design, space allowances, cage furnishings and suitable construction materials, are discussed, and suggestions made for upgrading existing housing where extensive rebuilding is not feasible or realistic. Evidence base: There is a relatively small body of empirical evidence to inform shelter design recommendations. The recommendations in this article are based on a careful review of the available evidence, some of which has come from allied fields such as the care of experimental animals. Where evidence is not yet available, recommendations have been based on field experience and collective expert opinion.

How the built environment affects change in older people's physical activity: A mixed- methods approach using longitudinal health survey data in urban China.

Although the general population in China is physically active, only 45% of older adults meet the World Health Organization's recommendation for weekly moderate-to-vigorous exercise, to achieve health benefits. This percentage is even lower (9.8%) in urban China. It is, therefore, important to understand the pathways by which physical activity behaviors are impacted by the built environment. This study utilized a mixed methods approach-interviews (n = 42) and longitudinal (2010-2015) health survey data (n = 3094) for older people residing in three neighborhoods in Huainan, a mid-sized city in Anhui Province, central eastern China. First, a content analysis of interview data was used to identify individual and built environment factors (motivators and barriers) that impacted physical activity within older people's activity spaces. Second, a multilevel path analysis was conducted using the health survey data to demonstrate the pathways by which these motivators and barriers contributed to the initiation, regulation, and maintenance of physical activity. This study found (a) that the liveliness of an apartment building and its proximity to functional spaces (fast-food stores, farmer's markets, supermarkets, pharmacies, schools, hospitals, PA facilities and natural and man-made water bodies) were important factors in attracting sedentary older people to initiate physical activity; (b) the social networks of apartment neighbors helped to initiate, regulate, and maintain physical activity; and housing closeness to functional spaces was important in maintaining physical activity, particularly for those older people with chronic diseases. To increase older people's overall physical activity, future interventions should focus on residential form and access to functional spaces, prior to investing in large-scale urban design interventions.

Study protocol for a natural experiment in a lower socioeconomic area to examine the health-related effects of refurbishment to parks including built-shade (ShadePlus).

INTRODUCTION: Parks in disadvantaged suburbs often have low quality and few amenities, which is likely to result in them being underutilised for recreation and physical activity. Refurbishment of parks, including shade, walking paths and other amenities, may have broad health-related benefits. METHODS AND ANALYSIS: The study design, methods and planned analyses for a natural experiment examining the effects of refurbishments including built-shade added to parks in disadvantaged outer suburbs of Melbourne are described. Three intervention parks and three comparison parks matched for equivalence of park and neighbourhood characteristics were selected. Using mixed methods, the outcomes will be assessed during three consecutive spring-summer periods (T1: 2013-2014; T2: 2014-2015: T3: 2015-2016). Primary outcomes included: observed park use, physical activity and shade use. Self-reported social connectedness, community engagement and psychological well-being were assessed as secondary outcomes. ETHICS AND DISSEMINATION: This study was approved by Cancer Council Victoria's Human Research Ethics Committee. Studies such as ShadePlus can improve understanding of the broader effects of park refurbishments (including physical activity levels and sun protection behaviours, as well as social connectedness and psychological well-being). The study findings will be disseminated through established urban planning and parks and recreation networks, peer review publications and conference presentations.

Local descriptive norms for overweight/obesity and physical inactivity, features of the built environment, and 10-year change in glycosylated haemoglobin in an Australian population-based biomedical cohort.

Descriptive norms vary between places. Spatial variation in health-related descriptive norms may predict individual-level health outcomes. Such relationships have rarely been investigated. This study assessed 10-year change in glycosylated haemoglobin (HbA1c) in relation to local descriptive norms for overweight/obesity (n = 1890) and physical inactivity (n = 1906) in models accounting for features of the built environment. HbA1c was measured three times over 10 years for a population-based biomedical cohort of adults in Adelaide, South Australia. Environmental exposures were expressed for cohort participants using 1600 m road-network buffers centred on participants' residential address. Local descriptive norms (prevalence of overweight/obesity [body mass index ≥25 kg/m(2)] and of physical inactivity [<150 min/week]) were aggregated from responses to a separate geocoded population survey. Built environment measures were public open space (POS) availability (proportion of buffer area) and walkability. Separate sets of multilevel models analysed different predictors of 10-year change in HbA1c. Each model featured one local descriptive norm and one built environment variable with area-level education and individual-level covariates (age, sex, employment status, education, marital status, and smoking status). Interactions between local descriptive norms and built environment measures were assessed. HbA1c increased over time. POS availability and local descriptive norms for overweight/obesity and physical inactivity were each associated with greater rates of HbA1c increase. Greater walkability was associated with a reduced rate of HbA1c increase, and reduced the influence of the overweight/obesity norm on the rate of increase in HbA1c. Local descriptive health-related norms and features of the built environment predict 10-year change in HbA1c. The impact of local descriptive norms can vary according to built environment features. Little researched thus far, local descriptive norms may play an important role in the evolution of HbA1c and thus cardiometabolic risk, over time. Further empirical research on local descriptive norms is necessary to understand how residential environments shape chronic disease risk.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014.

INTRODUCTION: A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. METHODS: Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. RESULTS: Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. CONCLUSION: An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

Assessing cycling-friendly environments for children: are micro-environmental factors equally important across different street settings?

BACKGROUND: As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. METHODS: We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. RESULTS: For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. CONCLUSIONS: Improving micro-scale attributes may increase the supportiveness of a street for children's transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children.

A Classification of Healthcare Facilities: Toward the Development of Energy Performance Benchmarks for Day Surgery Centers in Australia.

OBJECTIVE: In the literature, there is no consistent classification of healthcare facilities. In order to benchmark, assess, and compare the environmental performance of these buildings, it is important to clearly identify the typology within the scope of a particular research. This article identifies the different typologies within the healthcare sector, particularly in Australia, with the aim of the development of energy performance benchmarks for day surgery/procedure centers. BACKGROUND: Healthcare buildings encompass a wide range of facilities. They all share the same purpose of healing and offering a health service for patients. However, they vary significantly in terms of patient type and service provided. These buildings consume a considerable amount of energy, and as a result of the different designs and sizes, their pattern of energy consumption varies. METHODS: The research used a systematic review of the literature to determine how the term "healthcare facility" has been employed in different contexts. In order to better understand the differences in healthcare facilities, definitions and the origin of hospitals and healthcare facilities are introduced and a framework for the classification of healthcare facilities and hospitals is proposed. RESULTS: Healthcare facilities are classified into the following six categories: patient type, care provided, management and ownership, level of care, facility size, and location. Based on these classifications, a categorization for the studies of energy performance in healthcare is introduced. CONCLUSIONS: This study provides a basis for assessment and comparison for a particular healthcare building typology that will assist researchers working in the field of design and energy assessment of healthcare facilities.

Improving park space access for the Healthy Kids, Healthy Communities partnership in Denver, Colorado.

BACKGROUND: In 2010, Denver Public Health at Denver Health was awarded a Robert Wood Johnson Foundation Healthy Kids, Healthy Communities (HKHC) grant that supported policy, system, and environmental changes to expand healthy food access through gardens and large-chain grocery stores and expand environments that are safe for all children to play, walk, and bike. Systems-thinking approaches enhanced the Denver partnership's work to identify and address the multiple and complex factors affecting the environment changes implemented to increase active living and healthy eating. Continued application of the systems-thinking approach in Denver will sustain outcomes for obesity prevention efforts beyond the grant project cycle, specifically in park space redevelopment. METHODS: Key members of the Denver HKHC coalition were invited to participate in a half-day group model-building workshop to create behavior-over-time graphs and a causal loop diagram. These activities were intended to build on the Denver HKHC partnership's work by identifying factors that affect or are affected by policy, system, and environmental changes that influence active living, healthy eating or childhood obesity. RESULTS: Environments (ie, park space, farms, gardens) developed or renovated should consider identifying and addressing a range of factors that may influence access and utilization of active living and healthy eating. CONCLUSIONS: Denver's partnership found the experience highly valuable for identifying the policy, system, and environment change pathways that lead to increases in active living and healthy food access. In addition, it highlighted the need to identify and address the multiple and complex change pathways to ensure the outcomes of environment change, especially with park space, implemented in Denver achieve increased access to active living and healthy eating.

State and municipal innovations in obesity policy: why localities remain a necessary laboratory for innovation.

Municipal and state governments are surging ahead in obesity prevention, providing a testing ground for innovative policies and shifting social norms in the process. Though high-profile measures such as New York City's soda portion rule attract significant media attention, we catalog the broader array of initiatives in less-known localities. Local innovation advances prevention policy, but faces legal and political constraints-constitutional challenges, preemption, charges of paternalism, lack of evidence, and widening health inequalities. These arguments can be met with astute framing, empirical evidence, and policy design, enabling local governments to remain at the forefront in transforming obesogenic environments.

Home and workplace built environment supports for physical activity.

BACKGROUND: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA. PURPOSE: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel). METHODS: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA. RESULTS: In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction. CONCLUSIONS: This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

The association between green space and mental health varies across the lifecourse. A longitudinal study.

BACKGROUND: Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. METHODS: We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. RESULTS: When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. CONCLUSIONS: These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

Developing age-friendly cities: case studies from Brussels and Manchester and implications for policy and practice.

Developing environments responsive to the aspirations of older people has become a major concern for social and public policy. Policies and programs directed at achieving "age-friendly" communities are considered to require a wide range of interventions, including actions at the level of the social and physical environment. This article compares the age-friendly approaches of two European cities, Brussels and Manchester, with a particular focus on policies and initiatives that promote active aging in an urban context. The article examines, first, the demographic, social, and multicultural contexts of Brussels and Manchester; second, the way in which both cities became members of the World Health Organization Global Network of Age-Friendly Cities and Communities; third, similarities and differences in the age-friendly approaches and actions adopted by both cities; and fourth, opportunities and barriers to the implementation of age-friendly policies. The article concludes by discussing the key elements and resources needed to develop age-friendly cities.

Implementing AORN recommended practices for a safe environment of care.

Providing a safe environment for every patient undergoing a surgical or other invasive procedure is imperative. AORN's "Recommended practices for a safe environment of care" provides guidance on a wide range of topics related to the safety of perioperative patients and health care personnel. The recommendations are intended to provide guidance for establishing best practices and implementing safety measures in all perioperative practice settings. Perioperative nurses should be aware of risks related to musculoskeletal injuries, fire, equipment, latex, and chemicals, among others, and understand strategies for reducing the risks. Evidence-based recommendations can give practitioners the tools to guide safe practice.

Area-based variations in obesity are more than a function of the food and physical activity environment : area-based variations in obesity.

This study examines the area-based variations in obesity from a community-based epidemiologic survey of Boston, MA, USA, using a geographic information system and multilevel modeling techniques. A combination of quantitative and qualitative methods was used to assess whether a function of the food and the physical activity (PA) environment can explain the body weight of residents. First, a series of multilevel analyses was conducted after accounting for the well-established individual determinants and capturing a wide range of environmental attributes to represent a more realistic portrayal of urban typology. Second, the results of multilevel analysis were framed into the theoretical model of area-based variations in obesity to qualitatively summarize the association of contextual factors with the body weight of residents. Based on the overall correlation, the area-based variations defined by a function of the food and PA environment seem to be insufficient in explaining the body weight of residents. By testing the cross-level interactions of gender and race/ethnicity with contextual factors, the results suggest that the concept of area-based variations in obesity will have to consider how residents behave differently within a given environment. More research is needed to better understand the contextual determinants of obesity so as to put forth population-wide interventions.

Community design and policies for free-range children: creating environments that support routine physical activity.

Growing concern over childhood obesity has prompted a focus on underlying epidemics of physical inactivity and poor nutrition. Regarding the former, there is increasing understanding that behavior change promotion alone has not increased population physical activity levels and that an ecological approach is necessary. Therefore, the public health profession has moved beyond traditional behavior change campaigns toward a growing focus on altering policies and the built environment to create settings that support increases in routine, not just exercise or leisure time, physical activity among children. A survey of the literature suggests four broad factors that define settings where routine physical activity, especially active transportation, is more likely to occur: • a compact variety of land uses, with a mix of destinations in close proximity; • a comprehensive network of bicycle, pedestrian, and transit facilities; • inviting and functional site designs for pedestrians, cyclists, and transit users; • safety and access for users of all ages, incomes, abilities and disabilities. Although these principles are increasingly accepted as beneficial, not just to health but to a community's economic, environmental, and social well-being, many contemporary ordinances and development practices undermine these outcomes. Therefore, five specific policy and intervention approaches are recommended to guide communities to these outcomes: 1. zoning and development policies to protect open space, contain sprawl, and focus investment toward thriving, mixed downtowns and village centers; 2. Complete Streets policies, which require roadways that are safe and functional for pedestrians, bicyclists, and transit users, as well as motor vehicles; 3. a transportation- (not just recreation-) oriented trail network; 4. creation of bicycle- and transit-friendly infrastructure and incentive policies; 5. development of policy-based Safe Routes to School interventions. This proposed intervention framework requires evaluation both of effectiveness in increasing childhood physical activity and of the most promising means of getting policies implemented.

Out and about: association of the built environment with physical activity behaviors of adolescent females.

Locational data, logged on portable GPS units and matched with accelerometer data, was used to examine associations of the built environment with physical activity and sedentary behaviors of adolescent females. In a sample of 293 adolescent females aged 15 to 18 years old in Minneapolis and San Diego, the built environment around each GPS point and its corresponding sedentary, light, and moderate-to-vigorous intensity physical activity was examined using random intercept multinomial logistic regression models. The odds of higher physical activity intensity (3-level outcome: sedentary, light, MVPA) were higher in places with parks, schools, and high population density, during weekdays, and lower in places with more roads and food outlets. Understanding the places where physical activity and sedentary behaviors occur appears to be a promising strategy to clarify relationships and inform policy aimed at increasing physical activity and reducing sedentary behaviors.