Sustainability of the Italian Healthcare System and of the presently active hospitals: a methodological proposal for a systematic assessment of humanization of paedi-atric care and areas.

Introduction: In paediatrics, the word "humanization" means to care for the whole patient's family. It is vital to preserve a balanced relationship between family members to help the healing process for the young sufferer. How do we ensure that all the strategies adopted up to now have positively reached their objectives of humanization? How then can we measure hospital users' perception? The purpose of this research project is to identify the main factors that influence users' opinion about the quality of environment in paediatrics through a qualitative analysis on users' well-being. Monitoring the humanization level achieved by hospitals and testing the effectiveness of spaces devoted to host young people, may be considered essential phases in gathering new useful evidences as well as to identify potential emerging guidelines. Methods: Operative measurements were supported by the LpCp-tool, an effective tool that includes a questionnaire-based investigation and a processing software. The tool was then adapted to the specific explored field. The investigation was applied in three hospitals in Lombardy Region (Italy). Results: The most influent factors in users' perception were the space comfort and the standards of security services. Hospital staff generally had a worse opinion than patients/visitors on all items. Under no circumstances must users' involvement relevance be overlooked. Conclusions: The research highlights the relevance of the environmental well-being and involvement of users' in the decision-making processes, as well as the absolute requirement of a multicultural context.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

A proposal of hygienic and sanitary standards for the new Building Code in Italy.

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

Humanization of care in pediatric wards: differences between perceptions of users and staff according to department type.

BACKGROUND: As the quality and quantity of patient-centered care may be perceived differently by recipients and independent observers, assessment of humanization of pediatric care remains an elusive issue. Herein we aim to analyze differences between the degrees of verified existing vs. perceived humanization issues of a pediatric ward. Furthermore, we examine whether there is concurrence between the degrees of humanization perceived by users (parents/visitors) vs. staff members. METHODS: The study was conducted in the pediatric wards of seven medical centers of the Campania region (Italy) categorized as general (n = 4), children's (n = 1), and university (n = 2) hospitals. The degree of existing humanization was assessed by a multidisciplinary focus group for each hospital through a pediatric care-oriented checklist specifically developed to individuate the most critical areas (i.e., those with scores < 2.5). The degree of perceived humanization was assessed through four indicators: well-being, social aspects, safety and security, and health promotion. RESULTS: The focus groups showed that critical areas common to all centers were mainly concerned with welfare, mediation, translation, and interpretation services. Specific critical issues were care and organizational processes oriented to the respect and specificity of the person and care of the relationship with the patient. Perceived humanization questionnaires revealed a lack of recreational facilities and mediation and translation services. As for specific features investigated by both tools, it was found that mediation and interpretation services were lacking in all facilities while patient perceptions and observer ratings for space, comfort, and orientation concurred only in the general hospital evaluations. CONCLUSIONS: Future humanization interventions to ensure child- and family-friendly hospital care call for careful preliminary assessments, tailored to each pediatric ward category, which should consider possible differences between perceived and verified characteristics.

Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter.

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

Measuring the expected increase in cycling in the city of Milan and evaluating the positive effects on the population's health status: a Community-Based Urban Planning experience.

BACKGROUND: It's scientifically known that inactivity is one of the major risk factors for Non-Communicable Diseases. One of the elements affecting the choice of transport mode, regarding circulation in the city, is the cities' urban morphology, i.e. the infrastructural facilities for the slow mobility service. Cyclability, in fact, can help to increase daily physical activity level, therefore becoming a protective factor for individual health. METHODS: After a literature review about the state of the art regarding the correlation between built environment, active transport and quantification of the physical activity level, we have developed a specific questionnaire to collect information about current and forecast use of bicycle, in case of improvement and implementation of the cycling network. The questionnaire also investigated social and health aspects concerning the anamnesis of the interviewees (age, gender, health status, sport activity performed, etc) and users' opinions about existing infrastructure and planned interventions, designed to promote cycling mobility. Aim of the research was to quantify the increase of physical activity people would have realized in front of an improvement of the specific infrastructures, and the expected positive effects in terms of health. RESULTS: The collected data (343 interviewed in a district of Milan, named "Zona 7") demonstrate that through the implementation of the cycle network, there would be more cyclists to practice the 150 minutes weekly of physical activity recommended by WHO: time spent in cycling, indeed, would increases by 34.4% compared to the current level of cyclability, as detected by our survey. CONCLUSIONS: The investigation confirmed that urban interventions, especially those in small-scale, could play a key role in the promotion of healthy lifestyles, inducing therefore important positive effects on the population health. It was also carried out an application of the WHO "Health Economic Assessment Tool" to evaluate the benefits in terms of Non-Communicable Diseases' reduction, specifically a provisional quantification of deaths saved.

Making hospitals healthier: how to improve sustainability in healthcare facilities.

BACKGROUND: Debate about sustainable development has reached a peak, as it is now recognized worldwide by public opinion and, in general, by governments' political agendas. New hospitals need to be made more sustainable and existing ones must improve their standards: e.g. in Italy, more than 50% of all healthcare facilities were built before the Nineties, without any attention to environmental, social or economic sustainability. METHODS: Thanks to a sustainability evaluating system (environmental, social and economic) designed by the Milanese University 'Politecnico di Milano', two healthcare facilities were analyzed and compared. Both structures have approximately 600 beds and are located in the Lombardy region but they were built in different decades: one was built in the Sixties while the other one was built very recently. The analysis focused on underlining criticalities, implementing redevelopment measures for sustainability and eventually understanding whether attention was truly being given to those topics. RESULTS: A need to evaluate the sustainability parameters emerged from the comparison between the two case-studies. This is the only way of identifying strategic non-invasive and cheaper solutions that could directly influence sustainability. Following the above-mentioned comparison, a first look - albeit not an adequate one - was given to sustainability aspects. CONCLUSIONS: The assessment tool turned out to be efficient and could also prove effective in resource management and operational planning, whenever applied to any territorial facility.

Listening to people to cure people: the LpCp - tool, an instrument to evaluate hospital humanization.

BACKGROUND: In the healthcare environment, nowadays, only a few among the available evaluation systems pay enough attention to certain social sustainability aspects. Among these, humanization plays a key role in an environment, like hospitals, where the mental and physical well-being of patients and healthcare operators is crucial. Our research project, known as 'SustHealth', is focused on the deficiencies of the evaluation methodology and aims at developing an assessment system related to a questionnaire-based investigation capable of revealing the most influential conditions and dynamics in people's hospital experience, while also recommending areas in hospitals where efforts can be made to sustain improvement strategies. METHODS: The humanization of healthcare structures began with a significant investigation to assess all the major evaluation tools in both hospitals - to better understand the physical and emotional interactions in the structure-user ratio - and other areas. This helped understand the strengths and criticalities of the systems that were examined. This first step also allowed to shed light on the most important aspects to keep in mind when developing an evaluation system. During the operational steps an all-new LpCp - tool (Listening to people to Cure people) was created, which includes a questionnaire-based investigation and processing software, and its application for beta-testing in a 600-bed hospital in Milan. RESULTS: The LpCp - tool proved to be effective and capable of finding the deficiencies and potential in the examined hospital. Considering different themes through alternative viewpoints (staff, patients/visitors, technicians, etc.), the tool has allowed underlining different perceptions of the same place and also provided sound information to guide healthcare management in taking informed decisions about specific problems or users. Former interesting results show an inadequate appraisal about e.g. on-site facilities or recreational activities and a lack of perception on existing services by users (e.g. translation, P.R.). CONCLUSIONS: The LpCp - tool was presented to other healthcare centres in Milan for wider-scale testing. Therefore, the LpCp - tool will hopefully increase healthcare companies' responsiveness towards improving comfort and humanization levels in hospitals. Sometimes all that is needed are small and inexpensive actions that often improve a hospital user's experience, and often important services are not used due to a lack of communication and information.

Soft qualities in healthcare. Method and tools for soft qualities design in hospitals' built environments.

BACKGROUND: The design of hospital environments is determined by functional requirements and technical regulations, as well as numerous protocols, which define the structure and system characteristics that such environments need to achieve. In order to improve people's well-being and the quality of their experience within public hospitals, design elements (soft qualities) are added to those 'necessary' features. The aim of this research has been to experiment a new design process and also to create health care spaces with high environmental quality and capable to meet users' emotional and perceptual needs. METHODS: Such needs were investigated with the help of qualitative research tools and the design criteria for one of these soft qualities - colour - were subsequently defined on the basis of the findings. The colour scheme design for the new San Paolo Hospital Emergency Department in Milan was used as case study. Focus groups were fundamental in defining the project's goals and criteria. RESULTS: The issues raised have led to believe that the proper procedure is not the mere consultation of the users in order to define the goals: users should rather be involved in the whole design process and become co-agents of the choices that determine the environment characteristics, so as to meet the quality requirements identified by the users themselves. CONCLUSIONS: The case study has shown the possibility of developing a designing methodology made by three steps (or operational tools) in which users' groups are involved in the choices, loading to plan the environments where compliance with expectations is already implied and verified by means of the process itself. Thus, the method leads to the creation of soft qualities in Healthcare.

Evidence Based Design and healthcare: an unconventional approach to hospital design.

Evidence Based Design (EBD) is a scientific analysis methodology that emphasises the use of data acquired in order to influence the design process in hospitals. It measures the physical and psychological effects of the built environment on its users. EBD uses formularization of hypothesis, testing/analyzing and outcome gathering as a framework. The design practice, in general, has always been based on a combination of legal, technical/ functional/ and aesthetical knowledge. This generalization has been shifted to another level after the implementation of EBD. In the last 30 years many case studies were collected which demonstrate the built environment's impact on users. EBD methodology can be applied to any type of building, but it is particularly used to analyze the efficiency of healthcare facilities. The Goal of this paper is to demonstrate various applications of EBD principles in healthcare buildings through case studies concerning: - reduction of infections - reduction of stress on medical staff - improved patient healing In addition to the analysis of case studies, we will also focus on official EBD researches developed by healthcare designers and professionals as "alternative solutions". These alternative "ad hoc" solutions are developed in order to answer EBD research results. The solutions that are developed from the results can answer the real needs of each hospital and improve best technological practice to reduce infection, stress and improve patient comfort. Abroad the EBD research results are studied and used by many contemporary hospital architects to develop new solutions to meet the specific requirements of any hospital project they are currently designing. This procedure demonstrates that for each outcome and key finding, there is always at least one alternative solution and, therefore, the achievement of a new hypothesis, case studies to test/measure and outcome to gather occurs. This repetitive attitude leads to a "virtuous circle" where the development of new samples produces a double- positive effect in both EBD research (in terms of new case studies to analyze) and in EBD lessons for implementation in various hospitals. Through this paper the authors state that the combined effort is needed by EBD practitioners, healthcare architects and hospital managers for the improvement and diffusion of EBD in healthcare, especially in Italy where this methodology is not widely used.

Sustainable healthcare: how to assess and improve healthcare structures' sustainability.

BACKGROUND: Sustainability is a broad and debated subject, often difficult to be defined and applied into real projects, especially when dealing with a complex scenario as the one of healthcare. Many research studies and evaluation systems have handled this topic from different perspectives, but many limits and criticalities still have to be overcome to properly cope with actual needs. METHODS: The Sustainable Healthcare project has been developed through three main phases: a deep study of the state of the art, unraveling pros and cons of available sustainability scoring systems; an accurate analysis of the stakeholders network and their needs; the realization of an objective evaluation framework, through scientific methods, as the ANP. RESULTS: The newly developed evaluation system takes into consideration all the three pillars of sustainability, analyzing social, environmental and economic sustainability through a set of criteria, specified by measurable indicators. So the system identifies both global sustainability and specific critical areas, pointing out possible strategic solutions to improve sustainability. The evaluation is achieved through technical analyses and qualitative surveys, which eventually allow to quantitatively assess sustainability, through a sound scoring method. CONCLUSIONS: This study proposes an innovative evaluation method to determine the sustainability of a hospital, already existing or in the design phase, within the European context. The Sustainable Healthcare system overcomes some of the current evaluation systems' limits by establishing a multidisciplinary approach and being an easy-to-use tool. This protocol is intended to be of support in the identification of the main hospital's weaknesses and in setting priorities for implementation of the solutions.

Measuring hygiene and health perfomance of buildings: a multidimensional approach.

This paper proposes an innovative and transparent methodology to support the "ASL Milano" (Local Health Agency) in the hygiene and health evaluation of construction projects, in order to highlight their positive and negative performance beyond the requirements imposed by the current laws and regulations regarding buildings' hygiene performance, which are too old and therefore unsuitable to ascertain the real quality of indoor environments. The compliance with laws or regulations, mostly out of date, and the assessment of performance involving only a part of the current emerging needs and problems, in fact, should be considered as a necessary, although not a sufficient step, to ensure high quality indoors. Consequently, it is necessary to identify and test an assessment tool which could provide an effective and flexible support for the development of hygiene and health statements regarding projects at building scale (new construction, conversion of the existing, rehabilitation, extension, change of use, etc). The assessment tool suggested by this paper is tailored for the metropolitan area of the city of Milan, but its evaluation framework could be developed and applied to other contexts.

Hygiene and emergency. Considerations and proposals for improving hygiene and health features of Advanced Medical Post.

BACKGROUND: In the last decades has been recorded, both nationally and internationally, a significant increase in disasters with a high number of deaths and injuries involved. The presence at the venue of the Advanced Medical Post (AMP) has improved the survival of the affected population. However, these temporary structures, not according to common standards relating to health hospital environments are devoid of design guidelines and technologies designed to hygiene and safety. METHODS: Starting from the inquiry into the functioning and the structure of an Advanced Medical Post through interviews, questionnaires and joint activities with Italian organizations and structures, a number of measures have been established for the improvement of health standards. RESULTS: Through the survey and questionnaires developed for this purpose it was possible to determine the most hygienically critical areas and then several solutions were processed and evaluated (in synergy with associations previously interviewed). The most important priorities to satisfy were the hygiene improvement to be achieved through the use of specific materials (fabrics antimicrobial ...), the study of the articulation inside the operating room and intensive care of AMP (insulation and Zoning filter ...) and the definition of more efficient technological systems-plant (ventilation, aeration, lighting...). Therefore the solution proposed involves the use of a new layer fabric for mounting inside of curtains already supplied to the main associations and a series of technological devices and installations for limiting the spread of virus-bacteria. CONCLUSIONS: The introduction of this new unit for AMP modules could give a significant contribution to achieving high standards of hygiene during health care assistance in critical situations (maxi-emergencies and disasters) which, unfortunately, are actually becoming more frequent.

Flexible healthcare structures: analysis and evaluation of possible strategies and technologies.

Hospitals are complex buildings because of their articulation, function, organization and technology equipment. Planning hospitals needs an interdisciplinary approach in order to organize efficiently the construction of qualitative and flexible units, that must be able to answer to all the requirements of different users and to the fast changes due to the research innovations. Human and care activities have a rapid progress, that creates a constant demand of modernizations of the hospitals and readjustment of the functional connections. Flexibility becomes the core of all the modifications depending on the progress of the medical science. The future challenge is to build structures that promote sustainable flexibility and also allow to achieve wellness in a synergic relation with complementary external activities. Therefore the research aims to identify lay-out models, technical and constructive solutions to guarantee different levels of flexibility. The research was made of different stages to define flexibility inside healthcare structures using strategies and technologies. The first step has followed the evolution of hospital structures during the centuries. It illustrates the most efficient methods and solutions used in last fifty years to achieve the flexibility. The second step was the analysis of the most important contemporaries healthcare structures. In that analysis, the hospitals will be compared through an evaluation matrix made by diferent flexibility levels that underlines the most efficient technologies and strategies used. At the end it was made a list of design indications focused on the definition of a new design approach that guarantees flexibility for these complex systems.

[Thermovalorization: new technologies, impacts and mitigation strategies]. / Termovalorizzatori: analisi e confronto tra nuove tecnologie, impatti e strategie di mitigazione.

In recent decades the quantity (in weight and volume) of solid waste is grown so rapidly to become a real problem especially in densely urbanized areas. The disposal of Municipal Solid Waste by incineration with energy recovery (WtE) is recognized as the most suitable system to process non-recyclable waste. However in several countries there are still concerns from experts and local communities about the environmental impact of incinerators. Epidemiological studies, developed since the 80s, are still the subject of controversial discussion because the results of research often refer to old incinerators--built a few decades ago--and therefore more impactful. In fact inadequate levels of gas cleaning and combustion process control in these facilities tended to risk the health of plant workers and local environment. This situation furthermore contributes to increase public risk perception and the spread of the NIMBY (not in my backyard) syndrome while siting this unwanted but necessary facilities. Actually, new strategies as advances in emission control designs and very stringent new governmental regulations, have resulted in large reductions in the amount of emissions. So the first aim of this work has been to understand if these high perception of risk have a reason to exist also in modern and new municipal waste incinerators. The second aim is to discover if the law, the new technologies and the mitigation strategies can really set a limit on the negative impacts on human health and on environment and if is it possible to improve or increase these strategies. Work has been divided into two parts. The first part focuses on analysis of waste environmental impact regulations, of plant operation systems and of epidemiological studies results. The second part involves the examination of the actual use of regulatory instruments, the most advanced technologies and the strategies for mitigation in the most effective new concept incinerators plants. For this verification has been analyzed in detail some different incineration plants recently created or rehabilitated in the last decade. The case-studies showed that the preliminary evaluation tools and the constant control of the waste incinerator are very effective. Moreover the comparison between the maximum emission limits, the BAT and the analysis of the actual emission of the cases study has shown the effectiveness of the depuration systems currently used. The emissions are in fact much lower than these limits. By the comparison we also identified the most efficient strategies and the best policies to inform and to involve people. Success in siting an unwanted but needed facility requires that authorities fully involve the public with openness and integrity in all aspects of the planning process. Starting from these result and in order to exploit what is already effective, some proposals where outlined and aim to be the basis for further approaches to design waste disposal plants.

[Healthy design for sustainable communities]. / Sistema multicriteriale di valutazione degli aspetti igienico- sanitari di piani di governo del territorio e piani attuativi.

Health, quality of life and sustainable development are strongly interconnected. The quality of living is a complex concept that includes different meanings. The quality of life issue has been studied for a long time, even if its measurement is a more recent matter. It's possible to distinguish two main approaches: the first one, depending on which the quality of life corresponds to the social wellbeing and it can be measured objectively; the second one, that emphasizes the perceptive dimension of quality of life, such as needs, feelings and aspirations. According to the WHO's wide definition of wellbeing, this paper suggests an approach focused on the effects that urban planning and designing can have on the health of citizens. Actually many of the problems of the cities like pollution, inequity, lack of services and accessibility depends on decisions about the development of land and buildings. To have more attractive cities in the future it is important that professionals involved in planning and local authorities focus on the major determinants of health: the physical and social environment in which people live and the nature of their lifestyles. The experience explained in this paper shows as local authorities can support professionals in designing process, producing quick and effective benchmark in order to improve the quality of urban spaces and architecture. More in deep the tool works by a set of performance indicators developed with the purpose to assess the degree of sustainability of building and urban space proposals at the planning stage (and at later stages), against a range of criteria. This evaluation procedure can be considered as a common platform from which different stakeholders can agree goals and work together contributing to increase the benefits of a well-designed built environment.

[Light wellbeing in hospital: research, development and indications]. / Benessere luminoso in ospedale: ricerca, sviluppo e indicazioni di riferimento.

Aim of the research is to form design indicators to guarantee light comfort in hospital environments for inpatients as well for workers. The research is articulated in different phases: drawing up, elaboration and distribution of a questionnaire to study indoor natural and artificial lighting, and effects on human being; architectural and lighting analyses of the investigated hospitals; elaboration -through graphics- of the questionnaire answers; drawing up of design indications for visual comfort in hospitals. These indications relates natural lighting, artificial lighting, indoor spaces and human being.

[Environment and energy in hospitals: assessment of usage and impact of Health Facilities in the Lombardy Region]. / Ambiente ed energia in ospedale. Valutazione dei consumi e degli impatti delle Strutture Sanitarie della Regione Lombardia.

The research moves from the current global and local context and from shared development strategies. From the observation and the analysis of contemporary environmental and energy issues and redefined directions of growth of human activity, it is addressing the question of environmental sustainability and energy conservation of building hospital systems. The work has developed a field survey relating the specific topic of energy saving and efficiency of the Park Hospital in the Italian Lombardy Region. This has been articulated in a diagnosis of technology and efficiency of regional hospitals, implemented through a census, and in a subsequent identification of interventional cases, in order to show its economic, environmental and health performance of the energy efficiency consumption and the environmentally sound.

[Project, natural lighting and comfort indoor]. / Illuminazione naturale e benessere indoor: valutazione ed aggiornamento degli strumenti normativi locali.

The present research aims at analyzing the relationship between the project, the natural lighting, and the residential indoor environments. The reasons that lead to this research are to be found in the complex relationship between natural lighting, sunlight, and health in indoor environments and in the oncoming research of project and technological solutions in order to guarantee an adequate level of indoor health while preserving the environment. After describing the physical and hygienic characteristics of the natural lighting, the various laws (in particular the Italian ones) were taken into account according to the definition of the minimal performance and project requirements concerning the natural lighting of the indoor residential environments. The minimal requirements for the Coefficient of Daily Lighting--CDL (illumination levels on horizontal surface inside the room/illumination levels on the same horizontal surface situated outside, closed to the windows) were satisfied on average during the project phase with a lighting ratio (area of the windows hole/floor area) more than 12.5% (1/8) for every habitable rooms. An analysis based on CDL was then performed, since it is able to estimate the level of lighting of different indoor environments for dimensional and geometric aspects, for specific characteristics of each window opening and for the context situation of the building. During the analysis, the CDL of some rooms (42) was taken and analyzed according to the specific features of the indoor environment in order to evaluate the appropriateness of the current laws on the subject, which are too often recognized as only prescriptive. In conclusion, the current laws, considering the complex reciprocity between natural lighting and indoor environments, are not very adequate in orienting the architect towards more innovative quality and performance oriented choices. According to these deficiencies, it was proposed to integrate those laws with more adequate indications for the computation of the windows surface, and to write a document on the project phase in order to support the architect in her architectonic choices. Such instrument, coming from work in depth of analysis and observation of the behaviour of the natural light in order to better understand the factors able to condition its penetration into the indoor environments, could then be used along with the legislative instruments in order to improve those aspects of indoor health related to natural lighting.