RESUMO
Exposure to environmental stressors has physical and psychological consequences. A demanding physical environment involves the allocation of additional attentional resources and an increase in psycho-physical stress. This study illustrates the process of a research-intervention aimed at designing a workplace, using a participatory design approach, and considering the beneficial effect of restorative environments in reducing stressful elements and improving well-being at work. Stressful situations occur daily, compromising proper functioning while causing the occurrence of physiological and/or psychological disorders. To be able to safeguard their psycho-physical well-being, people normally adopt coping strategies, i.e., remedies that allow them to cope and manage situations that generate stress. One of these strategies is the exposure to natural environments, which promotes recovery and sustains psycho-physical well-being. The restorative properties of natural environments have been scientifically proven. However, even built spaces can be thought of as restorative environments, in particular when certain conditions are granted. An applied science, known as biophilic design, provides useful indications from this perspective. This project involved 57 employees of the Italian site of an international non-governmental organization, in the transition from a site no longer adequate to a new site requiring renovation. In a first phase, a survey was conducted, to verify the perceived quality of the current workplace and to detect the unmet workers' needs, and to assess some other important psychological constructs connected with perception of restorativeness and well-being. In a second phase, the findings emerged from the survey was analyzed in depth through a participatory interior design process, together with an interdisciplinary team of architects, technicians of the organization and environmental psychology researchers. The team, together with some representatives of employees, worked together through possible scenarios, adopting a biophilic design approach, to design the new workplace. At the end, the same survey of the first phase was conducted, to detect differences in perceived quality in the new workplace compared to the previous one.
RESUMO
BACKGROUND: To determine whether treatment with ritonavir-boosted protease inhibitor (PI) monotherapy is associated with detrimental effects on neurocognitive function or brain imaging markers compared to standard antiretroviral therapy (ART). METHODS: Neuropsychological assessment and brain magnetic resonance imaging were performed at the last study visit in a subset of participants randomized to PI monotherapy (PI-mono group) or ongoing triple ART (OT group) in the PIVOT trial. We calculated a global z-score (NPZ-7) from the average of the individual test z-scores and the proportion of participants with symptomatic neurocognitive impairment (score >1 standard deviation below normative means in ≥2 cognitive domains and neurocognitive symptoms). In a subgroup, white matter hyperintensities, bicaudate index, global cortical (GCA) and medial temporal lobe atrophy scores and single voxel (basal ganglia) N-acetylaspartate (NAA)/Choline, NAA/Creatine and myo-inositol/Creatine ratios were measured. RESULTS: 146 participants (75 PI-mono) had neurocognitive testing (median time after randomization 3.8 years), of whom 78 were imaged. We found no difference between arms in NPZ-7 score (median -0.4 (interquartile range [IQR] = -0.7; 0.1) vs -0.3 (IQR = -0.7; 0.3) for the PI-mono and OT groups respectively, P = .28), the proportion with symptomatic neurocognitive impairment (13% and 18% in the PI-mono and OT groups respectively; P = .41), or any of the neuroimaging variables (P > .05). Symptomatic neurocognitive impairment was associated with higher GCA score (OR = 6.2 per additional score; 95% confidence interval, 1.7-22.3 P = .005) but no other imaging variables. CONCLUSIONS: Based on a comprehensive neuropsychological assessment and brain imaging, PI monotherapy does not increase the risk of neurocognitive impairment in stable human immunodeficiency virus-positive patients.
