ABSTRACT
The practice of telemedicine started at the beginning of the 20th century but has never been widely implemented, even though it is significantly sustainable compared to traveling to healthcare However, the ongoing COVID-19 pandemic pushed organisations and patients to accept this technology. During the pandemic, telemedicine consultations took place in ad hoc environments without much preparation and planning. As a result, there is a knowledge gap in the field between telemedicine's clinical care services and healthcare built environment, in terms of design. This research focused on addressing the quality of service and experience of telemedicine in primary healthcare settings and how this could be influenced by the digital infrastructure. Our aim was to understand the correlations between telemedicine and healthcare built environment and whether the latter could have a significant impact on telemedicine practice. The methodology included interviews with professionals involved in healthcare planning, architecture and ethnography, and end user research involving telemedicine sessions. The interviews highlighted that professionals involved in the design of healthcare environments demonstrated limited consideration of telemedicine environments. Yet, the ethnographic, end-user research identified areas where the telemedicine environment could affect user experience and should be taken into consideration in the design of such spaces. © 2023 by the authors.
ABSTRACT
Background Psychoneuroimmunology (PNI) indicators, with the central role in low-grade systemic inflammation, are associated with major psychiatric disorders and late effects post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on the behaviour and mental disorders. Therefore, our primary objective is to evaluate whether the exposure to household environmental attributes can trigger PNI biomarker level changes, and to what extent a set of architecture parameters influence on the spatial dynamics of environmental variables. Methods A restricted systematic review is employed to generate knowledge synthesis about housing and mental recovery for the COVID-19 context in a resource-efficient manner. This review is conducted in accordance with the Cochrane Handbook guideline and PRISMA statement. We searched in Medline, EMBASE, Web of Science, Scopus, the Cochrane Library and Google Scholar. Included studies need to be peer-reviewed, written in English and meet pre-defined eligibility criteria. Observational or intervention studies investigating the effects of either environmental determinants within home environments -air pollution, thermal comfort, lighting, electromagnetic fields, noise and nature- using objective metrics or housing design, or combination with a set of circulating biomarkers in PNI and correlate gut microbiome composition are included. Quantitative measures of mental morbidities common in the cancer survivorship are included as secondary outcomes. Study eligibility and quality assessments are carried out by one team member and verified by a second reviewer. A descriptive analysis is conducted. To the best of our knowledge, this review is the first to systematically explore and integrate the evidence available on the association multifactorial and dynamic of housing environmental and design attributes with immune and microbiome mechanisms. Key messages Disease surrogate markers based on systems biology and PNI approaches may help understand multi-level and multi-directional interactions among neuroimmune-microbiota function and housing exposure. This timely study contributes to understand if household environmental and architecture parameters might facilitate cancer rehabilitation via home design, restoring mental-physiological functions.
ABSTRACT
Background From all buildings, houses are where we spent most of our lives. The impact of housing conditions on health was evident during the COVID-19 pandemic. Despite the 2018 Astana Declaration placing integrated delivery of primary health care and public health services across all sectors, a framework that explores health and care in relation to housing remains unexplored. The aim was to determine relevant evidence gaps to building capacity in supportive housing-health care research about chronic diseases and multimorbidity, identify ongoing strains and offer potential solutions. Methods An integrative review was conducted through multiple systematic searches in electronic databases. We employed an interdisciplinary approach integrating several research fields -built environment, clinical and human physiology, environmental health, and public health and health care services- around chronic illness and multimorbidity to understand the depth and scope of linkages. Inductive content analysis was used to describe emerging domains from evidence meeting inclusion criteria. Results We defined a multifaceted framework with priority eight building blocks for action: 1) expanding capacity for chronic care model into the primary care setting;2) scaling up environmental determinants to cover residential spaces;3) implementing acute methodologies for indoor environment risk assessment;4) increasing clinical research applicability into built environment studies;5) recognizing chronic conditions-promoting inflammation physiology;6) qualifying reliable surrogate disease biomarkers in human monitoring;7) enforcing technologies for new forms of outpatient care;and 8) renewing evidence-based healthcare design. Conclusions Future research needs to prioritise articulating these emerging insights through systematic, translational and multisectoral approaches to strengthen health and care delivery through housing design solutions for people living with chronic morbidity. Key messages Integrating the evidence-based design in future interventions may promote transformative changes in housing and public health programmes engaging primary healthcare services for chronic patients. This eco-biopsychosocial supportive framework informs practice to advance research capacity development in enabling health-conducive environments across various levels of care and health promotion.
ABSTRACT
The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children.