The Conceptualization of the Natural Environment in Healthcare Facilities: A Scoping Review.

OBJECTIVES: To identify how the natural environment (NE) in healthcare has been conceptualized. BACKGROUND: The NE appears to afford significant therapeutic benefits. A clear concept of the NE in healthcare affords a shared understanding from which to advance science to facilitate comparisons across contexts. In this article, the various meanings of the NE were brought together into one framework by which to map its themes and their relationships. METHOD: A scoping review was conducted using database searches in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane for articles published up to July 2018. The bibliography of the included articles were manually searched for published books. RESULTS: This review includes 137 peer-reviewed articles and research-based books from 27 countries. A conceptual framework was developed to identify five themes that conceptualize the NE in healthcare: (1) definitions of the NE in healthcare, (2) processes of the NE in healthcare, (3) usages of the NE in healthcare, (4) opinions about the NE in healthcare, and (5) NE's impacts on health and work outcomes in healthcare. These themes are filtered by the NE's physical and programmatic designs; changes in one affect the others. Definitions of the NE are described as human-made space, located in the indoors and outdoors, containing elements of nature and designed with the purpose to positively influence humans. Processes are described as the participatory approach in NE's development and its therapeutic goals. Usages are categorized into nature contact, frequency of usage, and accessibility. Opinions are accounted for by perceptions, preference, and satisfaction. Outcomes are related to physical health, mental health and well-being and work. CONCLUSIONS: This framework contributes to the conceptual discussion and emphasizes NE's complementarity to the biomedical healthcare system.

Need of integrated dietary therapy for persons with diabetes mellitus and "unhealthy" body constitution presentations.

From a perspective of Chinese medicine (CM), persons with unregulated "unhealthy" body constitution (BC) will further develop chronic diseases, such as diabetes mellitus (DM). Conventional dietary therapy with nutrition component has its limitations in the regulation of "unhealthy" BC. However, empirical evidence supports that "unhealthy" BC can be regulated with food natures and flavors from a perspective of CM. Presentations of "unhealthy" BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency were found in persons with DM. It would be necessary to regulate the "unhealthy" BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

Need of integrated dietary therapy for persons with diabetes mellitus and "unhealthy" body constitution presentations / 中西医结合学报

From a perspective of Chinese medicine (CM), persons with unregulated "unhealthy" body constitution (BC) will further develop chronic diseases, such as diabetes mellitus (DM). Conventional dietary therapy with nutrition component has its limitations in the regulation of "unhealthy" BC. However, empirical evidence supports that "unhealthy" BC can be regulated with food natures and flavors from a perspective of CM. Presentations of "unhealthy" BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency were found in persons with DM. It would be necessary to regulate the "unhealthy" BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

Initial validation of the Yin-Yang Assessment Questionnaire for persons with diabetes mellitus.

AIM: To initially test for the content validity, comprehensibility, test-retest reliability and internal consistency reliability of the Yin-Yang Assessment Questionnaire (YY-AQ). METHODS: The process of initial validity and reliability test covered: (1) content validation from the findings of 18 multiple-case studies, validated Yin- and Yang-deficiency assessment questionnaires, relevant literatures and registered Chinese medicine practitioners; (2) comprehension with the levels of comprehensibility for each item categorized on a 3-point scale (not comprehensible; moderately comprehensible; highly comprehensible). A minimum of three respondents selecting for each item of moderately or highly comprehensible were regarded as comprehensive; (3) test-retest reliability conducted with a 2-wk interval. The intraclass correlation coefficients (ICCs) and their 95%CIs were calculated using a two-way random effects model. Wilcoxon Signed Rank test for related samples was adopted to compare the medians of test-retest scores. An ICC value of 0.85 or higher together with P > 0.05, was considered acceptable; and (4) internal consistency of the total items was measured and evaluated by Cronbach's coefficient alpha (α). A Cronbach's α of 0.7 or higher was considered to represent good internal consistency. RESULTS: Eighteen Yin-deficiency and 14 Yang-deficiency presentation items were finalized from content validation. Five participants with type 2 diabetes mellitus (T2DM) performed the comprehensibility and test-retest reliability tests. Comprehensibility score level of each presentation item was found to be moderate or high in three out of the five participants. Test-retest reliability showed that the single measure ICC of the total Yin-deficiency presentation items was 0.99 (95%CI: 0.89-0.99) and the median scores on the first and 14(th) days were 17 (IQR 6.5-27) and 21 (IQR 6-29) (P = 0.144) respectively. The single measure ICC of the total Yang-deficiency presentation items was 0.88 (95%CI: 0.79-0.99) and the median scores on the first and 14(th) days were 10 (IQR 6-18) and 14 (IQR 7-23) (P = 0.144) respectively. The results of a descriptive correlation study on 140 survey participants with T2DM using the YY-AQ showed that internal consistency of the total Yin-deficiency and Yang-deficiency presentation items was satisfactory, with Cronbach's α of 0.79 and 0.78 respectively. CONCLUSION: The YY-AQ will be tested further for comprehensibility, test-retest and internal consistency reliabilities, scoring system validity, construct validity, convergent and discriminant validities, responsiveness and predictive validity.