Water use and water saving in Italian hospitals. A preliminary investigation

Aim. The aim of this work is to investigate about water use, wastage, saving and reuse in hospitals. Methods. An anonymous ad hoc questionnaire was tested in a sample of 36 public hospitals of Lombardy Region (21% of total public hospitals). Daily water consumption reported is on average equal to 481 m3, ranging from 30 to 2280 m3. There is a strong correlation between water consumption and number of hospital beds (p < 0.005). In 33 hospitals (92%) water consumption is measured and, among them, in about 48% more than one flow meter is installed; 86% consider “important” the reduction of water consumption and about 55% recognize that wastewater could be minimized within the structures. Discussion. There is consensus about the need to train health personnel and to implement technical measures to improve the water resources management, but initiatives to raise knowledge and awareness of health personnel have been promoted only in 10% of hospitals. Results. Results show not only a lack of awareness regarding water use and saving among the personnel in general, but also among heads of the hospitas’ technical office and energy managers as well. For this reason, it will be of interest to carry out this investigation at national level and also to develop recommendations to support and promote a safe reuse of water in all the hospitals

TRASPORTO ATTIVO E SALUTE: MISURAZIONE DELL’INCREMENTO PREVISIONALE DI CICLABILITA’ NELLA CITTA’ DI MILANO E VALUTAZIONE DELLE RICADUTE POSITIVE SULLO STATO DI SALUTE DELLA POPOLAZIONE

INTRODUZIONE: È scientificamente noto come l’inattività fisica sia tra i principali fattori di rischio per l’incremento delle malattie cronico-degenerative. L’emergenza è particolarmente rilevante nei contesti urbani, dove, tuttavia, la maggior parte degli spostamenti copre una distanza inferiore ai 5km, facilmente percorribile a piedi o in bicicletta. Questi spostamenti garantirebbero una sufficiente attività fisica giornaliera. Risulta pertanto necessario indagare quali caratteristiche delle infrastrutture ciclopedonali incentivino o scoraggino l’adozione di corretti stili di vita. METODI: Dopo un confronto con lo stato dell’arte relativo alle correlazione tra trasporto attivo, Physical Activity e salute, è stato redatto un questionario per raccogliere dati sul livello attuale della ciclabilità urbana e quantificare l’incremento previsionale in caso di miglioramento ed implementazione della rete ciclabile. Il questionario è stato somministrato digitalmente e in forma cartacea, per un periodo di 3 mesi nella città di Milano. RISULTATI: I dati raccolti (1675 compilazioni) dimostrano che la scelta della bicicletta come mezzo di trasporto aumenterebbe: nella situazione previsionale il 76,5% del campione (oltre il 21% in più rispetto alla situazione attuale) raggiungerebbe i 150 minuti settimanali di attività fisica raccomandata dall’OMS. È stata condotta inoltre una valutazione dei benefici sulla salute, in termini di riduzione della mortalità causata da malattie cronico-degenerative tramite l’applicazione dello strumento HEAT dell’OMS ha individuato un incremento dei benefici protettivi pari al 5%. CONCLUSIONI: L’indagine condotta ha perseguito lo scopo di individuare gli aspetti da migliorare dal punto di vista del progetto urbano. Scopo principale è quello di sensibilizzare i Policy Makers, evidenziando come gli interventi urbani, soprattutto quelli a piccola scala, potrebbero avere un ruolo chiave nella riduzione dell’inattività fisica e quindi di una maggior salute

IL VERDE PER MIGLIORARE LA QUALITÀ DELL’ARIA OUTDOOR NEI CONTESTI URBANI

Introduzione: I contesti urbani presentano elevati livelli di inquinamento atmosferico, responsabili di patologie acute e di malattie cronico-degenerative. La vegetazione è in grado di assorbire e trattenere alcune sostanze, tuttavia nelle aree densamente costruite è spesso difficile creare nuovi spazi verdi, se non ipotizzando di utilizzare le coperture. Scopo della ricerca è stato l’elaborazione di un modello di calcolo per la quantificazione delle possibili superfici trasformabili a verde e la relativa capacità di assorbimento degli inquinanti di uno specifico contesto urbano. Metodologia: Il confronto con la letteratura scientifica ha consentito da definizione di correlazioni tra patologie, inquinanti atmosferici e specie arboree in grado di abbatterli. In seguito, è stato sviluppato un modello di calcolo in grado di quantificare gli inquinanti abbattuti in relazione ad uno specifico aumento di verde di un’area urbana. Nella terza parte, il modello di calcolo, è stato sperimentato e validato in un quartiere di Milano. Risultati: L’applicazione dello strumento è avvenuta nel quartiere città studi, a Milano. Le ipotetiche trasformazioni di coperture piane in tetti verdi, porterebbero ad una riduzione degli inquinanti fino a 3,9 μg/m³ di PM10, 2,92 μg/m³ di PM2. 5 e 1,57 μg/m³ di O3 ogni giorno in tutto il quartiere. Se tale ipotesi fosse estesa a tutta la città di Milano si arriverebbe ad un abbattimento di circa 18,09 μg/m³ di PM10, 13,56 μg/m³ di PM2. 5 e 7,24 μg/m³ di O3. Lo strumento ipotizza anche una stima dei costi di realizzazione e i benefici sanitari in termini di riduzione del n. di ricoveri. Conclusioni: Considerando un progetto di riqualificazione urbana la possibilità di recuperare spazi verdi dalle coperture diviene una strategia fondamentale non solo per i benefici psicologici-percettivi, energetici e climatico-ambientali ma anche per la riduzione dell’inquinamento atmosferico urbano, con ricadute positive sulla salute della popolazione

Healthcare for all in emerging countries: a preliminary investigation of facilities in Kolkata, India

Introduction. India is one of the five countries with the lowest public health spending levels: the private medical services are one of the most developed fields, meanwhile public health ones are totally inadequate with the most number of health facilities concentrated in cities, where only the 25% of the population lives. Public facilities are mainly made up of primary level and not well distributed on the territories, so they do not guarantee accessibility to a wide sample of population, who live in rural areas of India. Methodology. Starting from the analysis of three different health care levels in the Indian context, the research team developed a meta-project that considers all the current criticisms and the Indian customs through a flexible layout that responds to the healthcare needs of population. Result and Discussion. The research work is aimed to develop a meta-project that considers all the current criticisms and the Indian customs through flexible layouts that responds to the healthcare needs of population. Conclusion. The innovation of the research work is to develop the hygienic aspects, the layout and the distribution, the sub-division of the medical functions through the Indian culture and the needs of the country. The choice of lowly technologies permits to promote the usage of local materials, their maintenance and skills for creating a virtuous economic system

2015-2018 Regional Prevention Plan of Lombardy (Northern Italy) and sedentary prevention: a cross-sectional strategy to develop evidence-based programmes

Cross-sector, life-course, and setting approaches are identified in the 2015-2018 Regional Prevention Plan (PRP) of Lombardy Region (Northern Italy) as valuable strategies to ensure the efficacy and sustainable prevention of the non-communicable disease (NCDs). The involvement of non-health sectors in health promotion activities represents a suitable strategy to affect on social, economic, and political determinants and to change environmental factors that could cause NCDs. A dialogue among communities, urban planning, and prevention know-how is a prerequisite to develop a system of policies suitable to promote healthy lifestyle in general and, specifically, active lifestyles. The 2015-2018 Lombardy PRP pursues its aims of health promotion and behavioural risk factors for NCDs prevention through programmes that implement their own setting networks (Health Promoting Schools – SPS; Workplace Health Promotion – WHP) and develop new networks. Sedentary lifestyle prevention and active lifestyle promotion are performed through the approach promoted by the Healthy Cities Programme (WHO), encouraging two main processes: 1. creating integrated capacity-building among health and social prevention services, academic research, and local stakeholders on different urban planning and design issues; 2. promoting community empowerment through active citizens participation. Through this process, Lombardy Region aims to orient its services developing evidence-based programmes and enhancing advocacy and mediating capacity skills in order to create a profitable partnership with non-health sectors. This paper reports the main impact data: 26,000 children that reach school by foot thanks to walking buses, 57% of 145 companies joining WHP are involved in promoting physical activity, 18,891 citizens who attend local walking groups

Bridging therapeutic landscapes to architecture. International experience-based design strategies for healthcare infrastructures

Background and aim: in Italy, many cases studies of therapeutic green spaces are built into healthcare infrastructures, but only some of these follow the principles of healing gardens. Scientific literature and international case studies offer many contributions of evidence relating to how therapeutic green spaces can support traditional treatments. The paper analyze the relationship between indoor and outdoor spaces and healing gardens' features; the main research questions were: "Can we synthetize experience-based design strategies for therapeutic green spaces and healing gardens? How can we prioritize the most relevant ones for the healthcare infrastructures?" Methods: Research Method is divided into three different steps: 1st case studies' selection; 2nd case studies' analysis, and 3rd quali-quantitative comparative matrix. Results: ten case studies were identifiedfour of them have the therapeutic green space on the ground floor,despite of the other six having the healing garden on the rooftop.The best experience-based design strategies for the therapeutic green spaces or healing gardens development were identified from the previous comparison matrix, and divided into A.Safety, Security and Privacy; B.Accessibility; C.Physical and Emotional Comfort; D.Positive distraction; E.Engagement with Nature; F.Maintenance and Aesthetics; and G.Sustainability. Conclusions: The results obtained from the comparative matrix are qualitative and quantitative design elements in terms of type of element / space, percentage, perimeter, area, number, materiality, shape, color, among others. The quali-quantitative matrix is a useful and practical tool that allows the designer to have a base of design guidelines that can be later applied to the proposal of new therapeutic gardens

Humanisation and soft qualities in emergency rooms

Scenario. Currently, there are few evaluation methods that analyse social aspects in healthcare issues, especially humanisation and well-being, as perceived by users in emergency departments which are places in which patients’ psycho-physical well-being is decisive. For this reason, research was conducted to create a tool to improve the quality of these areas. Methodology. In order to conduct the research, the work was structured in three phases: the first, based on the analysis of State-of-the-Art and the current studies on the interactions established between the physical and emotional conditions of the structure and the users; the second, through the definition of a questionnaire which explores humanisation and comfort aspects; the third, through the application of the instrument. Results. The paper presents and analyses data collected from the application on a case study in Milan, analysing the responses and proposing design suggestions for increasing the quality of emergency environments. Conclusions. In anticipation of future works, the application of such a tool can provide the opportunity to improve and enhance quality and staff efficiency in emergency department spaces

COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities

Background and aim of the work. The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it’s necessary to make resilient the systems and local capacities to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities? Methods. According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing. Results. Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services’ plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services’ network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders’ awareness of the factors affecting Public Health in the cities. Conclusions. The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments

SNAP House. Modulo abitativo temporaneo per i rifugiati in Europa

The refugees\u80crisis results one of the most relevant social and medical issues in the international panorama. The Aim of the research is to develop a design project for a refugees\u80 temporary housing module, able to solving specific social, typological and functional needs in the context of anthropogenic emergencies in Europe. Starting from the study of the refugee crisis phenomenon, through a careful analysis of case studies and by identifying the main requirements of temporary dwellings for housing emergencies, the SNAP House project presents innovative solutions related to modularity, flexibility, adaptability to the different users needs and it is able to ensure hygiene of spaces and indoor well-being

Cost of care and antibiotic prescribing attitudes for community-acquired complicated intra-abdominal infections in Italy: a retrospective study.

INTRODUCTION: Complicated intra-abdominal infections (cIAIs) are a common cause of morbidity worldwide, and in spite of improvements in patient care, therapeutic failure still occurs, impacting in-hospital resource consumption. This study aimed to assess the costs associated with the treatment of community-acquired cIAIs, from the Italian National Health Service perspective. METHODS: This retrospective study analyzed the charts of patients who were discharged from four Italian university hospitals between January 1 and December 31, 2009 with a primary diagnosis of community-acquired cIAIs. Patient characteristics, diagnosis, surgical procedure, antibiotic therapy, and length of hospital stay were all recorded and the cost of total hospital care was estimated. Costs were calculated in Euros at 2009 values. RESULTS: The records of 260 patients (mean age 48.9 years; 57% males) were analyzed. The average cost of care for a patient hospitalized due to cIAI was €4385 (95% CI 3650–5120), with an average daily cost of €419 (95% CI 378–440). Antibiotic therapy represented just under half (44.3%) of hospitalization costs. The strongest predictor of the increase in hospital costs was clinical failure: patients who clinically failed received an average of 8.2 additional days of antibiotic therapy and spent 11 more days in hospital compared with patients who responded to first-line therapy (both p < 0.05 vs. patients who were successfully treated). Furthermore, they incurred €5592 in additional hospitalization costs (2.88 times the cost associated with clinical success) with 53% (€2973) of the additional costs attributable to antibiotic therapy. Overall, antibiotic appropriateness rate was 78.8% (n = 205), and was significantly higher in patients receiving combination therapy compared with those treated with monotherapy (97.3% vs. 64.6%). CONCLUSION: The results of this study suggest that hospitals need to be aware of the clinical and economic consequences of antibiotic therapy of cIAIs and to reduce overall resource use and costs by improving the rate of success with appropriate initial empiric therapy