# data[].attributes.body
In this paper we use an individual-based model of disease transmission to assess how an epidemic is influenced by worker density and activity level, the probability of disease transmission, and the structural organization of the nest. First, we observed in our model a nonlinear interaction between worker density and the probability of disease transmission: high levels of both factors interact to enhance the likelihood of an epidemic. Additionally, when we incorporated in our model the empirical observation that only a fraction of the worker population in social insect colonies is active at any given point in time, results suggested that relatively low levels of worker movement can have a significant impact on the spread of disease, slowing its transmission through the colony. Finally, we found that nests having even a simple spatial separation of chambers could delay the spread of infection and diminish the severity of an outbreak. The effect of nest structure in delaying infection spread became more pronounced as nest architecture became increasingly unidimensional, as in the case of simple gallery nests. Therefore, nest architecture and worker activity patterns might indeed exert considerable influence on the dynamics of epidemics in social insects and should be incorporated into models of disease transmission.

Pie, Marcio R., Rebeca B. Rosengaus, and James FA Traniello. "Nest architecture, activity pattern, worker density and the dynamics of disease transmission in social insects." Journal of Theoretical Biology 226.1 (2004): 45-51.

# data[].attributes.body
The intent of this proposal is to create a prototypical office building that promotes health and individual well-being. The architecture will focus on the needs and concerns of each worker in relation to their physical, emotional and spiritual health. Due to the fast-paced American lifestyle, individual health is suffering. The rates of obesity and depression in the United States are skyrocketing and architecture has an obligation to address this urgent issue in terms of design.

Recommended Citation

Parris, Emily, "The fittingness of fitness: the movement of architecture at a human scale: a reinvention of the typical workplace" (2007). Architecture Theses. 4.

https://docs.rwu.edu/archthese/4

# data[].attributes.body
The concept of Work Ability, which has been developed as an important multi-factor concept that can be used to identify workers at risk for an imbalance between health, personal resources and work demands, has the potential to mitigate the decrease in work ability of office workers while aging. The framework for modeling the work ability of the office worker, described at a conceptual level in this work, is grounded in a holistic multidimensional model which accounts for both the cognitive and physical resources of the individual, and factors related to work and the environment outside of work. AI tools for prediction and risk assessment allow for dimension specific decision support and intervention, including on-the-fly flexible work management, coping with stress at work, and on-demand training.

Kocsis, Otilia, et al. "Conceptual architecture of a multi-dimensional modeling framework for older office workers." Proceedings of the 12th ACM International Conference on PErvasive Technologies Related to Assistive Environments. 2019.

# data[].attributes.body
Contemporary cities have high stress levels, mental health issues, high crime levels and ill health, while the built environment shows increasing problems with urban heat island effects and air and water pollution. Emerging from these concerns is a new set of design principles and practices where nature needs to play a bigger part called “biophilic architecture”. This design approach asserts that humans have an innate connection with nature that can assist to make buildings and cities more effective human abodes. This paper examines the evidence for this innate human psychological and physiological link to nature and then assesses the emerging research supporting the multiple social, environmental and economic benefits of biophilic architecture.

Soderlund, Jana, and Peter Newman. "Biophilic architecture: a review of the rationale and outcomes." AIMS environmental science 2.4 (2015): 950-969.

# data[].attributes.body
When the sleep pattern is off from its normal rhythm, it automatically sets to less sleep and less quality of sleep  which  contributes  to  poor  performances in doing their tasks (Khan, 2014). The circadian rhythm dips for an adult usually starts at 2.00 am to 4.00 am whereas in the afternoon, it would be occurring from 1.00 pm to 3.00 pm (both periods are the strongest derive  for  an  adult  to  feel  sleepy  (National Sleep Foundation,  2018). Thus, if an adult

could not meet their  own needs to sleep at this hour, it would disturb the body’s biological clock. This would lead to the adult to feel it hard to go to sleep after they had finished their shift  if they try to stay awake during those two crucial  periods. In conclusion, sleeping pattern and enough sleeping hours for an individual to perform their daily tasks are vital in keeping their cognitive abilities on track.

https://www.researchgate.net/publication/332041825_The_Relationship_Between_Workers%27_Health_and_Night_Shift_Work_in_Food_Franchise_Industry_in_Kuching_Sarawak_Malaysia

The effects of shift work occur most obviously on sleep, affecting both quality and quantity. Due to sleeping during the day, night shift workers have to sleep during the normal rising phase of the circadian rhythm, and this prolongs the period of feeling wakeful. Environmental conditions such as lighting, and noise can also further disturb sleep and exacerbate the period of wakefulness.

https://www.news-medical.net/health/What-Are-the-Health-Effects-of-Working-Night-Shifts.aspx

# data[].attributes.body
The majority of nurses in the focus groups suggested that daytime sleep was improved if a quiet environment was maintained. Most also suggested that this was difficult to accomplish. Answering machines and thick draperies were routinely used to reduce outside noise and light. Fans and radios were also regularly used to produce “white noise,” which the subjects stated helped them sleep. Earplugs were not considered as a strategy by the nurses interviewed even though routine daytime noise prevented sleep. Most subjects with young children noted that their presence in the home during day hours prevented adequate sleep. If possible, the spouses removed the children from the home while the shiftworker subject was sleeping. If this was not possible, most noted that their sleep was impaired, either because of increased noise levels or because of the workers’ desire to see their children during the day. The majority of nurses admitted that they did without sleep when young children were in the home.

https://www.tandfonline.com/doi/abs/10.3109/07420529609020916

# data[].attributes.attachment_link.title
Focus Group Evaluation of Night Nurse Shiftwork Difficulties and Coping Strategies

# data[].attributes.attachment_link.description
Focus group interviews were performed on 45 intensive care nurses who worked 12-h shifts in a large metropolitan hospital. The purpose of this study was to identify nurses' perceptions of difficulties associated with shiftwork and coping strategies used to combat them. Overall, the findings were not different than those currently discussed in the literature.

# data[].attributes.body
Previous research has established that you can delay the circadian clock by about one or two hours per day. To determine that, researchers measure the body’s circadian rhythm by monitoring "dim-light melatonin onset," or the time at which the pineal gland begins to secrete melatonin, which is triggered by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. "It’s an output that’s a way of seeing what the circadian clock is doing," Eastman says. "It’s a very good marker of the phase of the time of the clock."

By exposing experimental subjects to intermittent bright light during their night shifts and having them wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have found that within about a week, they can shift someone’s circadian rhythm to align perfectly with working a night shift and sleeping during the day.

https://www.apa.org/monitor/2011/01/night-work

# data[].attributes.attachment_link.readable_text
Nearly 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts, according to the Bureau of Labor Statistics. That means a significant sector of the nation's work force is exposed to the hazards of working nights, which include restlessness, sleepiness on the job, fatigue, decreased attention and disruption of the body's metabolic process.

Those effects extend beyond the workers themselves, as many of us share the road with night-driving truckers, count on the precision of emergency-room workers and rely on the protection of police and national security personnel at all hours.

Now, psychologists are gaining a better understanding of how exactly night and shift work affect cognitive performance and which interventions and policies could keep shift workers and the public safer.

"The basic take-home is that fatigue decreases safety," says Bryan Vila, PhD, a sleep expert and criminal justice researcher at Washington State University-Spokane. Learning healthy sleeping practices is "just as important as occupational training," he says.

Natural rhythms

Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major problems for night workers. That's because working at night runs counter to the body's natural circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in Chicago. The circadian clock is essentially a timer that lets various glands know when to release hormones and also controls mood, alertness, body temperature and other aspects of the body's daily cycle.

Our bodies and brains evolved to relax and cool down after dark and to spring back into action come morning. People who work the night shift must combat their bodies' natural rest period while trying to remain alert and high functioning. It doesn't matter whether they get enough sleep during the daytime, she says. All the sleep in the world won't make up for circadian misalignment.

That's especially dangerous for people whose jobs require them to be on high alert and make split-second, life-or-death decisions during the night, such as medical personnel or police officers. It's common for police departments, for example, to require rookies and lower-ranking officers to bear the brunt of night shifts. They'll often work a few days during normal daytime hours, then either work an extra-long shift that carries on until the morning, or take a day off, rest, then work a full night shift. But that seesaw scheduling approach is a doubly bad idea, says John Violanti, PhD, an organizational psychologist who was a New York state trooper for 23 years. Not only are these highly stressful, performance-draining shifts being foisted upon the least experienced officers, but the young officers aren't given time to adjust their sleep schedules for night work. Also, many officers seek night shifts to get overtime pay, he says. According to Vila's research, roughly 40 percent of the nation's 861,000 police officers work more than 12 hours a day - and a similar proportion suffer from a sleep disorder such as insomnia or excessive sleepiness.

Working against a person's natural sleep cycle causes such sleep disorders, as well as fatigue. Fatigue, in turn, worsens moods, decreases cognitive abilities and reflexes, and makes people more vulnerable to disease, says Vila. That resulting crankiness and warped perspective can interfere with one's ability to make sound decisions and manage people effectively, and can increase the frequency of negative encounters.

That's not a recipe for good decisions, says Vila, especially when officers must make decisions about whether to use deadly force - often in ambiguous, fast-paced, high-risk situations. Neither is it safe for more routine activities, such as driving. "When you're drowsy, local parts of the brain shut down for milliseconds or seconds at a time, then come back online," he says.

Night work and fatigue may also contribute to the risk of heart disease and cancer, according to research by Violanti, Vila and colleagues ( Policing, Vol. 30, No. 2). Working with 98 Buffalo, N.Y., police officers, the researchers looked for metabolic syndrome - a combination of symptoms that contribute to poor heart health and diabetes, including large waist circumference, elevated triglyceride levels, high cholesterol, high blood pressure and high levels of glucose when not eating. They found that the officers who most frequently worked the 8 p.m.-to-4 a.m. shift had the highest prevalence of metabolic syndrome symptoms. Those who commonly worked that shift and also averaged fewer than six hours of sleep were four times more likely than other officers to have metabolic syndrome.

Vila and Violanti hope their findings will spur changes in shift scheduling, both for the public's safety and the officers'.

Of course, police officers aren't the only night-shift workers suffering from circadian misalignment. A number of studies have found that fatigue due to prolonged work hours or being called into work in the middle of the night can result in lapses in judgment and impaired motor skills among medical workers. For instance, a 2008 article in the American Journal of Surgery (Vol. 195, No. 2) reports that, when performing "surgery" on a virtual patient, well-rested surgeons were significantly smoother in their hand motions and made fewer errors than did their sleep-deprived counterparts.

Fatigue is also risky for the physicians themselves, other research has found. A 2005 report published in the New England Journal of Medicine (Vol. 352, No. 2) found that medical interns whose shifts lasted longer than 24 hours were more than twice as likely to have a car crash and five times as likely to have a driving near-miss after leaving work as interns who worked shorter shifts.

In fact, any worker who must drive while tired - whether it's on the job or driving home after a night shift - is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was cited as a primary factor in the crash. But other factors such as driver inattention, speeding and running off the road can also be influenced by fatigue, the institute found.

Another report from 2004 found that workers across a variety of occupations who worked 12-hour night shifts were more likely than their day-shift-working colleagues to experience physical fatigue, smoke and abuse alcohol.

Possible solutions

Of course, many workers can't give up the night shift entirely. So the question is, how can night shift workers adapt to their schedules?

There are two ways, says Rush University's Eastman. One is through symptomatic relief by using such stimulants as coffee and caffeine pills to stay awake during the night, then taking sedatives to sleep in the morning. The other way is to shift the body's circadian clock so that it better tolerates working at night and sleeping during the day.

Eastman and her team are exploring the latter approach. "The circadian clock is very stubborn and hard to push around," she says.

Previous research has established that you can delay the circadian clock by about one or two hours per day. To determine that, researchers measure the body's circadian rhythm by monitoring "dim-light melatonin onset," or the time at which the pineal gland begins to secrete melatonin, which is triggered by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. "It's an output that's a way of seeing what the circadian clock is doing," Eastman says. "It's a very good marker of the phase of the time of the clock."

By exposing experimental subjects to intermittent bright light during their night shifts and having them wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have found that within about a week, they can shift someone's circadian rhythm to align perfectly with working a night shift and sleeping during the day.

But that's unrealistic for most people, she says. "The problem is that adapting completely physiologically would leave you a nocturnal person, unable to sleep until very late on days off and being out of phase with regular day-working people."

So Eastman and her team have developed a compromise system in which people who work permanent night shifts - say, 11 p.m. to 7 a.m. - adapt their circadian rhythms just enough to function well at night, but still be lively during their days off. It works like this: On his or her day off, the worker goes to sleep as late as possible (in Eastman's experiment, participants went to bed at 3 a.m. and woke up at noon). On a workday, he or she would be exposed to intermittent bright light, wear sunglasses on the way home from the night shift, then go to sleep as early as possible. "So the difference between sleep on their night shift days and their days off would likely be less than what most shift workers have now," Eastman says.

Last year, she tested the cognitive skills of workers who tried this compromise approach and compared those who fully adapted to a night-shift schedule to those who only partially adapted. Both groups performed about the same, and both scored almost as well as they did when they first took the tests when on a normal daytime schedule ( Sleep, Vol. 32, No. 11). "You don't have to be fully adapted to the night shift to get the benefits of shifting your circadian clock," Eastman says.

However, Eastman points out she doesn't yet have a solution for workers who have a combination of night and day shifts because it's impossible to keep shifting their circadian rhythms to keep up with an ever-changing work schedule. She says it falls on employers to assign shift work in blocks, giving workers enough time to adapt.

"You can't phase shift the circadian clock with a rapidly rotating shift schedule because the clock can't move that fast," she says. "The only thing you can do is symptomatic relief, meaning you'll have very sleepy people working at night, which is dangerous."
For more information on improving the health of workers, go to APA's Psychologically Healthy Workplace Program site.

# data[].attributes.attachment_link.description
Millions of American workers fight against their circadian clocks to work every day, putting them - and other in their paths - in danger.

# data[].attributes.body
A majority of the nurses suggested that their normal exercise patterns and activities were also altered by night work. Obtaining adequate time to exercise was found to be more difficult while working nights unless mealtime during the night shift was spent “walking rather than eating.” Approximately half the nurses did not exercise regularly, but those who did attempted to maintain their exercise regime by walking during night working hours. Those who did walk during the night shift also felt that exercise increased their vigilance and alertness.

https://www.tandfonline.com/doi/abs/10.3109/07420529609020916

# data[].attributes.attachment_link.title
Focus Group Evaluation of Night Nurse Shiftwork Difficulties and Coping Strategies

# data[].attributes.attachment_link.description
Focus group interviews were performed on 45 intensive care nurses who worked 12-h shifts in a large metropolitan hospital. The purpose of this study was to identify nurses' perceptions of difficulties associated with shiftwork and coping strategies used to combat them. Overall, the findings were not different than those currently discussed in the literature.

# data[].attributes.body
Shift workers should jealously guard the time set aside for their sleep. This time should be regular and predictable, and free from social or other commitments. During that time, telephones, doorbells and domestic appliances should be silenced. Heavy curtains and thick carpets should be used to help make the bedroom as quiet and as dark as possible. The bedroom should be used only for sleep and lovemaking.

https://www.tandfonline.com/doi/abs/10.1080/02678378808259160

# data[].attributes.attachment_link.readable_text
Abstract

A large proportion of the American and European work-force is engaged in night and shift work. The aim of this brief article is to present those involved with some practical advice regarding how they might best cope. The advice is presented in terms of a theoretical framework involving a triad of mutually interactive factors.

# data[].attributes.attachment_link.description
Abstract A large proportion of the American and European work-force is engaged in night and shift work. The aim of this brief article is to present those involved with some practical advice regarding how they might best cope. The advice is presented in terms of a theoretical framework involving a triad of mutually interactive factors.

# data[].attributes.body
https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.877.5088&rep=rep1&type=pdf

# data[].attributes.body
Fatigue, poor sleep quality and dangerous drives home were found in nurses who could not adapt to shift work. A descriptive study of 12 nurses in the USA who fell asleep while driving home indicated that although they were scared, they could not address this problem. In Greece a study of 163 nurses assigned to non-day shift work found increased unsafe driving incidents and accidents. In another study in the USA, 895 nurses were asked to keep a log book of shifts, hours worked, and drowsy driving incidents. Working the night shift was associtated with having a shorter duration of sleep, difficulty remaining awake at work and increased drowsiness while driving.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.877.5088&rep=rep1&type=pdf

In fact, any worker who must drive while tired — whether it’s on the job or driving home after a night shift — is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was cited as a primary factor in the crash. But other factors such as driver inattention, speeding and running off the road can also be influenced by fatigue, the institute found.

https://www.apa.org/monitor/2011/01/night-work

# data[].attributes.attachment_link.readable_text
Nearly 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts, according to the Bureau of Labor Statistics. That means a significant sector of the nation's work force is exposed to the hazards of working nights, which include restlessness, sleepiness on the job, fatigue, decreased attention and disruption of the body's metabolic process.

Those effects extend beyond the workers themselves, as many of us share the road with night-driving truckers, count on the precision of emergency-room workers and rely on the protection of police and national security personnel at all hours.

Now, psychologists are gaining a better understanding of how exactly night and shift work affect cognitive performance and which interventions and policies could keep shift workers and the public safer.

"The basic take-home is that fatigue decreases safety," says Bryan Vila, PhD, a sleep expert and criminal justice researcher at Washington State University-Spokane. Learning healthy sleeping practices is "just as important as occupational training," he says.

Natural rhythms

Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major problems for night workers. That's because working at night runs counter to the body's natural circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in Chicago. The circadian clock is essentially a timer that lets various glands know when to release hormones and also controls mood, alertness, body temperature and other aspects of the body's daily cycle.

Our bodies and brains evolved to relax and cool down after dark and to spring back into action come morning. People who work the night shift must combat their bodies' natural rest period while trying to remain alert and high functioning. It doesn't matter whether they get enough sleep during the daytime, she says. All the sleep in the world won't make up for circadian misalignment.

That's especially dangerous for people whose jobs require them to be on high alert and make split-second, life-or-death decisions during the night, such as medical personnel or police officers. It's common for police departments, for example, to require rookies and lower-ranking officers to bear the brunt of night shifts. They'll often work a few days during normal daytime hours, then either work an extra-long shift that carries on until the morning, or take a day off, rest, then work a full night shift. But that seesaw scheduling approach is a doubly bad idea, says John Violanti, PhD, an organizational psychologist who was a New York state trooper for 23 years. Not only are these highly stressful, performance-draining shifts being foisted upon the least experienced officers, but the young officers aren't given time to adjust their sleep schedules for night work. Also, many officers seek night shifts to get overtime pay, he says. According to Vila's research, roughly 40 percent of the nation's 861,000 police officers work more than 12 hours a day - and a similar proportion suffer from a sleep disorder such as insomnia or excessive sleepiness.

Working against a person's natural sleep cycle causes such sleep disorders, as well as fatigue. Fatigue, in turn, worsens moods, decreases cognitive abilities and reflexes, and makes people more vulnerable to disease, says Vila. That resulting crankiness and warped perspective can interfere with one's ability to make sound decisions and manage people effectively, and can increase the frequency of negative encounters.

That's not a recipe for good decisions, says Vila, especially when officers must make decisions about whether to use deadly force - often in ambiguous, fast-paced, high-risk situations. Neither is it safe for more routine activities, such as driving. "When you're drowsy, local parts of the brain shut down for milliseconds or seconds at a time, then come back online," he says.

Night work and fatigue may also contribute to the risk of heart disease and cancer, according to research by Violanti, Vila and colleagues ( Policing, Vol. 30, No. 2). Working with 98 Buffalo, N.Y., police officers, the researchers looked for metabolic syndrome - a combination of symptoms that contribute to poor heart health and diabetes, including large waist circumference, elevated triglyceride levels, high cholesterol, high blood pressure and high levels of glucose when not eating. They found that the officers who most frequently worked the 8 p.m.-to-4 a.m. shift had the highest prevalence of metabolic syndrome symptoms. Those who commonly worked that shift and also averaged fewer than six hours of sleep were four times more likely than other officers to have metabolic syndrome.

Vila and Violanti hope their findings will spur changes in shift scheduling, both for the public's safety and the officers'.

Of course, police officers aren't the only night-shift workers suffering from circadian misalignment. A number of studies have found that fatigue due to prolonged work hours or being called into work in the middle of the night can result in lapses in judgment and impaired motor skills among medical workers. For instance, a 2008 article in the American Journal of Surgery (Vol. 195, No. 2) reports that, when performing "surgery" on a virtual patient, well-rested surgeons were significantly smoother in their hand motions and made fewer errors than did their sleep-deprived counterparts.

Fatigue is also risky for the physicians themselves, other research has found. A 2005 report published in the New England Journal of Medicine (Vol. 352, No. 2) found that medical interns whose shifts lasted longer than 24 hours were more than twice as likely to have a car crash and five times as likely to have a driving near-miss after leaving work as interns who worked shorter shifts.

In fact, any worker who must drive while tired - whether it's on the job or driving home after a night shift - is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was cited as a primary factor in the crash. But other factors such as driver inattention, speeding and running off the road can also be influenced by fatigue, the institute found.

Another report from 2004 found that workers across a variety of occupations who worked 12-hour night shifts were more likely than their day-shift-working colleagues to experience physical fatigue, smoke and abuse alcohol.

Possible solutions

Of course, many workers can't give up the night shift entirely. So the question is, how can night shift workers adapt to their schedules?

There are two ways, says Rush University's Eastman. One is through symptomatic relief by using such stimulants as coffee and caffeine pills to stay awake during the night, then taking sedatives to sleep in the morning. The other way is to shift the body's circadian clock so that it better tolerates working at night and sleeping during the day.

Eastman and her team are exploring the latter approach. "The circadian clock is very stubborn and hard to push around," she says.

Previous research has established that you can delay the circadian clock by about one or two hours per day. To determine that, researchers measure the body's circadian rhythm by monitoring "dim-light melatonin onset," or the time at which the pineal gland begins to secrete melatonin, which is triggered by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. "It's an output that's a way of seeing what the circadian clock is doing," Eastman says. "It's a very good marker of the phase of the time of the clock."

By exposing experimental subjects to intermittent bright light during their night shifts and having them wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have found that within about a week, they can shift someone's circadian rhythm to align perfectly with working a night shift and sleeping during the day.

But that's unrealistic for most people, she says. "The problem is that adapting completely physiologically would leave you a nocturnal person, unable to sleep until very late on days off and being out of phase with regular day-working people."

So Eastman and her team have developed a compromise system in which people who work permanent night shifts - say, 11 p.m. to 7 a.m. - adapt their circadian rhythms just enough to function well at night, but still be lively during their days off. It works like this: On his or her day off, the worker goes to sleep as late as possible (in Eastman's experiment, participants went to bed at 3 a.m. and woke up at noon). On a workday, he or she would be exposed to intermittent bright light, wear sunglasses on the way home from the night shift, then go to sleep as early as possible. "So the difference between sleep on their night shift days and their days off would likely be less than what most shift workers have now," Eastman says.

Last year, she tested the cognitive skills of workers who tried this compromise approach and compared those who fully adapted to a night-shift schedule to those who only partially adapted. Both groups performed about the same, and both scored almost as well as they did when they first took the tests when on a normal daytime schedule ( Sleep, Vol. 32, No. 11). "You don't have to be fully adapted to the night shift to get the benefits of shifting your circadian clock," Eastman says.

However, Eastman points out she doesn't yet have a solution for workers who have a combination of night and day shifts because it's impossible to keep shifting their circadian rhythms to keep up with an ever-changing work schedule. She says it falls on employers to assign shift work in blocks, giving workers enough time to adapt.

"You can't phase shift the circadian clock with a rapidly rotating shift schedule because the clock can't move that fast," she says. "The only thing you can do is symptomatic relief, meaning you'll have very sleepy people working at night, which is dangerous."
For more information on improving the health of workers, go to APA's Psychologically Healthy Workplace Program site.

# data[].attributes.attachment_link.description
Millions of American workers fight against their circadian clocks to work every day, putting them - and other in their paths - in danger.

# data[].attributes.body
The participants experienced degrees of social isolation from old friends due to differences inherent in day and night work. One man said “I have all I can do to work, go to school, and help with the kids. My wife also works full time days. Forget social things. We gave that up for now.” Coping included staying connected by social media and making new friends at work.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.877.5088&rep=rep1&type=pdf

# data[].attributes.body
A potential risk concerned the weakening of relationships with one’s spouse or significant other. One woman described her marriage as a “strained normal”. One newly married nurse said her husband came home shortly before she had to leave for work. She coped in making dinner and “dressing up.” She created “special times” together before she had to “hurry off to work”. Relationship issues ranged from “supportive” to “stressed out” to “I hope this doesn’t cause a divorce!” Planning special times together on a regular basis was a way to cope. As one said “I make sure that we go out together at least once a week, even if it’s just to take a walk and talk”.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.877.5088&rep=rep1&type=pdf

# data[].attributes.body
A study of 243 female nurses in Turkey found work demands, rotating shifts, and overtime caused family conflicts and lowered life/job satisfaction. A survey was conducted with 60 female nurses in India where the common practice is shift rotation every 7 days. The nurses reported difficulties in meeting family responsibilities and attending social functions, getting sufficient sleep, and a lack of family cooperation. In 1997, a survey of 745 Korean hospital nurses found that those working evening and night shift rotations had poorer physical/mental health and insufficient family/leisure time. A 2009 qualitative study of night shift nurses in Brazil identified problems in social, personal and family matters. At the same time, the nurses found it beneficial to have increased time for activities outside of work.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.877.5088&rep=rep1&type=pdf

Particularly at risk from a domestic point of view are those shift workers who arc still expected to run a household and look after the children (Gadbois 1981). These shift workers are often 'working wives', and husbands should realize that this can severely cut into the sleep time of the shift worker, and will thus increase irritability and family tensions.

https://www.tandfonline.com/doi/abs/10.1080/02678378808259160

# data[].attributes.body
This review summarizes the evidence concerning effects of night shift work on women's reproductive health, specifically difficulty in conceiving and miscarriage. Night shift work may give rise to menstrual cycle disturbances, but effect sizes are imprecise. Endometriosis may be elevated in night shift workers, but evidence is only preliminary. The weight of evidence begins to point to working at night, whether in fixed or rotating shifts, as a risk factor for miscarriage.

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0036-1571354

# data[].attributes.attachment_link.readable_text
Semin Reprod Med 2016; 34(02): 074-082
DOI: 10.1055/s-0036-1571354

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

1   Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia

2   Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia

3   Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia

8   Fay Gale Centre for Research on Gender, University of Adelaide, Adelaide, South Australia, Australia

2   Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia

3   Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia

› Author Affiliations
Further Information

Abstract

This review summarizes the evidence concerning effects of night shift work on women's reproductive health, specifically difficulty in conceiving and miscarriage. We distinguish between fixed night shift and rotating night shift, as the population subgroups exposed, the social and biological mechanisms, and the magnitude of effects are likely to differ; of note, women working fixed night shift are known to have high tolerance for this schedule. We identified two relevant systematic reviews with meta-analyses and five additional studies. Night shift work may give rise to menstrual cycle disturbances, but effect sizes are imprecise. Endometriosis may be elevated in night shift workers, but evidence is only preliminary. Adequate data are lacking to assess associations between night shift work and infertility or time to pregnancy. The weight of evidence begins to point to working at night, whether in fixed or rotating shifts, as a risk factor for miscarriage. There are many methodological problems with this literature, with substantial variation in the definitions of night shift and schedule types making comparisons between studies difficult and pooling across studies questionable. Nevertheless, there appears to be grounds for caution and counselling where women have concerns about night shift work and their reproductive health.

Keywords

shift work - night shift work - fertility - pregnancy - miscarriage

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Thieme E-Journals - Seminars in Reproductive Medicine / Abstract

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When an individual stay awakes during the whole night and  also tries to sleep during the daylight, the hormones and chemicals in the body system are being disrupted due to the contradict sleeping pattern as our hormone usually starts to develop and neutralizes  on  its  own  during  the  night  time

(Khan, 2014).

https://www.researchgate.net/publication/332041825_The_Relationship_Between_Workers%27_Health_and_Night_Shift_Work_in_Food_Franchise_Industry_in_Kuching_Sarawak_Malaysia

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Although the total quantity of food ingested by shift workers does not affect total energy intake, the frequency and timing of eating often differ. Moreover, night shift workers may sometimes consume foods with greater fat and carbohydrate content as a result of sleep deprivation, as well as snacking more frequently during short breaks.

After sleeping, between 20 and 75% of overnight shift workers versus 10 to 25% of day workers experience digestive troubles. These are associated with the mismatch between mealtimes and gastrointestinal functions which are determined by the circadian phase.

Moreover, night shift workers tend to ingest food of reduced quality and composition i.e., those with a higher preservative content, as seen in pre-packed and highly processed foods.

https://www.news-medical.net/health/What-Are-the-Health-Effects-of-Working-Night-Shifts.aspx

# data[].attributes.attachment_link.readable_text
Night shifts are considered to be an impediment to alertness and performance as a result of sleep loss and a change in natural circadian rhythms. Across the world, healthcare workers comprise the largest proportion of shift workers to enable the provision of 24/7 emergency healthcare services.

Night shift patterns of work have both negative implications on the individual, as well as those affected by that provision of service; for example negative implications on patient safety and care in the case of healthcare workers, in addition to significant economic and productivity costs.

Image Credit: LightField Studios/Shutterstock.com

The Implications of Night Shift Work on Circadian Rhythms and Sleep Problems

Night shift work is a widely studied variable as it compromises several aspects of human health including homeostasis and well-being.

Night shift work affects individuals at the biological level. The inversion or perturbation of the sleep-wake cycle is a source of stress for the endogenous regulation of the circadian rhythms of biological functions. These are driven by the body clock and can be found in the suprachiasmatic nucleus (SCN) of the hypothalamus.

The SCN is the principal circadian pacemaker in the human brain, and it generates circadian rhythms during periods of rest and activity, as well as affecting core body temperature, the function of the neuroendocrine and autonomic systems, the performance of memory and psychomotor complex, as well as other physiological and behavioral processes.

The SCN is controlled by environmental cues which include the light-dark cycle. The optimal physiological condition for diurnal animals is to sleep during the night and awaken during the day. Therefore, those who work night shifts are subsequently forced to alter that psychophysiological state, resulting in changes in the fluctuations of biological functions.

Those functions which are typically active during the day and depressed during the night are inverted. The adjustment to the shift in phase occurs at a rate of ~one hour per day but can vary widely according to the duration of the night shift and schedule.

Most workers involved in rotating shift work have to adjust quickly to the variable shift periods, but night shift workers can adjust so long as they maintain an inverted sleep/wake cycle.

When the circadian rhythm is misaligned, those who operate night shifts suffer from feelings of sleepiness, tiredness, insomnia, digestive issues, poorer mental function, irritability, and reduced efficiency.

The Effect of Night Shifts on Sleep

The effects of shift work occur most obviously on sleep, affecting both quality and quantity. The effects depend on the nature of the night shift, i.e. length, frequency, and rest periods in between them as well as the worker's personality and behaviors.

Due to sleeping during the day, night shift workers have to sleep during the normal rising phase of the circadian rhythm, and this prolongs the period of feeling wakeful. Environmental conditions such as lighting, and noise can also further disturb sleep and exacerbate the period of wakefulness.

So, on average, night shift workers get two to four hours less sleep who is prematurely interrupted. Moreover, night shift workers experience poorer stage two rapid eye movement sleep, which is perceived as being less restful.

There is an increased likelihood of experiencing a sleep deficit during subsequent night shift work; this is most heightened during the second half of the shift which occurs in the early morning, resulting in a greater risk of errors and accidents, especially while traveling.

The Effect of Night Shift Work on Psychological and Mental Health

Epidemiological studies have been carried out over the past ten years have demonstrated the effects of night shift work on health.

According to these studies, shift workers experience nervousness, irritability, and anxiety as the consequences of most stressful working conditions. Due to the persistent disturbance of the circadian rhythm as well as a growing sleep deficit, work is my experience chronic fatigue, neuroticism, chronic anxiety, and depression, as well as mood disorders. As well as this, night shift workers also experienced higher absenteeism and some required treatment with psychotropic drugs including sedatives.

Image Credit: Tero Vesalainen/Shutterstock.com

The Effects of Night Shift Work on the Gastrointestinal System

Although the total quantity of food ingested by shift workers does not affect total energy intake, the frequency and timing of eating often differ. Moreover, night shift workers may sometimes consume foods with greater fat and carbohydrate content as a result of sleep deprivation, as well as snacking more frequently during short breaks.

After sleeping, between 20 and 75% of overnight shift workers versus 10 to 25% of day workers experience digestive troubles. These are associated with the mismatch between mealtimes and gastrointestinal functions which are determined by the circadian phase. These functions include basic creations of gastric, bile, and pancreatic fluids, the movement of the intestines, enzyme activity, rate of feed absorption in the intestine, and the release of hunger-associated hormones.

Moreover, night shift workers tend to ingest food of reduced quality and composition i.e., those with a higher preservative content, as seen in pre-packed and highly processed foods.

Night shift workers also tend to experience a greater frequency of gastrointestinal troubles and diseases compared to day workers. These vary from less severe which includes changes in bowel habits, poor digestion, flatulence, and heartburn - to more severe effects such as peptic ulcers, irritable bowel syndrome, and gastroduodenostomies. These experiences were recorded in past, predominantly cross-sectional, epidemiological studies which did not use a standardized form of diagnostic methods to determine these experiencing as well as not controlling for confounding factors such as age, smoking, and socioeconomic status.

The Effect of Shift Work on Metabolic Disorders

Collectively, obesity, elevated levels of triglycerides, reduced HDL cholesterol, increased fasting glucose, and high blood pressure comprises metabolic syndrome. Metabolic syndrome is an important risk factor for the development of type 2 diabetes and cardiovascular disease.

Several studies have reported a greater prevalence of metabolic disturbances in workers with night shifts. These include overweight and obesity, as well as increased triglycerides and total cholesterol levels. These effects are thought to be a result of a disturbed circadian rhythm, poor quality, and inconsistent sleep, digestive disturbances, as well as changes in lifestyle habits which include the quality and timing of meals as well as increased snacking. These effects are further exacerbated by the experience of disrupted social temporal patterns on psychological disturbances which include stress and experience of conflict.

Disrupted sleep patterns may also influence the efficiency of the liver and the kidney. This is important shift workers may be exposed to chemical substances are different times of the day and night. As a result, shift workers may experience a greater risk of intoxication or retention of harmful substances. In the 1984 Bhopal disaster (an industrial chemical leakage accident from a factory in Bhopal, Madhya Pradesh in India) thousands of non-adjusted shift workers died in their sleep relative to consistent night-shift workers who were only partially affected.

This illustrates the need to account for the level of environmental/biological exposure. These include, for example, modifications to the Threshold Limit Value (TLV), which determines a level of substance exposure to which a worker can be exposed in each shift without experiencing adverse effects.

The Effect of Shift Work on the Cardiovascular System and Cancer

There is a well-established body of research that suggests that there's a strong association between night shift work and the development of cardiovascular disorders; shift workers have on average, a 40% increased risk for ischemic heart disease compared to today's workers. Moreover, shift workers are more likely to participate in, or experience, lifestyle habits that are major cardiovascular risk factors, such as smoking, obesity, and elevated levels of total cholesterol.

It is important to note that a closer relationship between the two variables has not been established.

As with cardiovascular disease, there is a correlation but not necessarily a causative mechanism linking the development of cancer to night shift work period the information available that discusses is exposure to shift work is based on sporadic self-reported assessment or affiliation to a work sector in which shift work is prevalent. Additional information such as the number of night shifts per month, or per year, as well as the number of consecutive night shifts, and the length of duty periods are not reported.

References:

Costa G. (1996) The impact of shift and night work on health. Appl Ergon. doi:10.1016/0003-6870(95)00047-x.

Strohmaier S, Devore EE, Zhang Y, et al. (2018) A Review of Data of Findings on Night Shift Work and the Development of DM and CVD Events: a Synthesis of the Proposed Molecular Mechanisms. Curr Diab Rep. doi:10.1007/s11892-018-1102-5.

Figueiro MG, White RD. (2013) Health consequences of shift work and implications for structural design. J Perinatol. doi:10.1038/jp.2013.7.

# data[].attributes.attachment_link.title
What Are the Health Effects of Working Night Shifts?

# data[].attributes.attachment_link.description
Night shifts are considered to be an impediment to alertness and performance as a result of sleep loss and a change in natural circadian rhythms. Across the world, healthcare workers comprise the largest proportion of shift workers to enable the provision of 24/7 emergency healthcare services.

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Night work and fatigue may also contribute to the risk of heart disease and cancer, according to research by Violanti, Vila and colleagues (Policing, Vol. 30, No. 2). Working with 98 Buffalo, N.Y., police officers, the researchers looked for metabolic syndrome — a combination of symptoms that contribute to poor heart health and diabetes. They found that the officers who most frequently worked the 8 p.m.-to-4 a.m. shift were four times more likely than other officers to have metabolic syndrome.

https://www.apa.org/monitor/2011/01/night-work

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Nearly 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts, according to the Bureau of Labor Statistics. That means a significant sector of the nation's work force is exposed to the hazards of working nights, which include restlessness, sleepiness on the job, fatigue, decreased attention and disruption of the body's metabolic process.

Those effects extend beyond the workers themselves, as many of us share the road with night-driving truckers, count on the precision of emergency-room workers and rely on the protection of police and national security personnel at all hours.

Now, psychologists are gaining a better understanding of how exactly night and shift work affect cognitive performance and which interventions and policies could keep shift workers and the public safer.

"The basic take-home is that fatigue decreases safety," says Bryan Vila, PhD, a sleep expert and criminal justice researcher at Washington State University-Spokane. Learning healthy sleeping practices is "just as important as occupational training," he says.

Natural rhythms

Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major problems for night workers. That's because working at night runs counter to the body's natural circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in Chicago. The circadian clock is essentially a timer that lets various glands know when to release hormones and also controls mood, alertness, body temperature and other aspects of the body's daily cycle.

Our bodies and brains evolved to relax and cool down after dark and to spring back into action come morning. People who work the night shift must combat their bodies' natural rest period while trying to remain alert and high functioning. It doesn't matter whether they get enough sleep during the daytime, she says. All the sleep in the world won't make up for circadian misalignment.

That's especially dangerous for people whose jobs require them to be on high alert and make split-second, life-or-death decisions during the night, such as medical personnel or police officers. It's common for police departments, for example, to require rookies and lower-ranking officers to bear the brunt of night shifts. They'll often work a few days during normal daytime hours, then either work an extra-long shift that carries on until the morning, or take a day off, rest, then work a full night shift. But that seesaw scheduling approach is a doubly bad idea, says John Violanti, PhD, an organizational psychologist who was a New York state trooper for 23 years. Not only are these highly stressful, performance-draining shifts being foisted upon the least experienced officers, but the young officers aren't given time to adjust their sleep schedules for night work. Also, many officers seek night shifts to get overtime pay, he says. According to Vila's research, roughly 40 percent of the nation's 861,000 police officers work more than 12 hours a day - and a similar proportion suffer from a sleep disorder such as insomnia or excessive sleepiness.

Working against a person's natural sleep cycle causes such sleep disorders, as well as fatigue. Fatigue, in turn, worsens moods, decreases cognitive abilities and reflexes, and makes people more vulnerable to disease, says Vila. That resulting crankiness and warped perspective can interfere with one's ability to make sound decisions and manage people effectively, and can increase the frequency of negative encounters.

That's not a recipe for good decisions, says Vila, especially when officers must make decisions about whether to use deadly force - often in ambiguous, fast-paced, high-risk situations. Neither is it safe for more routine activities, such as driving. "When you're drowsy, local parts of the brain shut down for milliseconds or seconds at a time, then come back online," he says.

Night work and fatigue may also contribute to the risk of heart disease and cancer, according to research by Violanti, Vila and colleagues ( Policing, Vol. 30, No. 2). Working with 98 Buffalo, N.Y., police officers, the researchers looked for metabolic syndrome - a combination of symptoms that contribute to poor heart health and diabetes, including large waist circumference, elevated triglyceride levels, high cholesterol, high blood pressure and high levels of glucose when not eating. They found that the officers who most frequently worked the 8 p.m.-to-4 a.m. shift had the highest prevalence of metabolic syndrome symptoms. Those who commonly worked that shift and also averaged fewer than six hours of sleep were four times more likely than other officers to have metabolic syndrome.

Vila and Violanti hope their findings will spur changes in shift scheduling, both for the public's safety and the officers'.

Of course, police officers aren't the only night-shift workers suffering from circadian misalignment. A number of studies have found that fatigue due to prolonged work hours or being called into work in the middle of the night can result in lapses in judgment and impaired motor skills among medical workers. For instance, a 2008 article in the American Journal of Surgery (Vol. 195, No. 2) reports that, when performing "surgery" on a virtual patient, well-rested surgeons were significantly smoother in their hand motions and made fewer errors than did their sleep-deprived counterparts.

Fatigue is also risky for the physicians themselves, other research has found. A 2005 report published in the New England Journal of Medicine (Vol. 352, No. 2) found that medical interns whose shifts lasted longer than 24 hours were more than twice as likely to have a car crash and five times as likely to have a driving near-miss after leaving work as interns who worked shorter shifts.

In fact, any worker who must drive while tired - whether it's on the job or driving home after a night shift - is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was cited as a primary factor in the crash. But other factors such as driver inattention, speeding and running off the road can also be influenced by fatigue, the institute found.

Another report from 2004 found that workers across a variety of occupations who worked 12-hour night shifts were more likely than their day-shift-working colleagues to experience physical fatigue, smoke and abuse alcohol.

Possible solutions

Of course, many workers can't give up the night shift entirely. So the question is, how can night shift workers adapt to their schedules?

There are two ways, says Rush University's Eastman. One is through symptomatic relief by using such stimulants as coffee and caffeine pills to stay awake during the night, then taking sedatives to sleep in the morning. The other way is to shift the body's circadian clock so that it better tolerates working at night and sleeping during the day.

Eastman and her team are exploring the latter approach. "The circadian clock is very stubborn and hard to push around," she says.

Previous research has established that you can delay the circadian clock by about one or two hours per day. To determine that, researchers measure the body's circadian rhythm by monitoring "dim-light melatonin onset," or the time at which the pineal gland begins to secrete melatonin, which is triggered by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. "It's an output that's a way of seeing what the circadian clock is doing," Eastman says. "It's a very good marker of the phase of the time of the clock."

By exposing experimental subjects to intermittent bright light during their night shifts and having them wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have found that within about a week, they can shift someone's circadian rhythm to align perfectly with working a night shift and sleeping during the day.

But that's unrealistic for most people, she says. "The problem is that adapting completely physiologically would leave you a nocturnal person, unable to sleep until very late on days off and being out of phase with regular day-working people."

So Eastman and her team have developed a compromise system in which people who work permanent night shifts - say, 11 p.m. to 7 a.m. - adapt their circadian rhythms just enough to function well at night, but still be lively during their days off. It works like this: On his or her day off, the worker goes to sleep as late as possible (in Eastman's experiment, participants went to bed at 3 a.m. and woke up at noon). On a workday, he or she would be exposed to intermittent bright light, wear sunglasses on the way home from the night shift, then go to sleep as early as possible. "So the difference between sleep on their night shift days and their days off would likely be less than what most shift workers have now," Eastman says.

Last year, she tested the cognitive skills of workers who tried this compromise approach and compared those who fully adapted to a night-shift schedule to those who only partially adapted. Both groups performed about the same, and both scored almost as well as they did when they first took the tests when on a normal daytime schedule ( Sleep, Vol. 32, No. 11). "You don't have to be fully adapted to the night shift to get the benefits of shifting your circadian clock," Eastman says.

However, Eastman points out she doesn't yet have a solution for workers who have a combination of night and day shifts because it's impossible to keep shifting their circadian rhythms to keep up with an ever-changing work schedule. She says it falls on employers to assign shift work in blocks, giving workers enough time to adapt.

"You can't phase shift the circadian clock with a rapidly rotating shift schedule because the clock can't move that fast," she says. "The only thing you can do is symptomatic relief, meaning you'll have very sleepy people working at night, which is dangerous."
For more information on improving the health of workers, go to APA's Psychologically Healthy Workplace Program site.

# data[].attributes.attachment_link.description
Millions of American workers fight against their circadian clocks to work every day, putting them - and other in their paths - in danger.

# data[].attributes.body
According to these studies, shift workers experience nervousness, irritability, and anxiety as the consequences of the most stressful working conditions. Due to the persistent disturbance of the circadian rhythm as well as a growing sleep deficit, workers may experience chronic fatigue, neuroticism, chronic anxiety, and depression, as well as mood disorders. As well as this, night shift workers also experienced higher absenteeism and some required treatment with psychotropic drugs including sedatives.

https://www.news-medical.net/health/What-Are-the-Health-Effects-of-Working-Night-Shifts.aspx

# data[].attributes.attachment_link.readable_text
Night shifts are considered to be an impediment to alertness and performance as a result of sleep loss and a change in natural circadian rhythms. Across the world, healthcare workers comprise the largest proportion of shift workers to enable the provision of 24/7 emergency healthcare services.

Night shift patterns of work have both negative implications on the individual, as well as those affected by that provision of service; for example negative implications on patient safety and care in the case of healthcare workers, in addition to significant economic and productivity costs.

Image Credit: LightField Studios/Shutterstock.com

The Implications of Night Shift Work on Circadian Rhythms and Sleep Problems

Night shift work is a widely studied variable as it compromises several aspects of human health including homeostasis and well-being.

Night shift work affects individuals at the biological level. The inversion or perturbation of the sleep-wake cycle is a source of stress for the endogenous regulation of the circadian rhythms of biological functions. These are driven by the body clock and can be found in the suprachiasmatic nucleus (SCN) of the hypothalamus.

The SCN is the principal circadian pacemaker in the human brain, and it generates circadian rhythms during periods of rest and activity, as well as affecting core body temperature, the function of the neuroendocrine and autonomic systems, the performance of memory and psychomotor complex, as well as other physiological and behavioral processes.

The SCN is controlled by environmental cues which include the light-dark cycle. The optimal physiological condition for diurnal animals is to sleep during the night and awaken during the day. Therefore, those who work night shifts are subsequently forced to alter that psychophysiological state, resulting in changes in the fluctuations of biological functions.

Those functions which are typically active during the day and depressed during the night are inverted. The adjustment to the shift in phase occurs at a rate of ~one hour per day but can vary widely according to the duration of the night shift and schedule.

Most workers involved in rotating shift work have to adjust quickly to the variable shift periods, but night shift workers can adjust so long as they maintain an inverted sleep/wake cycle.

When the circadian rhythm is misaligned, those who operate night shifts suffer from feelings of sleepiness, tiredness, insomnia, digestive issues, poorer mental function, irritability, and reduced efficiency.

The Effect of Night Shifts on Sleep

The effects of shift work occur most obviously on sleep, affecting both quality and quantity. The effects depend on the nature of the night shift, i.e. length, frequency, and rest periods in between them as well as the worker's personality and behaviors.

Due to sleeping during the day, night shift workers have to sleep during the normal rising phase of the circadian rhythm, and this prolongs the period of feeling wakeful. Environmental conditions such as lighting, and noise can also further disturb sleep and exacerbate the period of wakefulness.

So, on average, night shift workers get two to four hours less sleep who is prematurely interrupted. Moreover, night shift workers experience poorer stage two rapid eye movement sleep, which is perceived as being less restful.

There is an increased likelihood of experiencing a sleep deficit during subsequent night shift work; this is most heightened during the second half of the shift which occurs in the early morning, resulting in a greater risk of errors and accidents, especially while traveling.

The Effect of Night Shift Work on Psychological and Mental Health

Epidemiological studies have been carried out over the past ten years have demonstrated the effects of night shift work on health.

According to these studies, shift workers experience nervousness, irritability, and anxiety as the consequences of most stressful working conditions. Due to the persistent disturbance of the circadian rhythm as well as a growing sleep deficit, work is my experience chronic fatigue, neuroticism, chronic anxiety, and depression, as well as mood disorders. As well as this, night shift workers also experienced higher absenteeism and some required treatment with psychotropic drugs including sedatives.

Image Credit: Tero Vesalainen/Shutterstock.com

The Effects of Night Shift Work on the Gastrointestinal System

Although the total quantity of food ingested by shift workers does not affect total energy intake, the frequency and timing of eating often differ. Moreover, night shift workers may sometimes consume foods with greater fat and carbohydrate content as a result of sleep deprivation, as well as snacking more frequently during short breaks.

After sleeping, between 20 and 75% of overnight shift workers versus 10 to 25% of day workers experience digestive troubles. These are associated with the mismatch between mealtimes and gastrointestinal functions which are determined by the circadian phase. These functions include basic creations of gastric, bile, and pancreatic fluids, the movement of the intestines, enzyme activity, rate of feed absorption in the intestine, and the release of hunger-associated hormones.

Moreover, night shift workers tend to ingest food of reduced quality and composition i.e., those with a higher preservative content, as seen in pre-packed and highly processed foods.

Night shift workers also tend to experience a greater frequency of gastrointestinal troubles and diseases compared to day workers. These vary from less severe which includes changes in bowel habits, poor digestion, flatulence, and heartburn - to more severe effects such as peptic ulcers, irritable bowel syndrome, and gastroduodenostomies. These experiences were recorded in past, predominantly cross-sectional, epidemiological studies which did not use a standardized form of diagnostic methods to determine these experiencing as well as not controlling for confounding factors such as age, smoking, and socioeconomic status.

The Effect of Shift Work on Metabolic Disorders

Collectively, obesity, elevated levels of triglycerides, reduced HDL cholesterol, increased fasting glucose, and high blood pressure comprises metabolic syndrome. Metabolic syndrome is an important risk factor for the development of type 2 diabetes and cardiovascular disease.

Several studies have reported a greater prevalence of metabolic disturbances in workers with night shifts. These include overweight and obesity, as well as increased triglycerides and total cholesterol levels. These effects are thought to be a result of a disturbed circadian rhythm, poor quality, and inconsistent sleep, digestive disturbances, as well as changes in lifestyle habits which include the quality and timing of meals as well as increased snacking. These effects are further exacerbated by the experience of disrupted social temporal patterns on psychological disturbances which include stress and experience of conflict.

Disrupted sleep patterns may also influence the efficiency of the liver and the kidney. This is important shift workers may be exposed to chemical substances are different times of the day and night. As a result, shift workers may experience a greater risk of intoxication or retention of harmful substances. In the 1984 Bhopal disaster (an industrial chemical leakage accident from a factory in Bhopal, Madhya Pradesh in India) thousands of non-adjusted shift workers died in their sleep relative to consistent night-shift workers who were only partially affected.

This illustrates the need to account for the level of environmental/biological exposure. These include, for example, modifications to the Threshold Limit Value (TLV), which determines a level of substance exposure to which a worker can be exposed in each shift without experiencing adverse effects.

The Effect of Shift Work on the Cardiovascular System and Cancer

There is a well-established body of research that suggests that there's a strong association between night shift work and the development of cardiovascular disorders; shift workers have on average, a 40% increased risk for ischemic heart disease compared to today's workers. Moreover, shift workers are more likely to participate in, or experience, lifestyle habits that are major cardiovascular risk factors, such as smoking, obesity, and elevated levels of total cholesterol.

It is important to note that a closer relationship between the two variables has not been established.

As with cardiovascular disease, there is a correlation but not necessarily a causative mechanism linking the development of cancer to night shift work period the information available that discusses is exposure to shift work is based on sporadic self-reported assessment or affiliation to a work sector in which shift work is prevalent. Additional information such as the number of night shifts per month, or per year, as well as the number of consecutive night shifts, and the length of duty periods are not reported.

References:

Costa G. (1996) The impact of shift and night work on health. Appl Ergon. doi:10.1016/0003-6870(95)00047-x.

Strohmaier S, Devore EE, Zhang Y, et al. (2018) A Review of Data of Findings on Night Shift Work and the Development of DM and CVD Events: a Synthesis of the Proposed Molecular Mechanisms. Curr Diab Rep. doi:10.1007/s11892-018-1102-5.

Figueiro MG, White RD. (2013) Health consequences of shift work and implications for structural design. J Perinatol. doi:10.1038/jp.2013.7.

# data[].attributes.attachment_link.title
What Are the Health Effects of Working Night Shifts?

# data[].attributes.attachment_link.description
Night shifts are considered to be an impediment to alertness and performance as a result of sleep loss and a change in natural circadian rhythms. Across the world, healthcare workers comprise the largest proportion of shift workers to enable the provision of 24/7 emergency healthcare services.

# data[].attributes.body
https://sleepopolis.com/education/guide-how-animals-sleep/

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Sleep is common to all living beings, from fruit flies to blue whales. Sleep is a state of altered consciousness that recurs on a 24-hour cycle known as the circadian rhythm. Though it was once believed to be a passive state, sleep involves complex physiological changes that allow for learning, memory processing, and essential processes such as healing and food metabolism.

Even one-celled organisms, which don't sleep in the traditional sense, display evidence of a circadian rhythm. Though all animals share the need to sleep, how they sleep varies widely across species. ( 1) Snakes can sleep more than twenty hours a day, whereas elephants slumber for only three. But what accounts for the difference? Is the nature of sleep the same in all animals, or does that vary, too? Let's take a closer look at how animals sleep.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn't take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
Why Do Animals Sleep?

Sleep limits the ability to defend against predators and prevents such important activities as mating and the collection of food. For these reasons, researchers theorize that sleep has a crucial evolutionary function.

Decades of studies prove that insufficient sleep has significant health effects such as reduced cognitive function, lowered immunity, increased risk of disease, and death. Sleep may serve to protect some species of animals from predators and other dangers by keeping them inactive during the night when they're more vulnerable. ( 2)

Other functions of sleep may include:

Helping the brain restructure and reorganize, particularly after injury

Improving the strength and speed of synapses between neurons

Restoring the capacity to learn

Increasing long-term memory

Unlike other states of altered consciousness such as coma or hibernation, sleep can be reversed easily. In addition to visual signs such as lying down or finding a protected place to perch, sleep in animals is recognizable by closing of the eyes in those with eyelids, and distinct patterns of brain waves on electroencephalogram (EEG).

One of the defining features of sleep is lowered arousal of the brain. Neurons fire more slowly during sleep, with a more coordinated pattern. ( 3) Neurons fire more rapidly during REM sleep, the stage of sleep that closely resembles being awake. This may be due in part to the vivid dream activity that occurs during REM sleep.

ElectroencephalogramA test that measures and records electrical activity in the brain.

Why Animals Sleep Differently

The way animals sleep depends on their size, what they eat, and their unique physiology. In general, small animals sleep more than large animals, though they may sleep for only a few minutes at a time. Whales and elephants sleep two to three hours a day. This type of sleep may not occur in uninterrupted blocks of time, but in brief stretches of half an hour or less.

Sleep and Metabolism

Small animals like mice have faster metabolisms, meaning their bodies use energy more quickly than animals with slow metabolisms, like buffalo. The brains of animals with faster metabolisms contain larger numbers of neurons, while the neurons in the brains of larger animals are less dense.

The secret to the way small animals sleep may lie in their brains, which generate more waste by-products called metabolites. ( 4) Metabolites accumulate during waking hours, while sleep clears them away. Accumulated waste products in the brain can cause smaller animals to fall asleep more frequently. They may even fall asleep while eating or engaged in other activities, and sleep more than twenty hours a day.

In contrast to the brains of bats and shrews, the brains of larger animals generate less waste material. This may explain in part why larger animals sleep less than those that are very small. Some researchers theorize that evolution may favor animals of a larger size by allowing them to consolidate sleep into one longer session, while smaller animals with faster metabolisms need to sleep multiple times in a twenty-four hour period.

Sleep, Body Size, and Diet

Another hypothesis about animals and sleep is that larger animals need to eat more to sustain their superior muscle mass. Many very large animals are non-carnivores, and take in relatively few calories in comparison to meat-eaters. Large animals who subsist on grasses and leaves spend less time sleeping than carnivores, and more time foraging for food.

Researchers speculate that the largest land animals in history, dinosaurs, probably slept in similar ways to the largest animals on earth today. Herbivore dinosaurs likely needed less sleep, leaving them more time to forage, while the calorie-dense diet of carnivorous dinosaurs may have allowed for longer stretches of slumber. The biggest animals on earth today, blue whales, spend approximately twenty-two hours awake each day. Similar animals include:

Larger animals tend to move more slowly than smaller animals, which may help explain their reduced need for sleep. ( 5) They also experience more time in each stage of sleep. Non-carnivores can devote nineteen hours of their daily wake time to munching on plants and roots.

Sleep and Predators

Smaller animals may be more at risk from predators, making the ability to sleep in shorter snatches of time essential to survival. Being awake, vigilant, and ready to move is important for prey animals, while sleep makes them vulnerable. Sleeping in underground burrows and other hidden areas can also make sleep less dangerous.

Larger animals have less to fear from natural predators, and can sleep for more consolidated periods of time with less fear. Consolidated sleep allows larger animals to spend less time in transitional states between waking and sleeping, and more time in productive activities such as hunting or mating.

Sleep and Immunity

Scientists have found an association between longer, more consolidated periods of sleep and environments with a greater risk of infection. Because sleep helps to boost immunity, animals who are exposed to more pathogens may have evolved to sleep in consolidated blocks of time so that energy could be directed to the immune system. ( 6)

Studies show that rabbits who sleep for longer periods of time after infection recover more quickly. ( 7) Higher densities of disease-fighting white blood cells appear to have evolved along with longer periods of sleep, further bolstering the hypothesis that sleep serves a protective function against parasites, viruses, and bacteria.

PathogenAny organism that can cause disease.

Unhemispheric Slow-Wave Sleep

Unhemispheric slow wave sleep, or USWS, is a type of sleep during which one half of the brain remains awake while the other half sleeps. ( 8) The eye corresponding to the sleeping half of the brain closes while the eye that corresponds to the awake half stays open.

Animals who exhibit USWS include dolphins, some species of birds, and seals. USWS allows dolphins to sleep and surface for air at the same time. Sleeping dolphins swimming on the outside of a group, or pod, will keep the eye that faces the pod open. This eye corresponds with the awake part of the brain. Researchers believe that half-asleep dolphins watch the pod to keep the members of the group swimming together.

USWS may benefit birds by allowing them to remain half awake to protect against predators. USWS can also allow birds to sleep during long flights or migration. Birds flying on the outside of a migrating flock may engage in USWS to watch for predators, while birds on the inside of the flock will sleep with both hemispheres of their brains.

Scientists consider the continuing existence of unhemispheric sleep an example of sleep's importance. They theorize that if sleep weren't crucial to survival, evolution would have eliminated it in animals that are able to switch sleep on and off in each half of the brain.

Monophasic, Biphasic, and Polyphasic Sleep

Sleep in animals can take place all at once, in two phases, or more than two phases. Sleeping in one consolidated block of time, known as monophasic sleep, is common in human beings but less common in other species. Monophasic sleep typically lasts between six and nine hours. Less than 14% of animals have sleep patterns that can be considered monophasic.

Monophasic sleep was not considered the norm for human beings until the industrial revolution and the extension of labor hours. Before that, biphasic sleep was common across cultures worldwide. Monophasic animals include primates such as the marmoset species of monkey. Marmosets sleep in trees and live in groups of stable families, making them less vulnerable to predators. This may explain why these animals adapted to monophasic sleep, unlike many other species of primates. ( 9)

Biphasic sleep refers to a larger sleep session lasting five to six hours, plus a nap or siesta. The nap can be brief or last a few hours. Another form of biphasic sleep is called segmented sleep. This refers to two segments of sleep interrupted by an hour or two of wakefulness.

Polyphasic sleep describes sleep that takes place in shorter sessions throughout the day and night. Most animals, including cats, dogs, and birds, are polyphasic sleepers, and sleep in four to six segments per day.

When Animals Sleep

Animals evolved to be active during the day, night, or at dawn and/or dusk. ( 10) When an animal sleeps depends on their environment, feeding habits, and vulnerability to predators. Types of activity behavior include the following:

Diurnal. Diurnal animals are active during the day and sleep at night. Diurnal animals include human beings, most primates, and many species of birds, including ostriches

Nocturnal. Nocturnal animals are active and feed at night. Nocturnal animals include raccoons, bats, wolves, skunks, and jaguars

Crepuscular. Crepuscular animals are most active at dawn and dusk, and include bears, deer, and housecats. Crepuscular animals can also be active on cloudy days and bright nights. Crepuscular activity is likely an adaptation to the behavior of predators, who tend to be most active at night or in full daylight

Metaturnal, also called cathemeral. The sleep of metaturnal animals is not diurnal, nocturnal, or crepuscular, and is distinguished by sporadic activity at all times of day. Examples of metaturnal animals include lions, some primates, mice, and rabbits. Some animals such as lemurs are considered metaturnal because they switch from diurnal to nocturnal with the seasons. This behavior may become more common as certain species attempt to adapt to climate change (11)

Hibernation Vs. Sleep

Some warm-blooded animals hibernate during the winter. A hibernating animal may not move, eat, or sleep for several months. Hibernation might appear similar to an extended sleep, but is quite different. ( 12) Hibernation is a state of torpor, and is characterized by reduced metabolism, heart rate, and breathing. These vital bodily functions decrease during sleep, as well, but the changes are much more significant during hibernation. Hibernation can last anywhere from days to months.

The most significant feature of hibernation is lower body temperature, which can decrease as much as ninety degrees Fahrenheit. Bears do not technically hibernate because their body temperature drops only minimally, but during the winter months they do experience an extended state of inactivity that closely resembles hibernation.

Cold-blooded animals can enter a hibernation-like state called brumation. This is a period of dormancy that occurs during cold weather. To brumate, a cold-blooded animal such as a snake will find an insulated place to stay during a particularly cold time of year. A hibernation-like state during hot weather is called estivation. Animals that practice estivation include salamanders, bees, and crocodiles.

Both hibernation and estivation allow for the conservation of energy during times of extreme temperatures and food scarcity. Animals coming out of hibernation or other dormant state may display the signs of sleep deprivation when they wake, and spend a few days sleeping while their bodies readjust to the usual environment.

TorporA state of reduced physiological activty.

How Mammals Sleep

Mammals are warm-blooded vertebrates who nurse their young and have hair or fur. They aso have a neocortex section of brain and three bones in the middle ear. Despite differences in size and physiology, all mammals share certain aspects of sleep. ( 13) Animals of this class, from bats that sleep twenty hours a day to horses that sleep four, experience cycles of rapid eye-movement sleep - or REM - alternating with non-REM. REM is the stage when dreaming occurs and the sleeping brain most closely resembles the waking one.

The duration of sleep in mammals ranges from twenty-two hours a day for koalas to no sleep at all during a dolphin's first month of life. Larger grown mammals may sleep as little as two hours a day, while smaller animals can sleep eighteen hours or more. Mammals such as bats that can hide from predators tend to sleep longer and more deeply than those that need to remain vigilant, like mice.

Though all mammals experience REM sleep, some spend more time in REM than others. Mammals born in a more fully developed state such as horses experience more non-REM sleep than animals who are less developed, like cats and human beings. This supports the theory that REM sleep and dreaming are essential to growth and development in young animals.

Because REM sleep causes muscle paralysis to prevent the acting out of dreams, most mammals must lie down during this stage of sleep, even if it lasts for only a few minutes. Even adult giraffes lie down for REM sleep, curling their long necks in a swan-like position and folding their legs.

How Reptiles Sleep

Researchers once believed that reptiles slept very differently from other animals due to the structure of their brains. But recent studies have found that reptiles display similar sleep patterns to human beings and other mammals. ( 14) These patterns include slow wave sleep and REM sleep, suggesting that reptiles dream to process and store memories. Reptile REM sleep originates in parts of the brain other than the hippocampus, which controls REM sleep in mammals.

Other research shows possible evolutionary connections between the way reptiles rest and bask in warmth and the sleep of mammals. ( 15) In fact, all waking and sleeping states in mammals might have come from reptiles, who evolved much earlier than mammals and birds. The starkest difference in the sleep patterns of reptiles and mammals may lie in the length of their sleep cycles. ( 16) A reptilian sleep cycle lasts only eighty seconds compared with mammalian cycles, which typically last ninety minutes. Though the sleep cycle is significantly shorter, the proportion of REM sleep to non-REM remains the same in reptiles as it does in human beings and other animals.

Most reptiles sleep around sixteen to seventeen hours a day, and may go into a state of brumation during particularly cold times of year. Some reptiles, like snakes and lizards, don't have eyelids to close when they sleep. Instead they have a protective scale called a brille that slides across their eyes. The brille is transparent or only slightly opaque, making it appear as if these animals sleep with their eyes open.

How Birds Sleep

Birds evolved from dinosaurs, which evolved from early reptiles. Mammals branched off from reptiles before the evolution of the dinosaurs. Birds experience both REM and non-REM sleep, and, depending on the type of bird, may be diurnal, nocturnal, metaturnal, or crepuscular. Like reptiles, the sleep cycles of birds are much shorter than those of human beings. They may spend only eight seconds in REM sleep before shifting to slow wave sleep.

Some birds perch on the edge of a branch or other object to rest, whereas others sleep on the ground, hidden among leaves, or at the water's edge. Birds are able to remain perched while asleep because their body weight causes the tendons in their feet to lock, preventing them from falling.

Birds sleep while flying during long migrations by utilizing their capacity for unhemispheric sleep. By opening or closing its eye, a bird can control how much of its brain is asleep. Some types of birds, such as the alpine swift, can fly for seven months at a time without landing. ( 17) They are able to drink, eat, and sleep while in flight, and rest by both sleeping and gliding with minimal flapping of their wings.

Though many animals exhibit signs of sleep deprivation like engaging in longer and deeper periods of sleep after extended activity, alpine swifts are able to completely recover from activity by sleeping in flight. This suggests that some birds are able to perform all physiological functions while in flight, including resting and sleeping.

REM sleepThe last of the four stages of sleep, characterized by rapid movement of the eyes, dreaming, and muscle paralysis. The brain is almost as active during REM sleep as it is during wakefulness.

How Fish Sleep

Brain patterns of certain types of sleeping fish are similar to land animals, raising the possibility that sleep functions developed in the brain before fish and land animals took different evolutionary paths. ( 18) Studies show that, like reptiles, mammals, and birds, fish experience slow-wave sleep and REM sleep. Signals from hormones control the sleep and wake cycles of fish, just as they do in mammals.

Fish have no eyelids and are unable to close their eyes. Like mammals and other animals, when fish sleep their vital signs such as heartbeat and breathing decrease. They remain still and relaxed, their tails drop, and they don't react to stimuli. The movements of their mouths and gills can decrease by half. Some fish simply float when they sleep, while others hide in rocks, nests, or coral.

Normal sleep patterns can take weeks to develop in young fish. ( 19) Some fish are able to go without sleep when constant activity is required, such as during spawning season or while fanning eggs to keep them oxygenated. Fish may also forego sleep during migration. Once these periods of high activity are over, the fish return to their normal sleep patterns, and can display symptoms of sleep deprivation until they "catch up" on sleep.

Some types of sharks need to stay in continual motion to keep water flowing across their gills and providing a steady supply of oxygen. Whereas some sharks do appear to sleep, sharks in constant motion may simply experience more restful periods when brain activity decreases and memories are formed. A shark may have limited memories to store due to its repetitive environment, decreasing its need for sleep.

A shark's spinal column regulates its movements as it swims, which may allow the brain to sleep while the body stays in motion. Further research is needed to help us understand how sharks sleep, and if they experience similar stages of sleep to other fish.

Do Animals Dream?

Researchers believe it's likely that animals who experience REM sleep also dream. REM sleep is associated with processing and storing memories, and may be essential to learning and survival. Studies on human beings show that REM sleep is also important for processing emotions, and can reduce negative emotions and reactivity. REM sleep may serve a similar function in more emotionally developed animals, such as dogs, primates, and dolphins.

Studies reveal that rats and human beings share similar brain activity during sleep. Neurons in the brains of rats rewarded with food will fire in a distintive pattern. This pattern will replay during rest, suggesting the formation of memories. ( 20)

Research conducted on cats in the 1950's demonstrated that, without the muscle paralysis characteristic of REM sleep, cats go through motions suggestive of dreaming, including stalking prey and pouncing. REM sleep appears to have a crucial survival function, allowing animals of all species to discard unnecessary memories, store important ones, and use past experiences to better adapt to their environments.

Do Animals Suffer From Insomnia?

Animals exposed to a stressful environment can display the symptoms of insomnia. ( 21) Studies show that insomnia in animals, like human beings, may occur for the following reasons:

Disruption of the circadian rhythm

Activation of the central nervous system, including wake-promoting regions of the brain

Release of stress hormones

Disturbance of the homeostatic regulation of sleep, or the sleep drive

When exposed to stressful conditions, animals seem to have difficulty sleeping just as human insomniacs do. Studies on animals are generally conducted in laboratories, zoos, and other unnatural environments, making it difficult to determine why insomnia may occur in certain species.

Fruit flies bred in the laboratory can suffer from the symptoms of insomnia, including difficulty falling asleep and staying asleep. It's unknown if flies not specifically bred for research purposes would suffer from insomnia in their natural environment. Zebrafish with a particular mutant gene will experience insomnia, sleeping 30% less than fish of the same species without the gene. Overexpression of a gene called Nmu, also found in mammals, appears to be the cause of the behavior. Studies of these fish, who have similar sleep patterns to human beings, may help lead to better insomnia treatments and more effective sleep medications.

ZebrafishA freshwater fish that belongs to the minnow family and is native to South Asia.

Animals and Other Sleep Disorders

Domestic animals can suffer from other sleep disorders common in human beings, such as bedwetting and sleepwalking. Further studies are needed to determine whether these disorders occur in animals in the wild. Dogs, cats, and horses may also display symptoms of narcolepsy, an autoimmune disease characterized by excessive sleepiness and sudden "sleep attacks." Muscle weakness is another common feature of the disorder. Narcolepsy in animals can be caused by a genetic mutation or occur without an apparent cause.

Last Word From Sleepopolis

Sleep is essential to life for all animals, from a two-inch pygmy shrew to an eighteen-foot giraffe. The characteristics of sleep vary widely across species, and depend largely on metabolism, the existence of predators, and feeding habits.

Sleep can look very different, even among animals of the same class. Mammals like dolphins sleep with half of their brains at a time for only a few hours each day, whereas koalas sleep with both hemispheres of the brain for around twenty-two hours a day. This diversity illustrates the fascinating variations in sleep among animal species, and its crucial importance to the health and wellbeing of all living things.

References

1. Miyazaki S, Liu CY, Hayashi Y., Sleep in vertebrate and invertebrate animals, and insights into the function and evolution of sleep, Neuroscience Research, May, 2017

2. Siegel JM., Sleep viewed as a state of adaptive inactivity, Nature Reviews, Neuroscience, October 2009

3. Schwartz JR, Roth T, Neurophysiology of Sleep and Wakefulness: Basic Science and Clinical Implications, Current Neuropharmacology, December 2008

4. Lulu Xie et al., Sleep Drives Metabolite Clearance from the Adult Brain, Science, October 18, 2013

5. Patrick J.O. Miller, Stereotypical Resting Behavior of the Sperm Whale, Current Biology, January, 2008

6. Preston BT, Capellini I, McNamara P, Barton RA, Nunn CL, Parasite resistance and the adaptive significance of sleep, BMC Evolutionary Biology, January 9, 2009

7. Toth LA, Tolley EA, Krueger JM., Sleep as a prognostic indicator during infectious disease in rabbits, Proceedings of the Society for Experimental Biology and Medicine, June 1993

8. Gian Gastone Mascetti, Unihemispheric sleep and asymmetrical sleep: behavioral, neurophysiological, and functional perspectives, Nature and Science of Sleep, July 12, 2016

9. Ishikawa A, Sakai K, Maki T, Mizuno Y, Niimi K, Oda Y, Takahashi E, Investigation of sleep-wake rhythm in non-human primates without restraint during data collection, Experimental Animals, October 18, 2016

10. Kronfeld-Schor N, Bloch G, Schwartz WJ., Animal clocks: when science meets nature, Proceedings of the Royal Society B, Biology Sciences, August 22, 2013

11. Levy Ofir, Time and ecological resilience: can diurnal animals compensate for climate change by shifting to nocturnal activity? Ecological Monographs, November 12, 2018

12. Kathrin H. Dausmann et al., Hibernation in a tropical primate, Nature, June 24, 2004

13. Tobler I., Is sleep fundamentally different between mammalian species? Behavioural Brain Research, July-August 1995

14. Libourel PA, Barrillot B, Arthaud S, Massot B, Morel AL, Beuf O, Herrel A, Luppi PH., Partial homologies between sleep states in lizards, mammals, and birds suggest a complex evolution of sleep states in amniotes, PLoS Biology, October 2018

15. Ruben V. Vial et al., Evolution of wakefulness, sleep and hibernation: From reptiles to mammals, Neuroscience & Biobehavioral Reviews, July 2010

16. Mark Shein-Idelson, Slow waves, sharp waves, ripples, and REM in sleeping dragons, Science, April 29, 2016

17. Felix Liechti, First evidence of a 200-day non-stop flight in a bird, Nature Communications, October 2013

18. Louis C. Leung, Neural signatures of sleep in zebrafish, Nature, July 10, 2019

19. Shapiro CM, Hepburn HR., Sleep in a schooling fish, Tilapia mossambica, Physiology and Behavior, May 1976

20. H Freyja Ólafsdóttir, Hippocampal place cells construct reward related sequences through unexplored space, eLIFE, June 26, 2015

21. Toth LA, Bhargava P., Animal Models of Sleep Disorders, Comparative Medicine, April 2013

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Is the nature of sleep the same in all animals? In this guide, we explore how animals sleep, why they sleep the way they do, and what the real difference is.

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http://www.presidentsmedals.com/Entry-53101

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Shaurya Chauhan Prominent urbanizing centres across the globe like Delhi, Dhaka or Manila have exhibited that development often faces a challenge in bridging the gap among top-down collective requirements of the city and bottom-up individual aspirations of the ever-diversifying population- resulting in unplanned sprawl, poor planning and low-density development emerging as automated responses. This research advocates a collaborative design method for future development: one that allows rapid application with its prototypical nature and an inclusive approach with mediation between the 'human' and the 'built', purely with use of empirical tools.Shaurya Chauhan

PrOpenCity: Where the Common Man Presides
Part 2 Project 2020

Building upon the concepts and principles of 'open-sourcing' in design, the project establishes a framework that serves current user requirements while allowing for future citizen-driven modifications. To bring forward specifics, the research looks at a redevelopment proposed in the core of rapidly urbanizing city of Delhi, encompassing extreme physical, demographic and economic diversity. Analytical tools such as Space, Event and Movement by Bernard Tschumi (1994) and Five-Point Mental Map by Kevin Lynch (1960) among others, are deep rooted in the process. Over the process, a rudimentary approach to Open Source in design is formed, that can be adopted and applied, across diverse built fabrics of contemporary cities.

Sushant University | India

# data[].attributes.attachment_link.title
PrOpenCity: Where the Common Man Presides

# data[].attributes.attachment_link.description
Shaurya Chauhan Prominent urbanizing centres across the globe like Delhi, Dhaka or Manila have exhibited that development often faces a challenge in bridging the gap among top-down collective requirements of the city and bottom-up individual aspirations of the ever-diversifying population- resulting in unplanned sprawl, poor planning and low-density development emerging as automated responses.

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8 Main Areas
1) Infrastructure & Maintenance
2) Health, Environment & Cleanlliness
3) Safety
4) Education & Skills
5) Concern towards children, elderly, persons with disabilities (PWD),Women, Single mothers and the Indigent
6) Entrepreneurship
7) Social Services
8) Sport and Recreation

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Supporting Data for National Housing Policy

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Supporting Data for National Housing Policy

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5 Main Focus:
1) Ensuring Good Quality Housing For All
2) Improving Accessibility & affordability of housing
3) Ensuring Quality and Cohesive Neighbourhoods
4) Improving Housing and Transportation coordination for better quality of life
5) Strengthening Institutional Capabilities to deliver NHP

Strategies:
1)  Improving Affordable Housing Provision Based on Locality and Needs
a) Increase the supply of affordable housing
b) Developing localised housing affordability threshold
c) Review Housing Component Cost
d) Shifting the development of affordable houses towards Build-then-Sell (BTS)
e) Encourage the construction of Retirement Village that can offer a good quality of life for senior citizen.

2) Improving affordable housing financing accessibility
a) In addition, financing facilities including the Fund for Affordable Housing, Youth Housing Scheme and Rent-to-Own Program (RTO) will be improved to ensure the B40 and M40 are not burdened by instalment payments.
b)In providing housing assistance to the poor, the Government will allocate RM2.25 billion in the Twelfth Plan. This allocation is to build and repair 85,500 houses under the Housing Assistance Programme, involving 75,000 houses in the rural area and almost 10,500 houses in the urban area. These do not include houses built by the state governments, corporate sector and civil society organisations (CSOs).
c) Incentives given to buyers and developers

3) Ensuring Good Quality Housing for All
a) Implementing sustainable design in affordable housing (eg. Building Orientation, Natural ventilation, vehicle Movement at the Building Site, Access for Disabled-Friendly Housing Units and Parking Spaces, Landscaping,Improve biodiversity and encourage more green open spaces)
b) Smart City Growth Model https://www.kpkt.gov.my/kpkt/resources/user_1/GALERI/PDF_PENERBITAN/FRAMEWORK/Malaysia_Smart_City_Handbook_21062021_Final.pdf

4) Strengthening Institutional Capabilities to deliver National Housing Policy
a) Establishing an integrated housing database system
b) Centralisation of affordable housing initiatives

5) Ensuring Quality and Cohesive Neighborhoods
a) Strengthening management and maintenance of public and low cost private housing ( Housing Management Corporation)
b) Providing and maintaining quality amenities and services in residential neighborhood to support community life.
c) Revitalizing the role and vibrancy of communities in strengthening neighborhood quality

6)Improving Housing and Transportation Coordination for Better Quality of Life
a) Streamlining housing and sectorial planning process in regional, structure, local and special area plans. And increase the effectiveness of public participation
b) Strengthening the capacity of state and local authorities to monitor and integrate housing and transportation considerations at the planning and implementation levels.

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Issues and Challenges & Sustainable design for affordable housing

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The Effects of Covid-19 Pandemic-Driven Home Behavior in Housing Preference

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The Effects of Covid-19 Pandemic-Driven Home Behavior in Housing Preference

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The pandemic situation creates a new standard of a healthy residential building where building should able to provide anxiety-reducing elements: boundaries and green open space. Public policies regarding healthy building standards are also needed to ensure a healthier living environment is accessible to all.

A. Real estate in the context of pandemic
Housing preferences were determined initially from the accessibility to public transportation modes and the toll road, shopping centres, schools, and hospitals before the pandemic. However, the social restriction policy forces people to work from home and closed offices and commercial place. Thus, the accessibility to public transportation modes may no longer be the primary determinant of people's housing preferences because there is no need to commute to offices and commercial places.

B. Housing preferences
People now have reduced participation in communal activities outside their homes. They also began rearranging expenses to cope with the uncertainty of the future while still making use of space available for the multi-activities that the whole family member, or occupants living in that house, might require.These adjustments are translated into three aspects: fear of meeting people, fear of economic recession, and the stay-at-home lifestyle.

Fear of meeting people
Residential types with common service areas are deprived of control on the surrounding external factor. Bumping into someone is common and unavoidable in apartment. High-density residences should accommodate the minimum housing density standard to provide a healthy living environment. The circulation and common areas should be supervised to ensure no crowding inside closed spaces.
Fear of economic recession
The economic recession should not affect the affordability of having a healthy and well-designed home. Governments play an essential role in ensuring healthy building standards for residential buildings.
Stay at Home’ Lifestyle
The size of the house, the existence of outdoor living space and greeneries , the green scenery , and the quality of indoor living space are significant in determining the occupant's health . Likewise, low-quality homes increase the symptoms of depression during quarantine.Therefore, people who live in apartments and have no option to relocate are suggested to create more green and open spaces, such as vertical gardens and natural ventilation through windows.

C. Homeowner’s need for control
From the architectural point of view, the need to avoid public activities and spaces is defined as having physical boundaries. At the same time, the fear of economic recessions means more demands toward an affordable and energy-efficient building design.In addition, the stay-at-home lifestyle requires adequate indoor and outdoor spaces to ensure a comfortable place that could equally well accommodate various activities.

Muhyi, M. M., & Adianto, J. (2021). Literature Review: The Effects of Covid-19 Pandemic-Driven Home Behavior in Housing Preference. Smart City, 1(1), 2.

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The socio-economic characteristics of neighbourhoods’ impact health as they are underlying factors of disadvantage and competition for scarce resources among neighbours; trust, social capital and collective action which can overcome challenges; and ‘contagious’ or ‘epidemic’
behaviours that make neighbours engage in similar behaviours (Smelser & Baltes 2001)

The overall focus in this category and touched upon by all studies was on mental health conditions (e.g. depression, anxiety, self-reported health, etc.) (five studies), health-risk behaviour (e.g. smoking, physical inactivity and early sex initiation) (two studies), and wellbeing (e.g. social health, loneliness) (four studies) outcomes.

Turcu, C., Crane, M., Hutchinson, E., Lloyd, S., Belesova, K., Wilkinson, P., & Davies, M. (2021). A multi-scalar perspective on health and urban housing: an umbrella review. Buildings & cities, 2(1), 734.

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Build Cities. Author manuscript; available in PMC 2021 Nov 3.

Published in final edited form as:

Abstract

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

Keywords: building, built environment, environmental health, health, housing, mental health, metaanalysis, neighbourhood, urban

1. Introduction

The influence of the urban built environment on human health is complex and multifaceted. Health is determined by local environmental exposure and behaviours of individuals, which are socially and spatially patterned ( Marmot 2005). Material aspects of the built environment give rise to various social processes that may directly and indirectly shape the health of its residents ( Rydin et al. 2012; Bai et al. 2016). This poses difficulties to both conceptualising the relation between health and the urban built environment, and when seeking to design and implement actions to protect and improve health.

The urban built environment may be broadly defined at three scales: building, neighbourhood, and the wider urban system encompassing processes that operate across the city and regional levels and extend as far as the planetary level. Addressing health at each spatial scale involves different types of planning and stakeholders, as well as governance frameworks. Hence, understanding the confluence of different scales is necessary to improve knowledge and actions in local urban environments ( Ramaswami et al. 2016). A multi-scalar perspective of the local built environment provides a comprehensive view of how health interventions may be implemented more efficiently at a particular scale. Multiple health objectives and outcomes, as well as health risks, may be considered simultaneously across the spectrum of policymaking and systematically reflected in decision-making. This requires a thorough understanding of the interrelations between the different scales of the built environment in which a policy intervenes, and this reaches beyond the local level and across social and political boundaries. Ultimately, local-level health considerations should be linked to the health of the wider urban system, including planetary health, whereby environmental processes can both be disturbed by and threaten to disturb local living conditions and health ( Rydin et al. 2012; Ramaswami et al. 2016; Whitmee et al. 2015).

Urban housing is a primary area for health intervention in the built environment. Current urbanisation estimates suggest that 68% of world's population will live in cities by 2050. At the urban level, housing covers on average 70% of land-use, thus it is a substantial sector for policymaking ( UN 2018). Traditionally, approaches to research supporting health-focused policy action in the housing sector have considered dwellings as atomised units of exposure ( Thomson & Thomas 2015; Ige et al. 2019), although some recent work has begun to consider wider connections ( Bird et al. 2018; Carlin et al. 2017; Núñez-González et al. 2020; Pérez et al. 2020). This paper aims to synthesise the current evidence on the built environment and health nexus, focusing on the urban housing sector as the entry point. The paper adopts the World Health Organization's ( WHO) (2018) relational definition of housing and includes the physical structure of the dwelling, its immediate environment and the community ( WHO 2018). Many systematic reviews already exist of the health impact of interventions and/or risks within the house or built environment. However, addressing the broader issues for policy implementation and decision-making across scales requires a broad synthesis of the evidence. Umbrella reviews are useful for efficiently summarising and comparing the evidence, assessing such considerations of aspects of health across built scales and identifying research gaps ( Aromataris & Munn 2020).

2. Methods

2.1. Literature Search Strategy

The umbrella review search strategy involved identifying peer-reviewed systematic reviews, published in the English language only, January 2011-December 2020. To ensure that both health and urban studies research is captured, 20 databases were included: MEDLINE, Academic Search Ultimate, CINAHL, Health Source Nursing/academic Edition, Family and Society Studies Worldwide, Environment Complete, Sociology Source Ultimate, GreenFILE, Engineering Source, Psychology and Behavioral Sciences Collection, Rehabilitation and Sports Medicine, Business Source Ultimate, Applied Science and Technology, Health Business elite, MasterFILE complete, Women's studies international, Legal source, LGBTQ+ source and British Education Index, as well as Scopus.

The search strategy was based on the intersection (Boolean AND) of terms for housing and its area of influence at the local and built scale ((built environment OR slum* OR favella OR dwelling OR neighbourhood* OR house OR housing OR urban OR green space OR metropol* OR residen* OR accommodation OR informal settlement*) OR (((housing OR city OR cities OR urban OR municipal OR environment*) N4 (plan* OR strateg* OR design* OR infrastructure))) and terms for health (health N4 (outcome* OR effect* OR assessment* OR benefit* OR gain* OR cost* OR impact* OR hazard*)). Health terms were broad in order to identify a wide spectrum of health outcomes, including those relating to planetary health (including health effects of environmental pollution, climate change and water scarcity).

2.2. Eligibility Criteria

Housing as defined here ( WHO 2018) included the dwelling and its immediate and wider surroundings, such as the neighbourhood services and facilities necessary for residential living, including green space, transportation, access to public services and facilities, and their connections to the city. Specific categories of housing such as student or elderly accommodation, residential care and shelters for the homeless were excluded. Systematic review articles published between January 2011 and December 2020 were eligible. Articles included meet the Cochrane Reviews criteria for systematic reviews: (1) clearly stated set of objectives with predefined eligibility criteria for included studies; (2) an explicit methodology; (3) a systematic search used to identify included studies; (4) an assessment of the validity of findings; and (5) a systematic presentation of results ( Higgins et al. 2019).

2.3. Data Extraction

From the initial number of 2413 articles found, 1029 duplicates and 208 studies published prior to January 2011 were removed, leaving 1176 for manual screening of titles and abstracts by the authors ( Figure 1 ). Articles were rated by two reviewers independently. A total of 264 articles were selected for full text review, of which 124 were agreed by the reviewers to meet the inclusion criteria and thus included in this umbrella review. The reasons for exclusion are summarised in the PRISMA diagram shown in Figure 1 .

2.4. Quality Assessment

The quality of included studies was assessed using the JBI manual for evidence synthesis of umbrella reviews ( Aromataris & Munn 2020). The following aspects were recorded: the topic or intervention of each paper, the context or geographical location, reported outcomes, study type ( i. e. experimental or observational studies) and a critical assessment of how the review evidence was synthesised. Information was also collated on (1) the built scale at which the study was focused (building, neighbourhood, urban system); (2) any mentioned of planetary outcomes or links to planetary outcomes; and (3) stakeholders ( i. e. public/private stakeholders at a local, city, regional or national level) and governance mechanisms ( i. e. policy, regulation, legislation, standard or guidance).

3. Results

3.1. Description of Study Quality and Characteristics

The 124 articles primarily included research from high-income countries (predominantly the UK, Europe and North America); few included studies from low-income countries ( Alaazi & Aganah 2020; Henson et al. 2020; Jung et al. 2017; Katoto et al. 2019; Quansah et al. 2017; Shuvo et al. 2020; Turley et al. 2013), and these were mainly in relation to urban slum interventions or impacts. The types of studies included in each review were diverse, but mainly collated evidence from cross-sectional population surveys. The majority of reviews assessed the quality of evidence in terms of potential publication bias and used criteria for appraising studies for inclusion. While the majority commented on the poor quality and potential bias of included papers, quality was not always stated. Few reported research from randomised controlled trials or quasi-experimental studies, and yet the quality of studies was generally reported by authors as medium quality. Study designs were generally broad, inclusive of qualitative and non-experimental evidence. The built environment was often broadly defined, although a few studies incorporated geographical information system (GIS) indicators when assessing outcomes at the neighbourhood or city scale ( Gong et al. 2016; Ma et al. 2020; Malambo et al. 2016; McCrorie et al. 2014; Nordbø et al. 2018).

The majority of studies focused on the neighbourhood scale ( n = 80), followed by the dwelling ( n = 31) and urban system ( n = 32) level. Some studies addressed multiple scales, but few identified these from a scale perspective ( Levy-Storms et al. 2018). Most focused on non-communicable disease and physical health, especially at the neighbourhood level; mental health was mostly examined at the neighbourhood level. At the dwelling level, physical and mental health outcomes featured with a greater focus on cardiorespiratory outcomes related to indoor air pollution and other hazards. Many studies focused on the general population, but some were of more specific populations, including children ( n = 20), older adults ( n = 9), mothers and pregnant women ( n = 3), the socially disadvantaged ( n = 5) or people with a specific chronic disease ( i.e. HIV, diabetes, asthma) ( n = 4). A narrative synthesis of the findings follows below, structured under the three broad levels of housing at scale: building, neighbourhood and urban system. Figures 2 - 4 show the number of studies identified at each spatial level.

3.2. Building Determinants of Health (31 Studies)

A total of 31 (25%) of the systematic reviews reported factors that affect health at the building or dwelling level under three broad areas: (1) indoor environmental quality (12 studies) such as air quality ( e. g. indoor pollution from location and construction materials) and occupant hazards ( e. g. burning fuel, cooking, heating); (2) dwelling condition (eight studies) such as home improvements ( e. g. energy retrofits, bathroom/kitchens) and soundness ( e. g. collapse and fire hazard); and (2) dwelling design (11 studies), including green buildings ( e. g. green walls, green design, green standards), building type ( e. g. high-rise, apartment, cohousing, shared facilities) and outdoor space ( e. g. gardens) ( Table 1 ; and see Table S1 in the supplemental data online).

Table 1

DETERMINANT

SPECIFIC ASPECTS

HUMAN HEALTH

PLANETARY HEALTH

Indoor environmental quality

Air quality
( e. g. particles including radon, fungi, PM, NO ₂, VOC; and, chemicals)

Impacts of exposure on lung cancer ( Ajrouche et al. 2017); cognitive and neurobehavioral outcomes ( Nussbaumer-Streit et al. 2020); exacerbation of asthma ( Sharpe et al. 2015; Tagiyeva & Sheikh 2014; Naldzhiev et al. 2020; Van Boven et al. 2020); respiratory and general health and wellbeing ( Vardoulakis et al. 2020)

Air pollution (PM, NO ₂, VOCs, etc.) ( Vardoulakis et al. 2020); energy demand ( Naldzhiev et al. 2020)

Impacts of exposure on thermal control in the elderly and those with respiratory conditions ( Jevons et al. 2016); cardio-respiratory, paediatric, maternal outcomes and mortality ( Lee et al. 2020a; Katoto et al. 2019)
Environmental equity ( Bailey et al. 2019); air pollution (PM) ( Katoto et al. 2019; Quansah et al. 2017); climate temperature ( Jevons et al. 2016)

Dwelling condition

Home improvements ( e. g. energy retrofit, upgrade of bathrooms and kitchens)

Injury and falls prevention, mobility, independence and wellbeing ( Carnemolla & Bridge 2020); health economic benefits ( Fenwick et al. 2013); reduction in depression in the elderly ( Garin et al. 2014); respiratory outcomes, QoL and mental health ( Ige et al. 2019); lung disease prevention ( Pega & Wilson 2016)

Energy required for ventilation ( Naldzhiev et al. 2020)

Soundness ( e. g. risk of fire, falls, structural integrity)

Interventions to reduce fire-related deaths and injuries avoided ( Senthilkumaran et al. 2019; Pega & Wilson 2016)

Dwelling design

Green buildings ( e. g. green designs, green standards, green walls)

Impacts of interventions on: respiratory symptoms and general wellbeing ( Allen et al. 2015); flood risk and outcomes such as waterborne diseases, mortality and psychological harm ( Houghton & Castillo-Salgado 2019); and heat-related morbidity and mortality ( Houghton & Castillo-Salgado 2017)

Reduced energy use and CO ₂ emissions ( Allen et al. 2015); attention to the interface between humans, habitats, wildlife and water systems ( Houghton & Castillo-Salgado 2017, 2019)

Building type ( e. g. high-rise, apartment, duplex, co-housing, accessible-by-design, size, shared sanitation)

Impacts of conditions on: social wellbeing, QoL and mental health ( Barros et al. 2019; Carrere et al. 2020; Cho et al. 2016; Garin et al. 2014); sedentary lifestyles ( Chastin et al. 2015); falls and mortality ( Cho et al. 2016); infectious diseases and maternal outcomes ( Heijnen et al. 2014)

Efficient use of resources ( Barros et al. 2019)

Interventions to improve the physical activity of children ( Carlin et al. 2017); stress reduction ( e. g. HR and BP) ( Kondo et al. 2018b)

3.2.1. Indoor environmental quality

A total of 12 systematic reviews were included in this category looking at air quality (seven studies) and occupant hazards (five studies). The air quality subcategory included studies of outdoor air pollution in the vicinity of the dwelling ( e. g. originating from such sources as a nearby traffic) ( Vardoulakis et al. 2020), its infiltration into the dwelling, and the associated risks for the cardiovascular and respiratory health of the residents, including asthmatic and allergic exacerbations ( Tagiyeva & Sheikh 2014; Van Boven et al. 2020). The extent to which outdoor air pollution enters the dwelling is related to the building structure, its fabric, operation and ventilation/air purification technologies ( Van Boven et al. 2020). This subcategory also included studies of radon, lead, volatile and semi-volatile organic compounds (VOCs, SVOCs) ( Ajrouche et al. 2017; Naldzhiev et al. 2020; Nussbaumer-Streit et al. 2020) as well as of biological agents ( Sharpe et al. 2015). The occupant hazards subcategory looked at wood and biomass burning for heating and cooking as well as cookstove efficiency, which are important determinants of poor household air quality and impact on a wide array of health endpoints ( Bailey et al. 2019; Quansah et al. 2017); low indoor temperatures may also direct effect blood pressure, blood clotting and other pathophysiological changes ( Jevons et al. 2016). Three studies addressed issue of environmental equity in relation to exposure to emissions from domestic wood fuel burning ( Bailey et al. 2019), air pollution impacts from cook stove and biomass burning ( Katoto et al. 2019), and thermal control in homes of the elderly ( Jevons et al. 2016).

3.2.3. Dwelling design

A total of 11 studies were identified under this category, further subcategorised into three groups: green buildings (three studies) looking at green walls, green design and green standards; building type (six studies) to do with high-rise, type of dwelling, shared facilities, etc.; and outdoor space (two studies). The green buildings studies assessed a range of health outcomes, including communicable disease (associated with water systems, vector-borne disease), allergens and air quality ( Allen et al. 2015; Houghton & Castillo-Salgado 2017, 2019). The building type studies reported on physical space and mental health and wellbeing ( Barros et al. 2019; Garin et al. 2014), the impact of accessible design on falls and mental health ( Cho et al. 2016), and how design can minimise risks of injury, particularly later in life ( Garin et al. 2014); sedentary lifestyles associated with apartment or duplex living ( Chastin et al. 2015); physical and mental health, and wellbeing ( Carrere et al. 2020); and shared sanitation's impact on communicable disease ( Heijnen et al. 2014). Two studies looked at health impacts associated with a dwelling's outdoor space, including one on the physical activity benefits of gardens and outdoor equipment for children ( Carlin et al. 2017), and one on stress and time spent gardening ( Kondo et al. 2018b).

3.2.4. Summary of building results

All systematic reviews in this category reported on physical health non-communicable outcomes associated with respiratory health (derived from exposure to allergens and air pollution) such as asthma, allergic, cardiovascular, blood pressure or thermoregulation conditions; and safety/physical injury from specific housing types ( e. g. duplex living). Only four reviews reported on communicable disease risks associated with water systems and shared sanitation as determinants for vector-borne disease. Compared with physical health, mental health outcomes were less reported (six studies) and in relation to a dwelling condition ( e. g. thermal comfort) and design ( e. g. type of building). Some reviews focused on vulnerable groups such as children and the elderly (indoor environmental quality and dwelling condition studies), the elderly (dwelling condition) and the disabled (dwelling design).

There was limited consideration of planetary health impacts (six studies). Studies reported on associated carbon emissions from traffic ( Vardoulakis et al. 2020) and from compensatory ventilation to address indoor air pollution and emissions from particular types of thermal insulation ( Naldzhiev et al. 2020); greenhouse gas mitigation, flood risk management and ecological impacts for wildlife ( Allen et al. 2015; Houghton & Castillo-Salgado 2017, 2019); and energy efficiency and efficient use of resources arising from high-density living ( Barros et al. 2019).

3.3. Neighbourhood Determinants of Health (80 Studies)

A total of 80 studies (64.5%) reported on various aspects of the neighbourhood, which are broadly defined here as an urban area made of residential and other buildings, as well as the supporting infrastructure for everyday living and its resident community. These were organised under five broad categories: (1) green and blue infrastructure (34 studies), looking at greenery, water collection and waste; (2) physical conditions (16 studies), reporting on the effects of soundscape (i.e. noise from traffic), urban design ( i.e. street layout, lighting, walkability), and neighbourhood renewal; (3) transport (14 studies), including traffic exposure, travel mode and mobility aspects; (4) access to local services (seven studies), such as shops, healthcare and education; and (5) socio-economic conditions (nine studies), reporting on effects of disadvantage, social capital and crime on health outcomes ( Table 2 ; and see Table S2 in the supplemental data online).

Table 2

DETERMINANT

SPECIFIC ASPECTS

HUMAN HEALTH

PLANETARY HEALTH

Green and blue infrastructure

Impacts on: physical, mental and/or social health and mortality ( Browning & Lee 2017; Calogiuri & Chroni 2014; Carmona 2019; Venkataramanan et al. 2019; van den Berg et al. 2015; de Keijzer et al. 2020; Dzhambov & Dimitrova 2018; Felappi et al. 2020; Shuvo et al. 2020; Gascon et al. 2015; Kondo et al. 2018a; Lai et al. 2019; Rojas-Rueda et al. 2019; Parker & de Baro 2019; Rugel & Brauer 2020; Macmillan et al. 2018; Audate et al. 2019), including for children ( Vanaken & Danckaerts 2018; de Keijzer et al. 2016; Hartley et al. 2020; Islam et al. 2020; McCormick 2017), maternal health ( Twohig-Bennett & Jones 2018; Lee et al. 2020c), elderly people ( Yuan et al. 2020; Garin et al. 2014; Levy-Storms et al. 2018; Chastin et al. 2015), people with disabilities ( Zhang et al. 2017; Saitta et al. 2019), and health inequalities ( Schüle et al. 2019)

Ecosystem services, wildlife and biodiversity ( Zhang et al. 2017; Felappi et al. 2020; Schüle et al. 2019; Lai et al. 2019; Parker & de Baro 2019); floods ( Yuan et al. 2020); air pollution ( Lee et al. 2020c); contributions to the SDGs ( Vanaken & Danckaerts 2018)

Floods ( Ishaq et al. 2020)

Physical conditions

Hypertension ( Van Kempen & Babisch 2012; Dzhambov & Dimitrova 2018), myocardial infarction ( Khosravipour & Khanlari 2020), stress recovery and self-reported health ( Aletta et al. 2018), disability in the elderly ( Garin et al. 2014), as well as combined pathways to health ( Peris & Fenech 2020)

Ecosystem responses to transport noise and natural environment impact on noise ( Peris & Fenech 2020)

Physical health including hypertension, BMI and type 2 diabetes ( Chandrabose et al. 2019; Leal & Chaix 2011; Malambo et al. 2016); physical activity in the elderly ( Chastin et al. 2015; Moran et al. 2014) and people with disabilities ( Eisenberg et al. 2017); child accidents ( Schüle & Bolte 2015); mental health and QoL ( Schüle & Bolte 2015; Garin et al. 2014)

Weather and environmental conditions ( Moran et al. 2014)

Impacts on socio-economic determinants of health ( Thomson & Thomas 2015), and mental health and wellbeing ( Moore et al. 2018)

Transport

Morbidity and mortality associated with cardiovascular, respiratory, metabolic and reproductive health ( Hamra et al. 2015; Rugel & Brauer 2020; Malambo et al. 2016), including child health for lung function ( Barone-Adesi et al. 2015), leukaemia ( Boothe et al. 2014) and obesity ( Audrey & Batista-Ferrer 2015)

Air pollution ( Barone-Adesi et al. 2015; Hamra et al. 2015; Rugel & Brauer 2020)

Changes in cycling behaviour ( Stewart et al. 2015); health associated with physical activity, air pollution and injuries ( Stankov et al. 2020; Patterson et al. 2019; Möller et al. 2020; Macmillan et al. 2018); health of children from disadvantaged socio-economic groups ( Ma et al. 2020)

Access to local services

Physical activity- and dietary-related health outcomes including blood pressure, BMI, type 2 diabetes, mental health and self-reported health ( Abeykoon et al. 2017; Garin et al. 2014; Macmillan et al. 2018; Malambo et al. 2016; Iacovou et al. 2013)

Congenital heart disease ( Davey et al. 2020)

Health of children from disadvantaged socio-economic groups ( Ma et al. 2020)

Environmental justice ( Ma et al. 2020)

Socio-economic conditions

Impacts on self-reported health, mental health and health-related behaviours ( Algren et al. 2015; Bécares et al. 2018; Bhavsar et al. 2020)

Environmental equity ( Bhavsar et al. 2020)

Physical activity, mental and social health ( Lee et al. 2020b; Rhodes et al. 2018; Pérez et al. 2020), including benefits for children and adolescents ( Vyncke et al. 2013)

3.3.1. Green and blue infrastructure

A total of 34 studies were concerned with the relationship between green and blue infrastructure and health, grouped under greenery (32 studies) regarding various green aspects of neighbourhoods, including parks, greenspace, vegetation, trees, etc.; and water collection and waste (two studies) reporting on sewerage systems and water-borne pathogens ( Jung et al. 2017) and pathogens in floodwater and respiratory disease ( Ishaq et al. 2020).

Of the greenery studies, 12 considered the relationship with physical health impacts only, mainly in the area of respiratory and cardiovascular disease or general health impacts ( Browning & Lee 2017; Twohig-Bennett & Jones 2018; Parker & de Baro 2019; Rugel & Brauer 2020); and 15 studies also reported on mental health outcomes. Several reviews focused on the health of particular population groups including older adults and mortality ( Rugel & Brauer 2020; Yuan et al. 2020; Rojas-Rueda et al. 2019); children and asthma ( Hartley et al. 2020); pregnancy outcomes ( Akaraci et al. 2020; Lee et al. 2020c); and early childhood ( Islam et al. 2020). Three studies specifically focused on the benefits of physical activity for health more generally ( Macmillan et al. 2018), children and adults with disabilities ( Saitta et al. 2019), and older adults ( Chastin et al. 2015). Five studies assessed various mental health outcomes, including stress and anxiety more generally ( Calogiuri & Chroni 2014; Felappi et al. 2020; Gascon et al. 2017; Kondo et al. 2018a; Chastin et al. 2015), and in children and adolescents ( Vanaken & Danckaerts 2018). One study assessed the mediating effects of vegetation on the relationship between stress and noise ( Dzhambov & Dimitrova 2018). Six studies reported other types of outcomes in addition to health including benefits to the economy and society ( Venkataramanan et al. 2019), social capital ( Venkataramanan et al. 2019), cognitive development in childhood and cognitive function in adulthood ( de Keijzer et al. 2016), and cognitive function in children, adults and the elderly ( de Keijzer et al. 2020); environmental and health inequalities ( Schüle et al. 2019); and food security and nutrition outcomes ( Audate et al. 2019). The relationship between noise and green space was investigated in one study ( Dzhambov & Dimitrova 2018).

3.3.3. Transport

This category encompasses 14 studies grouped in three subcategories: traffic exposure (six studies), travel mode (six studies) and mobility (two studies). Studies looking at traffic exposure reported on cardiovascular outcomes ( Malambo et al. 2016) in addition to mortality and other physical health impacts ( Rugel & Brauer 2020); lung cancer ( Hamra et al. 2015); and children and lung function ( Boothe et al. 2014), leukaemia ( Barone-Adesi et al. 2015) and obesity ( Audrey & Batista-Ferrer 2015). Six studies reported on impacts of travel mode on health. Three studies were specifically concerned with cycling interventions, two looked at the potential for general public health impacts ( Stewart et al. 2015; Stankov et al. 2020), and one at physical activity and diet-related health outcomes ( Macmillan et al. 2018). One study considered public transport and weight-related health outcomes ( Patterson et al. 2019). The remaining two studies looked at transport costs and health impacts ( Möller et al. 2020), and mode of travel and health impacts in children from lower socio-economic groups ( Ma et al. 2020). Two reviews looked at transport mobility issues such as barriers to transport arising from congenital cardiovascular conditions in children and adults ( Davey et al. 2020), and transport mobility restrictions and health impacts including premature mortality in older adults ( Rosso et al. 2011).

3.3.4. Access to local services

Seven studies were grouped in this category. Five studies focused specifically on access to and availability of local shops, with four looking at grocery shops and local food outlets such as supermarkets, farmers' markets, restaurants and community kitchens ( Abeykoon et al. 2017; Macmillan et al. 2018; Malambo et al. 2016; Iacovou et al. 2013), and one at retail more generally ( Garin et al. 2014). In terms of health impacts, one study looked at access to healthcare and congenital heart disease in children and adults ( Davey et al. 2020), and another reported on the health of children from lower socio-economic groups and exposure to traffic from their route to school ( Ma et al. 2020). Two studies considered body mass index (BMI)-related outcomes in relation to grocery stores and supermarkets ( Abeykoon et al. 2017; Malambo et al. 2016), one of which also considered blood pressure, diabetes mellitus and metabolic syndrome associated with fast-food restaurants ( Malambo et al. 2016). Two studies reported on mental health outcomes: one looked at depression in the elderly and retail availability in the neighbourhood ( Garin et al. 2014); and another looked at self-reported health and psychological health and grocery shops ( Abeykoon et al. 2017). One study linked community kitchens with wellbeing benefits such as social engagement and community cohesion ( Iacovou et al. 2013).

3.3.5. Socio-economic conditions

The socio-economic characteristics of neighbourhoods' impact health as they are underlying factors of: disadvantage and competition for scarce resources among neighbours; trust, social capital and collective action which can overcome challenges; and 'contagious' or 'epidemic' behaviours that makes neighbours engage in similar behaviours ( Smelser & Baltes 2001). Nine studies were identified in this category reporting on disadvantage (three studies), social capital (four studies) and risky behaviours (two studies).

While only two studies reported on general physical health outcomes related to gentrification ( Bhavsar et al. 2020) and adolescent pregnancy ( Smelser & Baltes 2001), the overall focus in this category and touched upon by all studies was on mental health conditions ( e. g. depression, anxiety, self-reported health, etc.) (five studies), health-risk behaviour ( e. g. smoking, physical inactivity and early sex initiation) (two studies), and wellbeing ( e. g. social health, loneliness) (four studies) outcomes. Moreover, many studies reported health impacts on vulnerable groups such children ( Bhavsar et al. 2020; Vyncke et al. 2013; Decker et al. 2018), ethnic minority populations ( Bécares et al. 2018; Bhavsar et al. 2020) and lower socio-economic groups ( Bhavsar et al. 2020). One paper reported on the health impacts on all these three groups and also referred to planetary health outcomes in relation to environmental equity aspects of 'green gentrification' which can result in displacing vulnerable residents and augment their need for more emergency room or mental health visits as well as their food insecurity ( Bhavsar et al. 2020).

The impact of disadvantage on health was reported in relation to neighbourhood deprivation and health-risk behaviour such as smoking and physical inactivity ( Algren et al. 2015); ethic segregation and mental health outcomes such as depression, anxiety, suicidality and suicide, psychotic experiences, and schizophreniform/psychotic disorders ( Smelser & Baltes 2001); and gentrification and self-reported health, physical and mental health outcomes and health-related behaviour, with a specific focus on negative health outcomes for ethnic groups, children and displaced residents ( Bhavsar et al. 2020). Four studies reported on social capital-related health outcomes looking at the amount of social capital in the neighbourhood and health outcomes in children and adolescents ( Vyncke et al. 2013); the benefits of spending time with others and mental health, quality of life and social health ( Lee et al. 2020b); social cognition from leisure-time and health outcomes ( Rhodes et al. 2018); and community life and healthy weight and depression ( Pérez et al. 2020). Two studies reporting on risky behaviours looked at unsafe local environments, early sexual initiation and adolescent pregnancy ( Decker et al. 2018), fear of crime and mental health ( Lorenc et al. 2013).

3.3.6. Summary of neighbourhood results

Across all reviews in this group, three overall findings were apparent: (1) the green and blue infrastructure category received the most attention to date (34 studies); (2) physical health outcomes (respiratory and cardiovascular) were predominantly reported; however, mental health outcomes were also reported by 27 studies, especially in relation to greenspace (15 studies) and neighbourhood socio-economic conditions (nine studies)-interestingly, no transport study reported mental health outcomes; and (3) in contrast to the building level/group, nine studies reported on the socio-economic determinants of health and discussed these in relation to various vulnerable groups including children (15 studies), elderly (10 studies), disabled people (three studies), women (three studies), low income (two studies) and ethnic minority groups (two studies); the intersectionality of health outcomes was also considered in three studies reporting on adverse health outcomes on low income and children or women.

One-fifth of studies ( n = 16) reported on planetary health aspects, predominantly under the greenery category (nine studies). Reported aspects included biodiversity ( Lai et al. 2019), (cultural) ecosystem services ( Zhang et al. 2017), conflicts between wildlife and human needs ( Felappi et al. 2020), environmental resources ( Schüle et al. 2019), environmental benefits ( Parker & de Baro 2019) and air pollution ( Lee et al. 2020c), sustainability-related aspects such as flooding ( Ishaq et al. 2020; Venkataramanan et al. 2019) and the United Nations' Sustainable Development Goals (SDGs) ( Vanaken & Danckaerts 2018); mediating effects of weather and environmental conditions on physical activity in older adults ( Moran et al. 2014); carbon emissions from road traffic ( Barone-Adesi et al. 2015; Hamra et al. 2015; Rugel & Brauer 2020); and air pollution from transport ( Möller et al. 2020; Ma et al. 2020).

3.4. Urban System Determinants of Health (32 Studies)

Local built environments are part of the wider urban system which extends beyond buildings and neighbourhoods to the whole city, immediate but also distant built or unbuilt hinterlands of regions, nations and, ultimately, to the planet. These are parts of the urban system connected by complex relations and feedback loops, which in turn can influence outcomes at the local level. In the housing sector, this occurs through, but it is not limited to, (1) planned action of housing at scale via spatial planning; (2) the unplanned, albeit regulated, interactions of agents and institutions seeking and providing housing represented by the housing system; and (3) via the consequential desired and undesired impacts on natural ecosystems. A total of 32 systematic reviews (25.8%) reported on urban system determinants of health categorised as spatial planning (17 studies); housing system (11 studies): and ecosystems (four studies) ( Table 3 ; and see Table S3 in the supplemental data online).

Table 3

DETERMINANT

SPECIFIC ASPECTS

HUMAN HEALTH

PLANETARY HEALTH

Spatial planning

Physical and mental health, as well as QoL and social capital ( Alaazi & Aganah 2020; Turley et al. 2013; Henson et al. 2020)

Rapid urbanisation and effects on the environment and SDGs ( Henson et al. 2020)

Morbidity and mortality, including gastroenteritis, cancer, CVD, reproductive outcomes, and neurogenerative disease, and risk of displacement following earthquakes ( Beaudeau 2018; Doocy et al. 2013; Habash et al. 2019)

Densification contributions to the SDGs ( Berghauser Pont et al. 2020)

Physical activity ( Nordbø et al. 2018; McCrorie et al. 2014; Durand et al. 2011; Rocha et al. 2019), mental health ( Gong et al. 2016), including the health of children and the elderly ( Sánchez-González et al. 2020; Kabisch et al. 2017), and morbidity and mortality ( Salgado et al. 2020)

Air pollution, noise, UHI, green and blue space ( Salgado et al. 2020; Kabisch et al. 2017; Rocha et al. 2019)

Housing system

Physical health, mental health and health-related behaviours ( Vásquez-Vera et al. 2017; Downing 2016; Tsai 2015; Singh et al. 2019; Davey et al. 2020; Aidala et al. 2016), as well as health-related social outcomes ( Aubry et al. 2020; Tanner et al. 2013)

Energy access and fuel poverty ( Tanner et al. 2013)

Diabetes ( Singh et al. 2019), obesity ( Tseng et al. 2018), and community health status ( Chaparro et al. 2020)

Ecosystems

Mental health ( Gascon et al. 2017)

All-cause mortality and cardiorespiratory morbidity ( Schinasi et al. 2018)

Climate change ( Schinasi et al. 2018)

3.4.1. Spatial planning

A total of 17 studies were identified in this category reporting on health outcomes and informality (three studies), urban infrastructure (three studies), type of development (three studies) and master planning (eight studies). The three studies reporting on informality assessed the health impacts of strategies to improve the infrastructure, conditions and land tenure of slums, including communicable and non-communicable disease prevention, the risk of injury from chemical and biological hazards, as well as social impacts such as quality of life, education and employment ( Alaazi & Aganah 2020; Turley et al. 2013; Henson et al. 2020). Three studies looked at urban infrastructure: one study assessed urban drinking water and gastroenteritis risk ( Beaudeau 2018); one study reported on the structural soundness of the city in the face of earthquakes and subsequent building collapses ( Doocy et al. 2013); and one study looked at urban exposure to overhead powerlines ( Habash et al. 2019). Type of development effects were reported in three studies in relation to walkability, physical activity behaviours and obesogenic health impacts ( Berghauser Pont et al. 2020; Chandrabose et al. 2019; Cyril et al. 2013). Eight studies focused on aspects of master planning at the city level and health outcomes such as morbidity and mortality related to non-communicable disease risks ( i.e. physical inactivity), injury and mental health. More specifically, these studies focused on nature-based approaches ( Kabisch et al. 2017), age-friendly infrastructure for the elderly or children ( Sánchez-González et al. 2020; Nordbø et al. 2018), and smart city technologies ( Rocha et al. 2019). Strategic planning and smart growth approaches were also included ( McCrorie et al. 2014; Durand et al. 2011; Gong et al. 2016; Salgado et al. 2020).

3.4.2. Housing system

Housing system studies ( n = 11) were categorised into two categories: vulnerability (eight studies) and policy (three studies). In the vulnerability subcategory, three studies looked at how foreclosure, either directly experienced or general risk in the neighbourhood, negatively affected physical and mental health, as well as health-relevant behaviours (including substance misuse and violence) ( Downing 2016; Tsai 2015; Vásquez-Vera et al. 2017); one study looked at how combinations of tenure precarity and poor physical characteristics of dwellings may combine to influence mental health ( Singh et al. 2019); one study assessed how permanent supportive social housing may benefit both health ( e. g. mental health, hospital admissions) and health-supporting social conditions ( e. g. employment and income) ( Aubry et al. 2020); and three studies looked at vulnerability by specifically focusing on a population subgroup (people living with HIV) ( Aidala et al. 2016), a risk type (cold weather) ( Tanner et al. 2013), and an outcome (congenital heart disease) ( Davey et al. 2020). Of the three studies classified in the policy subcategory, two looked at how a range of material housing changes and support contributed to changes in the risk of obesity ( Tseng et al. 2018) and diabetes ( Barnard et al. 2015). A third study considered strategies that combined material ( e. g. built infrastructure) and social ( e. g. community networking and empowerment) aspects to create healthy environments ( e. g. availability of healthy food; encouragement of physical activity) that would in turn improve community health ( Chaparro et al. 2020).

3.4.3. Natural ecosystems

Four studies reported on natural ecosystems such as air, water and climate. Two studies considered air pollution and its effects on cardiorespiratory outcomes in people of different age groups in Sub-Saharan Africa ( Katoto et al. 2019), and the health and health equity benefits of interventions aiming to reduce air pollution levels ( Benmarhnia et al. 2014). One study assessed the mental health benefits of wider natural ecosystems for residential areas ( Gascon et al. 2017), and one paper looked at microclimate influences on urban heat islands and the resulting impacts of mortality and cardiorespiratory morbidity ( Schinasi et al. 2018).

3.4.4. Summary of urban system results

More than half (17 studies) of all studies in this group focused on the impact of spatial planning on both health exposure and health interventions. Physical health impacts were discussed in relation to both communicable and non-communicable diseases, more specifically general health outcomes, mortality and morbidity, walkability and physical activity outcomes, drinking water quality and communicable disease, resilience to natural disasters, cancer, reproductive health, obesity and cardiorespiratory. Mental health impacts were discussed in relation to informality and master planning aspects; housing system's vulnerability (mainly measures of housing insecurity) and policies (material change and material and social support) aspects, and the natural ecosystem. There was some evidence reporting on the health of particular demographic groups such as the elderly and children (under spatial planning), and vulnerable groups including those with underlying health conditions (HIV, heart disease) and especially those with insecure housing tenure (under housing system).

Surprisingly, less than one-sixth of studies ( n = 5) discussed planetary health outcomes. These reported on the impacts of rapid urbanisation on the environment and implications for the SDGs ( Henson et al. 2020; Chandrabose et al. 2019); and climate change impacts of air pollution ( Benmarhnia et al. 2014; Katoto et al. 2019) and microclimates ( Schinasi et al. 2018).

4. Discussion

This paper provides an overview of the last decade's evidence on health and urban housing from a spatial scale perspective. Most of the systematic review evidence (64.5%) reviewed by this paper focused on the neighbourhood level of the local built environment, while the building and urban system levels accounted for the rest in equal shares. Across the three scales, however, five out of 11 categories of built environment determinants of health have received most attention to date: green and blue structure (32/124); spatial planning (17/124), neighbourhood's physical conditions (16/124) and transport (14/124), and a dwelling's indoor environmental quality (12/124). The number of reviews focusing on health impacts at the building level was less than anticipated; this can be explained by the fact that existing evidence is not yet published in English and/or summarised by systematic reviews during the period 2011-20.

Three overall observations can be made across all scales and all studies. Physical health outcomes remained predominantly reported by systematic reviews, primarily in relation to non-communicable diseases in high-income settings. This may be because the majority of reviews focused on developed contexts where non-communicable diseases form the predominant burden of health. Mental health outcomes were included in 40 studies (one-third of all studies): 27 were at the neighbourhood level, and six and seven at the building and urban system scales, respectively. Only one-fifth of studies (27/124) reported some planetary health outcomes, and again mostly at the neighbourhood level (16/27), and 6/27 at the building and 5/27 at the urban system levels.

4.1. Where Next for Research?

This umbrella review indicates three potential directions for further research, more generally, and systematic review research, more specifically. First, research on urban health usually involves two distinct communities of scholars, health scientists and urban scientists, who can come from completely different research paradigms. This requires time to learn or synthetise across disciplines, transdisciplinary methods to account for the variety of entry points, but also relational thinking to acknowledge the multiple connections between the different elements of the urban system and the continuum of health outcomes, e. g. physical-mental-wellbeing. The studies identified by this paper come from teams of primarily health scientists, hence grounding findings with urban scientists can be challenging. There is also a predominant focus on the 'negative psychology' approach to health whereby treating the effects of a particular condition ( i.e. cardiovascular, respiratory, BMI, blood pressure) is in focus, as opposed to 'positive psychology' approach when the cause of the condition (poverty/deprivation, vulnerability) is analysed ( Seligman 2004). While some mental health and wellbeing outcomes are mentioned at the neighbourhood and wider urban system levels, they need better understanding. Here, a 'flourish' approach to health can be explored, whereby the focus is on people, rather than their health, under the assumption that improving the wider quality of life and social health would make for healthier people ( Seligman 2011).

Second, there are three obvious gaps in the literature: the intersectionality of health outcomes, lack of evidence from low-income settings and little current discussion of communicable disease burden. While there are often clear pathways for increased risk for vulnerable population groups, review evidence for these groups appears to be limited and tends to be focused on children and the elderly; there is little consideration of how, e. g., age, gender and socio-economic status may intersect in the built environment and affect health. There was also very limited evidence from low-income countries and/or communicable disease outcomes; where reviews were identified they reported health outcomes associated with indoor air pollution from cooking stoves and informal living, lack of water infrastructure and sanitation, and vector-borne disease. The current COVID-19 pandemic will certainly move the focus back onto communicable disease outcomes.

Third, planetary health impacts are mainly reported in relation to carbon emissions. Expanding understanding beyond this point is another research direction worth exploring. Research reporting on planetary impacts in conjunction with human health ones, across all scales of the built environment, can reinforce advocacy for urban sustainability transitions. If the challenges of the health-climate crisis is to be met, the nexus of human and planetary health needs better understanding of unintended consequences, better policymaking and urban governance at all levels ( Crane et al. 2021).

4.2. A Role for Policy and Urban Governance

Urban health research is closely associated with relevance to policymaking ( Hawkes et al. 2016; Sallis et al. 2016; Schneidera & Blythb 2017). This paper found that many studies note implications for policymaking and urban stakeholders ( e. g. urban planners, landscape architects, communities, residents, etc.), but discussion is rather general. This may be explained by the fact that most reviews take a health perspective whereby roles outside health in implementing or changing exposure risks in the built environment are not considered. In what follows, this paper contributes to expanding policy understanding in this area by exploring different types of policy interventions and actors involved across the scales of the built environment.

At the building level, exposure to many identified environmental risk factors is long-term and difficult to modify without substantial investment of time and resources. For example, remedial factors to address risks from exposure to low indoor temperatures via energy retrofitting to protect against winter cold may take substantial investment. Likewise, factors related to a building's condition have clear benefits in terms of health when considering safety measure ( e. g. injury from fire, falls, etc.) and building regulations usually address these issues, but regulation and compliance may be challenging in some settings or differ amongst sectors and professions. The building level is usually addressed by architects, designers, developers, building contractors, owners of individual structures and health practitioners.

At the neighbourhood level, the weight of evidence suggests positive health outcomes are associated with green space, although these may be confounded by socio-economic status, i.e. wealthier neighbourhoods having higher density of green space and living in deprived/poor neighbourhoods is linked to adverse health impacts for vulnerable groups such as children, the elderly and disable people, women and ethnic minority groups. While it may be challenging to add new green space to established cities, modifications to existing green space can be made to encourage physical activity, along with fair and equal access for all socio-economic groups and education to effect behaviour change. Actors involved in the governance of the neighbourhood level primarily include local government, local planning and local health trusts, communities, civil society and business organisations.

At the urban system level, the evidence presented points to at least two important 'alignments', e. g. between health, spatial planning and housing policy; and between climate change and health outcomes. City-level spatial planning policies can impact on health by providing adequate levels of affordable or social housing and so de-risking housing security, an important socio-economic determinant of health, while housing policy at the regional or national level can help to absorb shock-related health impacts from events such as the financial crisis in 2007-08 or the current COVID-19 pandemic. Furthermore, increasing greenspace and energy retrofitting are associated with clear health and climate change-positive outcomes; high density or shared living can reduce pressure on resources and associated carbon emissions, but some evidence suggests mental health-negative outcomes from overcrowding and impacts on physical health from limited space. The latter is easier to address in policy terms, e. g. the provision of easily accessible parks and recreational facilities to allow physical activity, while overcrowding is harder to address and requires long-term action and investment, but policy measures such as standards and regulations can help. The governance of the urban system involves all the actors at the building and neighbourhood level and much more, i.e. regional and national governments involved in strategic policymaking, but also global organisations including international institutions such as the WHO and European Union.

The above examples frame urban health within the wider process of policymaking in the build environment. Policymaking is a complex and, most importantly, a political process; it is not something happening at a particular time, in a particular spot, but part of wider multilevel governance frameworks, which frame the complexity of the urban system and local built environment. As seen above, the governance of urban health involves policymakers responsible for health- or housing-related policy and regulation, and other stakeholders involved in health interventions such as government agencies, architects, builders, housing providers, developers, engineers, urban planners, industry regulators, financial institutions as well as social services, community groups and public health professionals. These stakeholders are ultimately required to ensure that housing is built, maintained, renovated, used and demolished in ways that support health.

By taking a scale perspective on health, the connections between different policies and levels of policymaking become apparent. For example, national government needs to align health with SDGs, ensure geographical equity and combat siloed approaches, while local government must ensure that public health and spatial planning work together to strengthen the link between people and places and break administrative boundaries to reap the benefits of planetary health. Also, the wider the scale, the more complex the array of actors involved and the dynamic lines of power and networks inside and outside policymaking ( Bulkeley & Kern 2006). Communities may hold important knowledge about public health in their locality, but may not have a voice, especially if marginalised; civil society organisations may lobby or support government and communities, while professional communities such as urban planners share many communalities with public health professionals including an interest in the public good, and use of evidencebased and long-term assessment approaches ( WHO 2020). If evidence fails to engage with the multi-scalar, multilevel nature of urban governance, which makes links across scales from local to supranational, and where power is distributed across horizontal and vertical networks which do not operate in a hierarchical manner ( Bulkeley & Betsill 2005). This paper suggests that a better grounding of urban health research in existing urban governance landscapes would not only support a faster and more efficient implementation of health interventions at the local level, but also gauge potential synergies and tensions at the urban system level with other pressing urban challenges such as climate change.

4.3. Strengths and Limitations

This paper is novel for synthesising evidence on housing from the perspective of scales within the urban built environment. Most research has either considered housing from a narrow understanding of the individual's dwelling or disconnected the built environment from its purpose of providing liveability ( Giles-Corti et al. 2019). To the present authors' knowledge, this is the first umbrella review to take a comprehensive view of the local built environment and housing at scale while looking at both physical and socio-economic characteristics that define the complex urban system.

This review is limited to systematic review evidence and generic geographical regions. Evidence derived purposely for specific countries was excluded because of the specific content and context. As such, the authors acknowledge the broad conclusions made in this review. The intent was not to assess the size of health impacts or the effectiveness of interventions and make no assessment of the importance of one health determinant or built factor over another. Furthermore, the study excluded research on shelters for the homeless, residential care or student accommodation, and rural housing, which also pose built environment, societal and health concerns.

5. Conclusions

This paper provides an umbrella review of reported health impacts across three broad spatial scales and notes that most research has focused on health at the neighbourhood level. Discussions of planetary health and policy implications have been limited, and only a few studies have evaluated the economic implications of health interventions. This study is the first of its type: it applies a multiscalar perspective to health, it suggests directions for potential future research, and it expands the discussion of urban governance for health.

​

Evidence about local built environment determinants of health have focused to date on physical health outcomes and the neighbourhood level; there is also significant evidence about mental health outcomes and greenspace. Future research can strengthen understanding of mental health outcomes across all scales and determinants of the built environment; investigate more robustly planetary health outcomes; and provide additional evidence at the building and wider urban system level, especially in relation to low-income settings, vulnerable groups and communicable disease. There is limited discussion of implications for policymaking and economic evaluations of health interventions, i.e. the cost of intervention versus health outcomes. Urban health interventions have focused to date on treating the effects of health conditions; however, there is potential for constructive interventions in the built environment (at various scales) which improve health and/or reduce environmental health risks if the policy focus is on dealing with the causes of health conditions.

Acknowledgements

The authors are indebted to UCL's Complex Urban Systems for Sustainability and Health (CUSSH) project, funded by the Wellcome Trust in the UK, for support that has made this research possible. The authors are also grateful for the comments of three reviewers and the editor, who have helped via constructive and substantial feedback to shape this paper into its current form.

Funding

This research was funded by the Wellcome Trust (grant number 209387/Z/17/Z). For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Footnotes

Contributed by

Author Contributions

C.T. conceived the idea for the paper, drafted the manuscript and dealt with the revisions. M.T. and C.T. designed the methodology and compiled the search and library of data. C.T., M.C., E.H., K.B. and S.L. screened the papers. All authors contributed to the writing of the paper.

Competing Interests

The authors have no competing interests to declare.

Contributor Information

Catalina Turcu, The Bartlett Faculty of the Built Environment, University College London, London, UK.

Melanie Crane, The Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.

Emma Hutchinson, Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.

Simon Lloyd, Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.

Kristine Belesova, Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.

Paul Wilkinson, Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.

Mike Davies, UCL Institute for Environmental Design and Engineering, Faculty of the Built Environment, University College London, London, UK.

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A multi-scalar perspective on health and urban housing: an umbrella review

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With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health ...

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Like housing and health, safety is another basic need as everyone desires to live in a crime-free and safe neighbourhood. Crime is a violation of law and order, usually against a person or property. A high crime rate and unsafe environment can only result in fear and worry about the neighbourhood. It is impossible to bring about a good quality of life in an area with a high crime rate, even if other living conditions are satisfied. Indicators of crime and safety domain are expected to measure a neighbourhood’s safety level.

Indicators of the safety domain can be grouped into three types of measures.
Almost all case studies use crime rate to indicate the frequency of crime in an area. This measure is often applied to different types of crime, including violence, homicide, property crime, sexual assaults, and child abuse. Incidents of injuries/accidents and poisoning form another type of safety indicator. The third type measures the efforts made by local governments towards safety neighbourhoods. For example, some studies use the population per police officer to indicate the availability of the police, and government expenditure on police to measure the economic availability as a result of the government’s response to the area.

Sun, Y. S., "Crime and Safety Indicators." Development of Neighbourhood Quality of Life Indicators, University of Saskatchewan, 2005, pp. 21-29.

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As reviewed above, there is substantial evidence that living in deprived neighbourhood is associated with poor physical health and it is also reasonable to assume that health-related QOL is influenced by actual physical health. Additionally, the neighbourhood deprivation index, SIMD, also incorporated some health statistics such as mortality rate, substance abuse, and number of emergency admissions to hospital, possibly creating some overlap in content. Indeed, the association between the physical aspect of QOL and neighbourhood deprivation appeared to be to some extent mediated by the number diseases that people had been diagnosed with.

Mõttus, R., Gale, C. R., Starr, J. M., & Deary, I. J. (2012). “On the street where you live”: Neighbourhood deprivation and quality of life among community-dwelling older people in Edinburgh, Scotland. Social Science & Medicine, 74(9), 1368–1374. doi:10.1016/j.socscimed.2011.12.050

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About Desa ParkCity -A pedestrianand cyclist friendly township

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KL'S MOST LIVABLE COMMUNITY

In 1999, ParkCity acquired the 473-acre Desa ParkCity site. From a barren quarry mine, the site has become the cradle of one of Malaysia’s top selling communities. Today, the multiple award-winning master-plan of Desa ParkCity is regarded by many as innovative, imaginative and successful model for a lively, safe, sustainable and healthy community.

Desa ParkCity is truly a self-contained township, centered on the ideals of good, wholesome living, where its residents are able to foster family, neighborhood and community ties.

1. Separated & shaded sidewalk
2. Jogging & cycling tracks with intermittent rest stops
3. With massive greenery and natural lighting, Park Place is  providing a holistic lifestyle combining work, social and privacy to the home.
4. Desa ParkCity are a great place to stay due to the urban green spaces, accessibility, and a large number of amenities.

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Plaza Arkadia The Waterfront ParkCity Medical Centre The International School @ ParkCity The ParkCity Club The SportsCenter The Central Park The East Park The West Park

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There are three key healthy neighbourhood design elements:
I. complete: a variety and mix of land uses are available in the community
II. compact: the community is concentrated, not spread thinly over a large area
III. connected: the layout makes it convenient and pleasant to get to destinations

Why is healthy neighbourhood design important for health and well-being?
1. Enables physical activity
2. Encourages healthy eating
3. Increases social capital and safety
4. Strengthens social connections and improves access to services

Why does healthy neighbourhood design matter for local governments?
1. Develop community plans with goals and principles for health and well-being, accessibility, and active transportation.
2. Design policies and guidelines that emphasize street connectivity, mixed land use, and human-scaled developments in existing town centres.
3. Zoning can facilitate the development of buildings that provide end-of-trip amenities such as secure bike parking, showers, and lockers; require that buildings face the street to create a walkable and safe environment; and locate a mix of uses in neighbourhoods to increase housing affordability and provide residents with services nearby.
4. Develop plans to address the needs of different populations in the community.

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The built environment is the human-made, physical setting for human activities – where people live, work, learn, and play. Whether rural, urban, or suburban communities, healthy built environments are places that can be intentionally designed to support good health and help people to thrive.

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Considering the significance of neighborhood planning on reducing carbon emissions, we proposed low-carbon neighborhood planning technologies from six aspects: layout planning, traffic planning, architecture planning and design, environment planning, municipal engineer- ing planning and construction management.
In summary, the aim of building a neighborhood low-carbon indicator system is not only to guide the construction of low- carbon neighborhood but also to provide the neighborhood resi- dents a harmonious, comfortable, green and healthy life.

Wang, Xiaoming, et al. "Low-carbon neighborhood planning technology and indicator system." Renewable and Sustainable Energy Reviews 57 (2016): 1066-1076.

Enumerating the key characteristics of “Age-Friendly” cities, the World Health Organization lists out the following aspects which are the key elements, also termed as “City Elements”, which are desirable for a better neighborhood design. It comprises of housing, transportation, social participation, community support and health services, communication and information, social participation, civic participation and employment, and outdoor spaces and buildings, which include parks and open spaces.

Dash, Shanta Pragyan. "TO STUDY THE IMPACT OF NEIGHBORHOOD PLANNING ON HEALTHY AGEING." International Journal of Advanced Science and Technology29.2 (2020): 3439-3453.

Under these significant transitions, sustainable challenges, such as declining social capital, urban sprawl, traffic congestion, environmental deterioration, declining urban culture, land overdevelopment and social inequality, etc., have put neighborhood sustainability issues in the spotlight.

To develop sustainable neighborhoods in China, identifying the major obstacles that hinder neighborhood planning development becomes more significant and urgent. Particularly, the strong association between policies, urban planning and sustainable development in China highlighted the significant effect of institutional elements. Theoretically, decentralization and community empowerment, public participation, cultivation of community sense, iterative and adaptive planning etc. were the four main aspects in which neighborhood sustainability can be affected institutionally. But these aspects may vary from country to country because of different local context.

Zhang, Qi, Esther Hiu Kwan Yung, and Edwin Hon Wan Chan. "Towards sustainable neighborhoods: Challenges and opportunities for neighborhood planning in transitional urban China." Sustainability 10.2 (2018): 406.

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Also, Dines, Cattell, Gesler and Curtis (2006) argues that the presence of CFs helps people to be attached to their locality as well as presents the opportunities of meeting with other people. And these play vital roles in enhancing the lives of residents (Rabinowitz, 2012); as many of these facilities play varied roles in neighbourhoods. For instance, whilst the libraries and museum open doors to knowledge, ideas and culture; the health of residents are safe guarded by medical facilities. Furthermore, the transportation facilities offer mobility and access in a more convenient way to residents; in addition, the green parks provide green spaces. Combining all these together, help in enhancing the quality of life of the people ‘socially, intellectually, culturally, economically, politically and psychologically’ (Rabinowitz, 2012).
Highlighting the importance and roles CFs play, Montgomery (2005); Dines, Cattell, Gesler and Curtis (2006) and Rabinowitz (2012); noted that these facilities help improve the general quality of life in the community by providing outdoor life for residents. They also provide an avenue for physical, intellectual and cultural activities through sports, music and provide chances for experiences. Furthermore, CFs instils a sense of community pride and an opportunity for residents to pay attention to the maintenance of the community. Again, it provides services for all, especially in the area of commuting, as well as preventing crime through active participation of residents.

Fakere, Alexander A., and Dorcas A. Ayeni. "Communal Facilities and Residential Neighbourhoods in Akure, Nigeria." Civil and Environmental Research 3.1 (2013): 48-56.

There are several ways on how density may impact on sustainability. Areas with  higher  density  would  give  the  opportunity  to  have  better  access  to services  and  local  facilities. Bramley et al. (2010, p. 111) stated that “there are reasons to expect access to services to be better in denser urban forms,  while  the  quality  of neighbourhood environment,  community  and social interaction may be less good in denser areas”. It was also claimed that higher density would promote commercial viability and  therefore  revived  public  realm.  Similarly,  Dempsey  et.al (2012) also claimed that residential density impacts several aspects of social

sustainability  and positive  influence  on  the  use  of  local  services  and facilities is the most obvious.  However, Bramley and Power (2009) argued that  in  terms  of  quality  of

neighbourhood environment,  community,  and social interaction it may  be better in lower density areas.

In terms of social interaction, higher density may provide more possibilities for people to meet each  other  on  the  street  than  slower  density  areas.  However,  beyond  a certain  level,  high  densities  may  make people  feel that  their  personal  space

is  compromised  and  the  sheer  number  of  people  makes  for  anonymity. Lower   densities   provide   less   potential   for

spontaneous  interaction  and  lead  to  greater  dependency  on  car  travel.

Rani, Wan Nurul Mardiah Wan Mohd. "Evaluating the impact of Density on Access to Local Facilities in Urban Neighbourhoods." PLANNING MALAYSIA 12 (2014).

Campaigns to improve diets or increase exercise or social contacts should target not only individ- uals but also public and private sector provision of a range of facilities including food retailing, social facilities, public transport, street lighting and cleaning, and policing. Intersectoral co-oper- ation may be crucial to providing a health pro- moting locality; policing or transport may be as important as the provision of health services (for example reducing policing in a public park may render it unsafe for women and children to use it, and reducing bus services may render people more dependent on relatively expensive local stores which do not stock a wide range of healthy foodstuffs).

MacIntyre, Sally, and Anne Ellaway. "Short reportSocial and local variations in the use of urban neighbourhoods: a case study in Glasgow." Health & place 4.1 (1998): 91-94.

Often there is a lack of recreational facilities, play grounds and opportunities for physical activity. In addition,environmental health risks such as high traffic load, heightend burden of noice and pollution and poor safety levels are often present in such neighbourhoods.

Westenhöfer, Joachim, Johanna Buchcik, and Jana Borutta. "Healthy Neighbourhoods: Health Promotion and Prevention in Urban Neighbourhoods." Proceedings 5th CARPE Conference: Horizon Europe and beyond. Editorial Universitat Politècnica de València, 2019.

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Malaysian government has a special commitment to provide the adequate, affordable housing and quality to all income levels, particularly for low-income group. Over the recent years, Malaysian property market was not balance in terms of supply and demand, where the demand is exceeding supply especially for low-cost housing. The first objective of this paper is to study the relationship between household income and housing affordability. Besides, the second objective is to examine housing satisfaction level by the residents focusing on the public low-cost flats under the supervision of Kuala Lumpur City Hall.

Housing affordability is the term used to describe medium- and low-income housing.. Housing
affordability is a concept that interprets socio-economic and development environments. According to Suhaida and Tawil (2010), it can be considered as a household selection decision function between housing and non-housing product expenditure

The aim for this paper is to examine housing satisfaction level by the residents focusing on the public low-cost flats under the management of Kuala Lumpur City Hall (KLCH). This paper has addressed the housing issue within the PPR low cost housing.

Mohd-Rahim, F. A., Zainon, N., Sulaiman, S., Lou, E., & Zulkifli, N. H. (2019). Factors affecting the ownership of low-cost housing for socio-economic development in Malaysia. Journal of Building Performance, 10(1), 1-16.

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Active transport – including walking for transport– [1,2,3,4] is both health-promoting and supports sustainable living [5, 6]. A growing body of international evidence [7,8,9,10], shows the built environment plays an important role in creating pedestrian-friendly neighbourhoods that promote walking and reduce chronic disease risk factors.

A number of built environment features are consistently shown to facilitate transport walking around residential homes, which are the origins of many walking trips. These include: highly connected streets, high population density, mixed land use and good access to destinations and transit, and sidewalk provision

Gunn, Lucy Dubrelle, et al. "Designing healthy communities: creating evidence on metrics for built environment features associated with walkable neighbourhood activity centres." International Journal of Behavioral Nutrition and Physical Activity 14.1 (2017): 1-12.

Within the existing evidence on the importance of neighborhood environmental attributes for active transport, more attention has been given to active transport to school than to other forms of active transport [27, 28]. A recent review of D’Haese et al. (unpublished data) showed that in a number of studies high neighborhood walkability, absence of freeway crossings, high land use mix accessibility and high neighborhood safety were associated with higher levels of active transport to school in children. Nevertheless, no consistent results were found concerning the association between active transport to school and other neighborhood environmental attributes like: land use mix diversity, street connectivity, the availability of walking and cycling infrastructure, the presence of sidewalks and cycle tracks, altitude differences, aesthetics, crime and traffic safety, recreational facilities and the degree of urbanization. Furthermore, no definite conclusions could be drawn with regard to the contribution of neighborhood built environmental attributes to explain active transport during leisure time (e.g. to visit friends).

De Meester, Femke, et al. "Parental perceived neighborhood attributes: associations with active transport and physical activity among 10–12 year old children and the mediating role of independent mobility." BMC public health 14.1 (2014): 1-14.

In particular, Healthy Neighborhoods believes that the health of any given neighborhood is dependent upon factors such as the availability of housing that is safe, lead-free, and affordable, healthy and accessible food, places to exercise safely, training and employment opportunities, good medical care, and social supports.
This also holds true when layering two different categories over each other such as food access and neighborhood safety. It might be intuitive that the clusters of food access will not overlap with clusters of neighborhood safety. If they do, this could tell Healthy Neighborhoods to ask a question in a future focus group like, do you ever feel unsafe buying groceries? If yes, why? Answers might inform healthy neighborhoods that a barrier to food access is lack of neighborhood safety.
By assessing what the most popular places where people go to eat, we can figure out what kind of food they are eating and question whether or not these options qualify as “healthy.”

Robert, Cata, Emily Halford, and Abby Myers. "Healthy Neighborhoods: Engaging Residents in Neighborhood Assessment." (2018).

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https://www.coroflot.com/ryanridge/AM-PM-Metaturnal-Office

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International Tropical Architecture Design 2015 - Green Office Status : Competition Entry
Year : 2015
Team : Laurel Jan, Laurensia Levina, Kevin Lie - by Ryan Ridge

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We designed a survey that integrates 22 items grouped into 5 dimensions (cleanness, visual aesthetics, landscape and nature, feeling of pressure, feeling of safety), as well as the socio-demographic attributes of the participants. Safety and cleanness related factors are considered in many studies, our findings confirm prior research as items related to the feeling of safety and cleanness appear to play a key role on the PNW. In this regard, factors related to safety have been found to play a substantial role in walking, especially for women.

Saadi, Ismaïl, et al. "A participatory assessment of perceived neighbourhood walkability in a small urban environment." Sustainability 14.1 (2021): 206.

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Europe is being severely challenged by the ageing of the population, and although for well over a decade now is looking for strategies to effectively increase the labour force participation of older workers and reduce the rates of early retirement and labour market exit, the unemployment amongst older people remains particularly high. The design and realization of age-friendly living and working environments is a huge challenge that we have just only started to address as the number of older citizens who are and want to continue being active members of society and live independently is constantly increasing. This paper introduces the SmartWork project, which aims at building a worker-centric Artificial Intelligence system for work ability sustainability, integrating unobtrusive sensing and modelling of the worker state with a suite of novel services for context and worker-aware adaptive work support.

Kocsis, Otilia, et al. "Smartwork: designing a smart age-friendly living and working environment for office workers." Proceedings of the 12th ACM International Conference on PErvasive Technologies Related to Assistive Environments. 2019.