The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.
Exposure to green spaces may strengthen resilience and support mental health in the face of the covid-19 pandemic
Open accessAbstract
Background Several recent trials in chronic obstructive pulmonary disease (COPD) have assessed the effectiveness of the fluticasone–salmeterol combination inhaler in preventing COPD exacerbations, while finding an increased risk of pneumonia. The number needed to treat (NNT) is a simple measure to perform the comparative benefit–risk impact, but its calculation involving repeated outcome events such as COPD exacerbations has been incorrect. We describe the proper methods to calculate the NNT and, using data from published trials, apply them to evaluate the relative impact of fluticasone–salmeterol treatment on exacerbations and pneumonias in patients with COPD. Methods We review the fundamental definition of NNT and quantify it for situations with varying follow-up times. We review the ‘event-based’ NNT, proposed and used for repeated event outcomes, show its inaccuracy, describe its proper use and provide an approximate formula for its application. Results We show that a 1-year trial of the fluticasone–salmeterol combination versus salmeterol used the incorrect event-based approach to calculate the NNT as two patients that need to be treated for 1 year to prevent one COPD exacerbation, when the proper calculation results in a NNT of 14. In contrast, 20 patients need to be treated to induce one pneumonia case. For the TORCH trial, the NNT is 44 patients treated for 3 years with fluticasone–salmeterol versus salmeterol to prevent one exacerbation compared with 16 patients to induce one pneumonia case. Conclusions The NNT is a useful measure of the effect of drugs, but its proper calculation is essential to prevent misleading clinical practice guidelines.
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“On the other hand, exposure to nature may regulate stress, thus enhancing tolerance to negative emotions (34, 35), which may further reduce the risk of depression and anxiety (36, 37).”
From Can Viewing Nature Through Windows Improve Isolated Living? A Pathway Analysis on Chinese Male Prisoners During the COVID-19 Epidemic (2021) · cites this paper as [34]
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Nature and mental health: An ecosystem service perspective
Bratman, G. N., Anderson, C. B., Berman, M. G., Cochran, B., de Vries, S., Flanders, J., Folke, C., Frumkin, H., Gross, J. J., Hartig, T., et al. (2019) · Science Advances · doi:10.1126/sciadv.aax0903 · Cited by 2,001
Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health.
Pouso, S., Borja, Á., Fleming, L. E., Gómez-Baggethun, E., White, M. P., & Uyarra, M. C. (2021) · Science of The Total Environment · doi:10.1016/j.scitotenv.2020.143984 · Cited by 604
Aerts, R., Honnay, O., & Van Nieuwenhuyse, A. (2018) · British Medical Bulletin · doi:10.1093/bmb/ldy021 · Cited by 521
Self-citationSlater, S. J., Christiana, R. W., & Gustat, J. (2020) · Preventing Chronic Disease · doi:10.5888/pcd17.200204 · Cited by 419
Dzhambov, A. M., Hartig, T., Tilov, B., Atanasova, V., Makakova, D. R., & Dimitrova, D. D. (2019) · Environmental Research · doi:10.1016/j.envres.2019.108708 · Cited by 144
Mental health support through primary care during and after covid-19
Mughal, F., Hossain, M. Z., Brady, A., Samuel, J., & Chew-Graham, C. A. (2021) · BMJ · doi:10.1136/bmj.n1064 · Cited by 22
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Sia, A., Tan, P. Y., Wong, J. C. M., Araib, S., Ang, W. F., & Er, K. B. H. (2021) · Urban forestry & urban greening · doi:10.1016/j.ufug.2021.127448 · Cited by 85
Nigg, C., Petersen, E., & Macintyre, T. E. (2023) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2023.102009 · Cited by 37
Change of urban park usage as a response to the COVID-19 global pandemic
Zhao, H., Mailloux, B. J., Cook, E. M., & Culligan, P. J. (2023) · Scientific Reports · doi:10.1038/s41598-023-46745-1 · Cited by 34
The influence of the COVID ‐19 pandemic on the demand for different shades of green
Yap, K. K. L., Soh, M. C. K., Sia, A., Chin, W. J., Araib, S., Ang, W. P., Tan, P. Y., & Er, K. B. H. (2022) · People and Nature · doi:10.1002/pan3.10304 · Cited by 33
Li, H., Zhang, X., You, C., Chen, X., Cao, Y., & Zhang, G. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.720722 · Cited by 30
Metadata
- Authors
- Aerts, R., Vanlessen, N., & Honnay, O.
- Affiliations
- Sciensano (Belgium) (BE)
- KU Leuven (BE)
- Corresponding author
- Aerts, Raf
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-06-21
- Volume
- 373
- Pages
- n1601
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W3174017609
- Cited by
- 18
- References
- 6
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 8 · 2022: 4 · 2021: 3
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Document Server@UHasselt (UHasselt) (submittedVersion)
- Lirias (submittedVersion)
- Topics
- Social Sciences › Urban Studies › Urban Green Space and Health
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Keywords
- green spaces, nature exposure, resilience, mental health, COVID-19 pandemic, psychological well-being
- MeSH terms
- Parks, Recreational, COVID-19, SARS-CoV-2, Humans, Mental Health, Primary Health Care, Resilience, Psychological, Pandemics
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