Background:While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults.Methods:This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute – depression outcome and by combining all depression outcomes.Results:Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied.Conclusion:This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute – depression outcome associations.

Family harmony, an important Confucian ideal in Chinese society is believed to determine family happiness and therefore health, but is this accurate? This is a qualitative study of 41 Hong Kong Chinese family members. Individual recorded interviews were thematically analysed describing perceived interactions between harmony, happiness and health. Family harmony comprised four components: communication, mutual respect, lack of conflict and family time [notably ‘Gou tong’ (in Cantonese 溝通)—opportunity and willingness to spend time together—requiring good interpersonal communication, emphasized by female respondents]. Lack of conflict was emphasized, while diverse values, parenting styles and financial difficulties were common causes of conflict. Respect required reciprocity. Family happiness comprised four elements: family harmony, an important pre-requisite; mutual caring and supportive orientation; sense of security emphasizing financial security in middle-class versus sense of togetherness in lower social class groups and contentment. Healthy families were harmonious; ‘typical’ (children/two-parent/two-grandparent); happy; caring and respectful, with individual health and healthy behaviours. Family harmony, happiness and health are interrelated and built on a communicative, respectful, caring and contented set of attitudes, in particular allowing for family time. Harmony is apparently a core element of good family functioning.

Walking for transport can contribute to the accrual of health-enhancing levels of physical activity in elders. Identifying destinations and environmental conditions that facilitate this type of walking has public health significance. However, most findings are limited to Western, low-density locations, while a larger proportion of the global population resides in ultra-dense Asian metropolises. We investigated relationships of within-neighborhood objectively-measured destination categories and environmental attributes with walking for transport in 484 elders from an ultra-dense metropolis (Hong Kong). We estimated relationships of diversity (number of different types) and prevalence of within-neighborhood destination categories (environmental audits of 400 m buffers surrounding residential addresses) with transport-related walking (interviewer–administered questionnaire) in 484 Chinese-speaking elders able to walk unassisted and living in 32 neighborhoods stratified by socio-economic status and transport-related walkability. We examined the moderating effects of safety and pedestrian infrastructure-related neighborhood attributes on destination-walking associations. Participants reported on average 569 and 254 min/week of overall and within-neighborhood walking for transport, respectively. The prevalence of public transit points and diversity of recreational destinations were positively related to overall walking for transport. The presence of a health clinic/service and place of worship, higher diversity in recreational destinations, and greater prevalence of non-food retails and services, food/grocery stores, and restaurants in the neighborhood were predictive of more within-neighborhood walking for transport. Neighborhood safety-related aspects moderated the relationship of overall walking for transport with the prevalence of public transit points, this being positive only in safe locations. Similar moderating effects of safety-related attributes were observed for the relationships of within-neighborhood walking for transport with diversity of recreational and entertainment destinations. Pedestrian-infrastructure attributes acted as moderators of associations of within-neighborhood walking for transport with prevalence of commercial destination categories. Composite destinations indices consisting of destination categories related to the specific measures of walking were positively associated with walking for transport. The availability of both non-commercial and commercial destinations may promote within-neighborhood walking for transport, while recreational facilities and public transit points may facilitate overall walking for transport. However, destination-rich areas need to also provide adequate levels of personal safety and a physically-unchallenging pedestrian network.

Objective To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. Design Randomised controlled trial. Setting University of Hong Kong, 2001. Participants 169 fourth year medical students. Main outcome measures Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. Results The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. Conclusions Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making.

Presenteeism is a behavior in which an employee is physically present at work with reduced performance due to illness or other reasons. Hospital doctors and nurses are more inclined to exhibit presenteeism than other professional groups, resulting in diminished staff health, reduced team productivity and potentially higher indirect presenteeism-related medical costs than absenteeism. Robust presenteeism intervention programs and productivity costing studies are available in the manufacturing and business sectors but not the healthcare sector. This systematic review aims to 1) identify instruments measuring presenteeism and its exposures and outcomes; 2) appraise the related workplace theoretical frameworks; and 3) evaluate the association between presenteeism, its exposures and outcomes, and the financial costs of presenteeism as well as interventions designed to alleviate presenteeism amongst hospital doctors and nurses. A systematic search was carried out in ten electronic databases from 1998 to 2017 and screened by two reviewers. Quality assessment was carried out using the Critical Appraisal Skills Program (CASP) tool. Publications meeting predefined assessment criteria were selected for data extraction. A total of 275 unique English publications were identified, 38 were selected for quality assessment, and 24 were retained for data extraction. Seventeen publications reported on presenteeism exposures and outcomes, four on financial costing, one on intervention program and two on economic evaluations. Eight (39%) utilized a theoretical framework, where the Job-Demands Resources (JD-R) framework was the most commonly used model. Most assessed work stressors and resources were positively and negatively associated with presenteeism respectively. Contradictory and limited comparability on findings across studies may be attributed to variability of selected scales for measuring both presenteeism and its exposures/outcomes constructs. The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures, economic costs, or interventions amongst hospital healthcare workers. This review will aid researchers in developing a standardized multi-dimensional presenteeism exposures and productivity instrument to facilitate future cohort studies in search of potential cost-effective work-place intervention targets to reduce healthcare worker presenteeism and maintain a sustainable workforce.