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Purpose: The aims of this study were to identify depression rates depending on the sex among elderly people living alone and to compare depression-related ecological system factors between two sex groups.Methods: A cross-sectional study was conducted using secondary data from the 7th Korean Longitudinal Study of Aging survey in 2018. A total of 893 elders living alone were included (152 men and 741 women). Hierarchical logistic regression was used to identify depression-related ecological system factors depending on the sex.Results: Men had significantly higher rates of depression (28.6%) than women (24.0%, p<.001). Depression-related ecological system factors in elderly women were higher educational level, poor subjective health status, impairment of instrumental activities of daily living, low satisfaction with children’s relation, financial based on children’s support, and rare meetings with close people. However, relation satisfaction with children was the only relevant depression-related ecological system factor in the men’s group.Conclusion: Our study findings show that depression-related ecological system factors vary depending on the sex of elderly people living alone. Thus, mental health professionals should provide sex-specific interventions to develop or implement depression-prevention strategies for the elderly living alone depending on the sex.

Abstract Introduction Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners’ (PCPs’) clinical decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece, Romania). Methods PCPs participated in an online questionnaire that asked for demographic data, practice characteristics, and information on health system factors. Participants were also asked to make clinical decisions in a vignette of a patient with possible lung cancer. Results The survey was completed by 475 PCPs. There were significant national differences in PCPs’ direct access to investigations, particularly to advanced imaging. PCPs from Bulgaria, Greece, and Romania were more likely to organise relevant investigations. The highest specialist referral rates were in Bulgaria and Romania. PCPs in Bulgaria were less likely to have access to clinical guidelines, and PCPs from Slovenia and Croatia were more likely to have access to a cancer fast-track specialist appointment system. The PCPs’ country had a significant effect on their likelihood of investigating or referring the patient. Conclusions There are large differences between Balkan region countries in PCPs’ levels of direct access to investigations. When faced with a vignette of a patient with the possibility of having lung cancer, their investigation and referral rates vary considerably. To reduce diagnostic delay in lung cancer, direct PCP access to advanced imaging, availability of relevant clinical guidelines, and fast-track referral systems are needed.

Background: Access to a doctor, nurse, or a midwife during childbirth is key to the global effort to reduce maternal mortality ratios. Ghana has recorded significant improvements in maternal care over the past three decades. However, despite many policies aimed at improving health care for pregnant women such as the free maternal care policy, many Ghanaian women still deliver without a skilled birth attendant present. This systematic review, therefore, sought to identify the various factors affecting utilisation of skilled birth attendance in Ghana. Methods: PubMed Central, African Journals Online (AJOL), CINAHL Plus with Full Text (EBSCO), and Science Direct were searched for studies from January 2010 to December 2020. A broad range of search terms was used. Studies included had diverse designs, were conducted among Ghanaian pregnant women, and had skilled delivery as an outcome of interest. The quality of studies was assessed. Due to the diversity of types of studies included in this systematic review (including qualitative, descriptive, and evaluative studies that ranged from simple bivariate analyses to complex multivariate modelling), a meta-analysis was neither possible nor appropriate. We, therefore, conducted a narrative synthesis of the search findings. Results: Twenty-four (24) studies met our inclusion criteria for this review. Included studies comprised sixteen (16) cross-sectional studies and eight (8) qualitative studies. The sample size of the included studies cumulatively was 86,998 participants. The emerging themes were: health system factors (10); maternal and family factors (5); and sociodemographic factors (9). Conclusion: In general, health system factors; maternal and family factors; and sociodemographic factors were found to influence skilled delivery services in Ghana. Therefore, in order to ensure that there is a skilled birth attendant present at every birth, efforts should aim at addressing social and cultural factors which have been identified as key determinants to utilisation of skilled delivery in Ghana.

Abstract BackgroundThe use of modern contraceptive methods among adolescents and youth is a public health priority to prevent unwanted pregnancies. To our knowledge, no study has ever explored and documented the promoting factors for contraceptive use among urban adolescents and youth in Guinea. The objective of this study was to explore the personal, community, and health system factors that promote the use of contraceptive methods among urban adolescents and youth in Guinea. MethodsWe conducted a qualitative exploratory and descriptive study with adolescents and youth aged 15 to 24 living in Conakry, Guinea. Data were collected through twenty-six individual in-depth interviews, and 10 group interviews with an additional eighty individuals, for a total of 106 participants. The investigation was conducted from June to October 2019. Both individual and group interviews were audio-recorded, and the verbatims were afterwards transcribed. Data was analyzed using the “thematic analysis” method (deductive and inductive approaches).ResultsThe personal factors favoring contraceptive use among adolescents and youth pertained to perceived benefits of the methods, knowledge of the family planning service channels, means to afford the cost of the method, and spouse/sexual partner approval. The community factors included peer suggestions about contraceptive methods, and socio-cultural beliefs about the method. The health system factors referred to access to free contraceptive methods, availability of methods, clinical competence and attitude of the health care provider to advise or administer methods, and proximity of family planning services to users’ place of residence. ConclusionsThis research shows that many adolescents and youth living in Conakry are sexually active and want to avoid unwanted pregnancy by using modern, traditional or cultural contraceptive methods. Access to free or affordable methods, discretion of method use, proximity and availability of methods, and suggestions of methods by peers are factors that motivate adolescents and youth to use contraception. This knowledge can inform policies and programs to improve the use of effective contraceptive methods by adolescents and youth living in Conakry, Guinea, and ultimately contribute to the optimal sexual and reproductive health of this population.

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

Abstract Aim Ride-sharing is an innovative on-demand transport service that aims to promote sustainable transport, reduce car utilization, increase vehicle occupancy and public transport ridership. By reviewing ride-sharing studies around the world, this paper aims to map major aspects of ride-sharing, including online platforms, user factors and barriers that affect ride-sharing services, and extract useful insights regarding their successful implementation. Method A systematic literature review is conducted on scientific publications in English language. Articles are eligible if they report a study on user factors affecting ride-sharing use and/or barriers preventing ride-sharing implementation; ride-sharing online platforms in these articles are also recorded and are further explored through their official websites. A database is built that organizes articles per author, year and location, summarizes online platform attributes, and groups user factors associated with the likelihood to ride-share. Findings The review shows that the term “ride-sharing” is used in the literature for both profit and non-profit ride-sharing services. In total, twenty-nine ride-sharing online platforms are recorded and analyzed according to specific characteristics. Sixteen user factors related to the likelihood to ride-share are recorded and grouped into sociodemographic, location and system factors. While location and system factors are found to follow a pattern among studies, mixed findings are recorded on the relationship between sociodemographic factors and ride-sharing. Factors that may hinder the development of ride-sharing systems are grouped into economic, technological, business, behavioral and regulatory barriers. Conclusion Opportunities exist to improve the quality of existing ride-sharing services and plan successful new ones. Future research efforts should focus towards studying ride-sharing users' trip purpose (i.e., work, university, shopping, etc.), investigating factors associated to ride-sharing before and after implementation of the service, and perform cross-case studies between cities and countries of the same continent to compare findings.

Low level of in-class participation can be a problem for lecturers when they teach Asian students. One of the reason is the characteristics of the Asian students, which are quiet and passive. Active learning is needed to solve this problem. Gamification is one of the things that can improve active learning. This study aims to understand how to design gamification system for higher education teaching, the factors contributed to the gamification system in higher education, and the impacts of the gamification system for students with the case study of Bina Nusantara University in Indonesia. The finding shows that there are several things to consider in designing gamification system. Factors in the system, the lecturers, the course, and the students also take important parts in the implementation. When it is done correctly, there will be a lot of positive impacts for the students and the teaching.