Hypertension and depression are increasingly common noncommunicable diseases in Ghana and worldwide, yet both are poorly controlled. We sought to understand how healthcare workers in rural Ghana conceptualize the interaction between hypertension and depression, and how care for these two conditions might best be integrated. We conducted a qualitative descriptive study involving in-depth interviews with 34 healthcare workers in the Kassena-Nankana districts of the Upper East Region of Ghana. We used conventional content analysis to systematically review interview transcripts, code the data content and analyze codes for salient themes. Respondents detailed three discrete conceptual models. Most emphasized depression as causing hypertension: through both emotional distress and unhealthy behavior. Others posited a bidirectional relationship, where cardiovascular morbidity worsened mood, or described a single set of underlying causes for both conditions. Nearly all proposed health interventions targeted their favored root cause of these disorders. In this representative rural Ghanaian community, healthcare workers widely agreed that cardiovascular disease and mental illness are physiologically linked and warrant an integrated care response, but held diverse views regarding precisely how and why. There was widespread support for a single primary care intervention to treat both conditions through counseling and medication.

Non-specialist mental health interventions serve as a potential solution to reduce the mental healthcare gap in low- and middle-income countries, such as Sri Lanka. However, contextual factors often influence their effective implementation, reflecting a research-to-practice gap. This study, using a qualitative, participatory approach with local mental health workers (n = 9) and potential service users (n = 11), identifies anticipated barriers and facilitators to implementing these interventions while also exploring alternative strategies for reducing the mental healthcare gap in this context. Perceived barriers include concerns about effectiveness, acceptance and feasibility in the implementation of non-specialist mental health interventions (theme 1). The participants’ overall perception that these interventions are a beneficial strategy for reducing the mental healthcare gap was identified as a facilitating factor for implementation (theme 2). Further facilitators relate to important non-specialist characteristics (theme 3), including desirable traits and occupational backgrounds that may aid in increasing the acceptance of this cadre. Other suggestions relate to facilitating the reach, intervention acceptance and feasibility (theme 4). This study offers valuable insights to enhance the implementation process of non-specialist mental health interventions in low-and middle-income countries such as Sri Lanka.

Compared to the global average, the exit rate of old-aged Iranian labourers is significantly higher than that of middle-aged, raising the hypothesis that social security generosity pulls older workers into early retirement. We used a unique individual dataset of Iran’s Social Security Organization (ISSO), including 267, 000 newly retired in 2016 and 2018, to assess the impact of ISSO’s pension policies on employees’ retirement age. In a counterfactual evaluation design, this study first estimated the implicit tax on work continuation and then applied the Heckman two-stage selection model. The findings show that ISSO’s retirement rules determining the age of exit and benefit eligibilities significantly increase the retirement probability and simultaneously decline the retirement age. Moreover, the implicit tax on work continuation, which reflects ISSO’s benefit formula, has a significant positive effect on retirement probability. The replacement rate also has a significant negative impact on retirement age. The retirement probability in hazardous jobs is higher than in normal ones, while exemptions significantly fall the outflow age of hazardous job holders. To maintain the scheme’s sustainability, reforms have to target an increase in the statutory retirement age, a reduction in the accrual rate, the calculation of reference salary for more extended periods, and the decline of the exemption coefficient for hazardous jobs.

Economic sanctions have inflicted various economic difficulties on Iranian families. The extent to which these sanctions-induced calamities have affected Iranian older adults’ material well-being remains unknown. Meanwhile, inadequate institutional support for the disadvantaged older population may worsen their precarious economic well-being. We use household-level surveys and quantile regression analysis to explore changes in Iranian older persons’ material well-being during the sanctions era. We also examine whether Iran’s pension system has alleviated the adverse effects of economic sanctions. Our investigation indicates that older adults’ material well-being decreases during sanctions. However, those without pension coverage are economically more vulnerable compared with pensioners. Among the non-pensioners, low-income and low-consumption ones are susceptible to relatively more considerable material well-being losses. To protect these vulnerable groups, policymakers should implement appropriate policy interventions, such as expansions in non-contributory anti-poverty schemes.

In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool’s performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.

There is a growing recognition of the benefits of collaborating with people with lived experience (PWLE) of mental health conditions in mental health research and implementation of services. Such collaboration has been effective in reducing mental health stigma and improving the quality of mental health care. Here, we describe using PhotoVoice as a collaborative method in which PWLE use visual narratives to tell their recovery stories for promoting social contact, debunking myths and reducing stigma. First, we outline the framework of this collaboration, drawing on theories from medical anthropology and social psychology and focusing on reducing mental health stigma among primary healthcare workers. Then, we describe the process using our learnings from implementing PhotoVoice in Nepal, Ethiopia and Uganda. We highlight collaboration in five key steps with associated considerations: (1) identifying PWLE for collaboration; (2) training in photography, distress management and presentation skills; (3) developing a photographic recovery story; (4) training healthcare workers using the PhotoVoice narratives; and (5) ongoing support of mental health systems strengthening in collaboration with PWLE. Then, we critically reflect on the process, highlighting the benefits and challenges to the participants and researchers, thereby paving the way for expanding collaborations with PWLE using the PhotoVoice method.

In the recent years, there has been an upsurge in the number of countries that are mainstreaming gender equality concerns in their trade and investment agreements. These recent developments challenge the long-standing assumption that trade, investment, and gender equality are not related. They also show that gender mainstreaming in trade and investment agreements is here to stay. However, very few countries – mostly developed countries – have led this mainstreaming approach and have made efforts to incentivize other countries to negotiate gender-responsive trade and investment agreements. The majority of developing countries are yet to take their first steps in negotiating such policy instruments with a gender lens, and their hesitation can be grounded in various reasons including fears of protectionism, lack of data, paucity of understanding and expertise, and, more broadly, constraints relating to their negotiation capacity. Moreover, the inclusion of gender-related concerns in the negotiation of such agreements has deepened and widened the negotiation capacity gap between developed and developing countries. In this article, the authors attempt to assess this widening negotiation capacity gap with the help of empirical research, and how this capacity gap can lead to disproportionate and negative repercussions for developing countries more than developed countries.

Why do oil-dependent developing countries exhibit divergent responses to oil crises? This study employs a comparative case study approach and utilizes a ‘most similar system design’ to examine the varying state responses to the 1973 oil shock in Turkey and South Korea. While the former refrained from implementing radical short-term adjustment policies and reforms, the latter adopted proactive measures to mitigate the worsening impact of escalating oil prices. This research contends that the existing literature, which emphasizes distinctions in industrialization strategies and fiscal policies among developing nations, offers an incomplete explanation for the divergent reactions of states to external price shocks. Instead, the study proposes a sociological perspective, focusing on the influence of varying degrees of state autonomy and the characteristics of bureaucratic systems on the decision-making processes of states. The key finding suggests that while pre-crisis economic policies and industrialization strategies may limit the array of policy tools available to counteract the adverse effects of an oil crisis, the extent of state autonomy and the organization of the bureaucracy – whether adhering to Weberian or non-Weberian principles – impact the efficacy of these policy tools and the determination of decision-makers to act in the best interests of the long-term public good.

As mental health issues continue to rise in Latin America, the need for research in this field becomes increasingly pressing. This study aimed to explore the perceived barriers and resources for research and publications among psychiatrists and psychiatry trainees from nine Spanish-speaking countries in South America. Data was collected through an anonymous online survey and analyzed using descriptive methods and the SPSS Statistical package. In total, 214 responses were analyzed. Among the participating psychiatrists, 61.8% reported having led a research project and 74.7% of them reported having led an academic publication. As for the psychiatry trainees, 26% reported having conducted research and 41.5% reported having published or attempted to publish an academic paper. When available, having access to research training, protected research time and mentorship opportunities were significant resources for research. Further support is needed in terms of funding, training, protected research time and mentorship opportunities. However, despite their efforts to participate in the global mental health discussion, Latin American psychiatrists and psychiatry trainees remain largely underrepresented in the literature.

Brazil has changed its negotiation strategy in World Trade Organization (WTO) negotiations. In the first half of the WTO era (1995–), Brazil adopted a strong developing country leadership role as coordinator and spokesperson of the G20 group of developing countries. More recently, however, this group has disappeared from the negotiation scene. This article examines how Brazil has departed from a 2000 status quo and arrived at a more flexible approach, less reliant on the industrialized-developing divide as a structuring principle of its diplomacy. Using WTO negotiation documents, trade delegate interviews, dispute settlement case law, and secondary literature, I outline the contours of new directions in Brazilian trade policy. These include joint legislative initiatives with the EU, a move towards the plurilateral level on non-traditional issues, a greater heterogeneity of dispute settlement targets, and a newly flexible handling of its rights under the WTO's special and differential treatment status. The article contributes to ongoing debates on Brazil's status in international affairs, its reliance on large coalitions, and the maintenance of followership as key directives of its foreign policy, and scholarship that sees Brazil as stuck in a ‘graduation dilemma’.

We argue that education's effect on political participation in developing democracies depends on the strength of democratic institutions. Education increases awareness of, and interest in, politics, which help citizens to prevent democratic erosion through increased political participation. We examine Senegal, a stable but developing democracy where presidential over-reach threatened to weaken democracy. For causal identification, we use a difference-in-differences strategy that exploits variation in the intensity of a major school reform and citizens’ ages during reform implementation. Results indicate that schooling increases interest in politics and greater support for democratic institutions—but no increased political participation in the aggregate. Education increases political participation primarily when democracy is threatened, when support for democratic institutions among educated individuals is also greater.

Health systems globally demand more competent workers but lack competency-based training programs to reach their goals. This study evaluates the effectiveness of a competency-based curriculum (EQUIP-FHS) for trainers and supervisors to teach foundational helping knowledge, attitudes and skills, guided by the WHO/UNICEF EQUIP platform, to improve the competency of in-service and pre-service workers from various health and other service sectors. A mixed-methods, uncontrolled before-and-after trial was conducted in Nepal, Peru, and Uganda from 2020 to 2021. Trainees’ (N = 150) competency data were collected during 13 FHS trainings. Paired t-tests assessed pre- to post-change in ENACT competency measures (e.g., harmful, helpful). Qualitative data was analyzed using thematic analysis. EQUIP-FHS trainings, on average, were 20 h in duration. Harmful behaviors significantly decreased, and helpful behaviors significantly increased, across and within sites from pre-to post-training. Qualitatively, trainees and trainers promoted the training and highlighted difficult competencies and areas for scaling the training. A brief competency-based curriculum on foundational helping delivered through pre-service or in-service training can reduce the risk that healthcare workers and other service providers display harmful behaviors. We recommend governmental and nongovernmental organizations implement competency-based approaches to enhance the quality of their existing workforce programming and be one step closer to achieving the goal of quality healthcare around the globe.