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Background: Equitable access to health care is a challenge in many low-income countries. The most vulnerable segments of any population face increased challenges, as their vulnerability amplifies problems of the general population. This implies a heavy burden on informal care-givers in their immediate and extended households. However, research falls short of explaining the particular challenges experienced by these individuals and households. To build an evidence base from the ground, we present a single case study to explore and understand the individual experience, to honour what is distinctive about the story, but also to use the individual story to raise questions about the larger context. Methods: We use a single qualitative case study approach to provide an in-depth, contextual and household perspective on barriers, facilitators, and consequences of care provided to persons with disability and HIV. Results: The results from this study emphasise the burden that caring for an HIV positive and disabled family member places on an already impoverished household, and the need for support, not just for the HIV positive and disabled person, but for the entire household. Conclusions: Disability and HIV do not only affect the individual, but the whole household, immediate and extended. It is crucial to consider the interconnectedness of the challenges faced by an individual and a household. Issues of health (physical and mental), disability, employment, education, infrastructure (transport/terrain) and poverty are all related and interconnected, and should be addressed as a whole in order to secure equity in health. [ABSTRACT FROM AUTHOR]

The stock assessment data provided by ICES’s Arctic Fisheries Working Group represents a unique source of insight into the interplay between environmental factors, stock dynamics, fisheries and management decisions. This paper explores how the life history of year-classes constituting the Northeast Arctic cod stock could be used as performance measures for fisheries management. Five biological indicators are suggested for management evaluation, together with time series of environmental variables (ocean temperature and salinity). A brief evaluation of the indicator values indicates successful management of the cod stock, where most of the indicators develop in a positive direction, reflecting a sound stock situation in line with expressed management objectives. [ABSTRACT FROM AUTHOR]

Introduction: In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. Methods and analysis: The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents' life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people's organisations is collected separately. Ethics and dissemination: This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. [ABSTRACT FROM AUTHOR]

Background: Despite the high worldwide prevalence and association with other mental disorders and disability, only few studies are available on social phobia in low-income countries. Aims: This study aims to assess the prevalence, socio-demographic correlates and comorbidity of social phobia and its association with disability among long-term internally displaced persons (IDPs) in one urban and one rural area in Central Sudan. Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas.Results:The overall lifetime prevalence of social phobia was 14.2%, with higher rates among IDPs in the rural area and among those who were less educated. Social phobia was associated with other mental disorders in both study areas. Disability and prolonged displacement increased the risk of having social phobia in the rural area. Conclusion: Further work needs to be done to improve our understanding and to establish proper interventions in dealing with social phobia, other common mental disorders and disability among long-term IDPs in these impoverished areas. [ABSTRACT FROM AUTHOR]

Introduction The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. Methods This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. Results The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. Conclusion To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate gender differences in the importance of participation in core domains of life, and the association to perceived hindrances for return to work (RTW) before (T1) and after (T2) vocational rehabilitation. Methods: Two hundred-seventy (T1) and 149 (T2) respondents completed the questionnaire. Gender differences in the importance of participation were calculated using t-tests. A principal component analysis was conducted on 21 questions of hindrances for RTW. A four-component structure was chosen. The family care barrier component was kept as an outcome variable in the logistic regression. Results: There were mean gender differences in importance of participation in family prior to chronic pain and at T1. Importance of work changed from prior to pain to rehabilitation. At T1 children, age and importance of participation in work and family contributed to the model for women. For men importance of participation in leisure contributed to the model. The variables which contributed to the model at T2 for women were age and importance of participation in work and for men; children and importance of participation in leisure. Conclusion: Understanding gender differences in participation, and the association to hindrances for RTW, can enhance the rehabilitation counsellor's ability to work collaboratively with the clients. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country. Methods: A cross-sectional community survey ( n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated. Results: The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale. Conclusions: A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised. [ABSTRACT FROM AUTHOR]

The Northeast Arctic cod (NEA cod) fisheries in Norway are now one of the richest cod fisheries in the world. In the past the fishery has experienced several stock declines and low economic returns. In this paper we review management approaches applied over 20 years to address one of the most severe crises in the fishery. Emphasis is on management strategies and the measures carried out to ensure successful rebuilding of the fishery, both biologically and economically. Though the rebuilding of the Northeast Arctic cod fisheries has in many ways been a success, a multitude of issues connected to social and economic consequences still remain. The lessons learned from this study relate to management, legitimacy, and economic issues, and may be relevant to other struggling fisheries. [ABSTRACT FROM AUTHOR]

Aims: There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations.Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas.Results: The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area.Conclusion: This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate respon [ABSTRACT FROM AUTHOR]

Background: Health policies have the potential to be important instruments in achieving equity in health. A framework - EquiFrame -for assessing the extent to which health policies promote equity was used to perform an equity audit of the health policies of three international aid organizations. Objective: To assess the extent to which social inclusion and human rights feature in the health policies ofDFID (UK), Irish Aid, and NORAD (Norway). Method: EquiFrame provides a tool for analyzing equity and quality of health policies with regards to social inclusion and human rights. Each health policy was analyzed with regards to the frequency and content of a predefined set of Vulnerable Groups and Core Concepts. Results: The three policies vary but are all relatively weak with regards to social inclusion and human rights issues as defined in EquiFrame. The needs and rights of vulnerable groups for adequate health services are largely not addressed. Conclusion: In order to enhance a social inclusion and human rights perspective that will promote equity in health through more equitable health policies, it is suggested that EquiFrame can be used to guide the revision and development of the health policies of international organizations, aid agencies and bilateral donors in the future. Limitations: Analyses are limited to "policy on the books" and does not measure how effectively vulnerable groups are included in mainstream health policy work. [ABSTRACT FROM AUTHOR]