Awareness challenges of mental health disorder and dementia facing stigmatisation and discrimination: a systematic literature review from Sub-Sahara Africa

Background: Mental health disorders (MHD) are leading causes of disabilities. Awareness of MHD in Sub-Saharan Africa (SSA) is crucial to both health care professionals and general community if those affected by MHD are to be allowed to live in dignity and be socially included, rather than being treated as outcasts or witches, as is presently the case. Therefore, this review aims to map and summarise the extent to which awareness of MHD and dementia in SSA challenges stigmatisation issues. Methods: A systematic review was conducted using electronic databases (PubMed, CINAHL, PsycINFO). A content analysis of selected studies was performed. Findings on awareness challenges and stigmatisation were identified and categorised. Results: A total of 230 publications were screened, 25 were selected for this review. The results demonstrate strong supernatural beliefs influencing peoples' perceptions of diseases. These perceptions promote stigmatising attitudes towards people with MHD and dementia. The education level correlated with stigmatising attitudes, whereby higher educated people were less likely to distance themselves socially from people with MHD and from people living with dementia (PwD). Astonishingly, even people educated in health issues (eg, nurses, medical practitioners) tended to have strong beliefs in supernatural causations of diseases, like witchcraft, and hold negative attitudes towards MHD and PwD. Conclusions: This review provides some evidence on the influence of traditional beliefs on MHDs in SSA. Those beliefs are powerful and exist in all segments in SSA-communities, promoting superstitious perceptions on diseases and stigmatisation. Awareness and education campaigns on MHD are absolutely mandatory to reduce stigmatisation

Dementia Awareness Challenges in Sub-Saharan Africa: A Cross-Sectional Survey Conducted Among School Students in Ghana

The survey focuses on identifying dementia awareness challenges among Ghanaian school students. Data were generated in a cross-sectional survey (n = 1137). 9.3% of school students showed dementia awareness whilst the community respondents, representing both higher age and level of education, showed greater awareness (32.2%, P < .001). 45% of respondents believed in witchcraft and 57% were afraid of potentially being harmed by witchcraft. Age and education did not influence people's belief in witchcraft. Moreover, dementia symptoms were often mistaken for witchcraft, especially by those who had encountered a person accused of witchcraft: "swearing at others" (24%), displaying "memory loss" and "confused speech" (22%), "forgetfulness" and who was seen "roaming around" (19%). Lack of dementia awareness was particularly evident among school students whereas belief in witchcraft was similar in both respondent groups. There was a correlation between low dementia awareness rates and misinterpretation of dementia symptoms with attribution to witchcraft

Reflecting on the boundaries of the demos : a virtual deliberative experiment with German citizens

This article combines the fields of deliberative theory and citizenship studies. Drawing from a deliberative experiment on foreigner political rights with almost 300 German citizens, we find that a short virtual deliberative treatment produced a clarification effect, whereby especially those with already negative views increased their scepticism. Participants in our deliberative treatment displayed higher levels of argument repertoire and integrative complexity, underlining that the treatment led to well‐considered opinions. A qualitative analysis of participants’ substantive rationales unravels traces of what De Schutter and Ypi dub ‘mandatory citizenship’, implying that political rights must be attached to obligations. These results have wide ranging implications: They indicate that the practice of deliberation is not quasi‐automatically programmed to progressive outcomes (as some have argued) but can have a communitarian dimension (where preferences are determined on the basis of existing communal values and self‐understandings); this suggests that participatory practices may not always advance progressive reforms

Structural and superelastic properties of Fe–Mn–Al–Ni shape memory alloy sheets produced on industrial process routes by hot rolling

In the present study the structural and functional properties of Fe–Mn–Al–Ni shape memory alloy sheets produced on an industrial process route focusing on hot rolling were investigated. The as-processed condition is characterized by a high fraction of the non-transforming γ-phase, which ensures good workability, but is associated with poor superelasticity. The alloy shows good structural properties with a yield strength of about 600 MPa, which is well above the usual transformation stress related to the martensitic phase transformation for the investigated alloy composition. After solution annealing, a microstructure showing no preferred orientation being characterized by distinctly larger grains is present. The results obtained reveal that the previous thermo-mechanical processing had no impact on the subsequent texture, however, provided a sufficient amount of driving force for abnormal grain growth. Imposed by a cyclic heat treatment, oligocrystalline structures with grain sizes above 10 mm can be achieved in the industrially processed material, which show superelastic properties similar to material processed in small batches in the laboratory

Abnormal Grain Growth and Pseudoelasticity of Industrially Processed Fe–Mn–Al–Ni Shape Memory Alloy Joined by Metal Inert Gas Welding

The effect of metal inert gas welding on the microstructure, abnormal grain growth and the pseudoelastic properties of industrially processed Fe–Mn–Al–Ni shape memory alloy sheets were studied. Square-butt welds were manufactured using similar filler material. The influence of alternating mean arc linear energy on the microstructure of the individual zones is shown. A correlation between the process parameters, the associated heat input, the grain morphology and the α/γ-ratio could be deduced. As the mean arc linear energy increases, the α/γ-ratio in the fusion zone and the heat-affected zone increases. To evaluate the influence of the welding process on abnormal grain growth, a post-weld cyclic heat-treatment was carried out. Although no loss of major alloying elements in the fusion zone was observed after welding, metal inert gas welding has a significant effect on grain growth upon cyclic heat treatment. While abnormal grain growth occurred in the base material, a polycrystalline microstructure characterized by significantly smaller grain sizes was visible in the former fusion zone. Incremental strain tests revealed severe plastic deformation near the grain boundaries in the former fusion zone. However, the grain boundaries of the bamboo-like grown grains in the base material turned out to be more critical for structural failure

Development of EN AW-6082 Metal Foams and Stochastic Foam Modeling for the Individualization of Extruded Profiles

Lightweight design and hybrid components enable innovative and new component concepts, especially when combining structurally reliable metal components with individualized polymer components. In this research, a process for additive manufacturing polymers on the surface of extruded aluminum profiles is examined. The extrusion process is adapted to produce foamable aluminum profiles, which can be utilized to enable a form fit between the two materials and ensures sufficient bond strength. For this purpose, a novel aluminum block material based on the standard wrought alloy EN AW-6082 was developed. It consists of a solid EN AW-6082 core and powder metallurgically produced outer layer, which allows local foaming of the aluminum profile surface. The main objective of this study was to optimize the bond strength of the hybrid aluminum-polymer components. The methods employed include fabricating aluminum test specimens, performing mechanical tests, x-ray microscopy to analyze the pore structure and evaluating the 3D pore distribution and the wall thickness. Virtual foam models were created to numerically investigate suitable pore sizes and foam geometries for form-fit with the polymer. The porosity achieved as a function of the processing of the components are discussed and a comparison is made between the real and virtual pore structures

Patient-Reported Outcome of Physical Therapy in Amyotrophic Lateral Sclerosis: Observational Online Study

Background: Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. Objective: The purpose of this study was to examine patients’ perception of physical therapy during symptom progression using an internet assessment approach. Methods: A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the progression of the disease with the ALS Functional Rating Scale-Revised (ALSFRS-R) and tracked the efficacy of targeted physical therapy using Measure Yourself Medical Outcome Profile (MYMOP). We used the net promoter score (NPS) to inquire into recommendation levels of physical therapy. Results: Forty-five participants with ALS were included in the study. Twenty-seven (60.0%) started the online assessment. The mean duration of physical therapy sessions per week was 142.7 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP input, the most concerning symptoms were reported in the legs (62.2%), arms (31.1%), and less frequently in the torso (6.7%). As expected for a progressive disease, there was a functional decline of 3 points in the ALSFRS-R at the end of the observation period (n=20). Furthermore, the MYMOP showed a significant loss of 0.8 in the composite score, 0.9 in the activity score and 0.8 in the targeted symptom. In spite of functional decline, the recommendation for physical therapy jumped from a baseline value of 20 NPS points to a very high 50 points at the end of study (P=.05). Conclusions: Physical therapy is perceived as an important treatment method by patients with ALS. Despite functional deterioration, patients are satisfied with physical therapy and recommend this intervention. The results also underline how the meaning of physical therapy changes throughout the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters

Real world experience of patients with amyotrophic lateral sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD)

Background: Treatment of spasticity poses a major challenge in amyotrophic lateral sclerosis (ALS) patient management. Delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (THC:CBD), approved for the treatment of spasticity in multiple sclerosis, serves as a complementary off-label treatment option in ALS-related spasticity. However, few structured data are available on THC:CBD in the treatment of spasticity in ALS. Method: A retrospective mono-centric cohort study was realised in 32 patients that meet the following criteria: 1) diagnosis of ALS, 2) ALS-related spasticity; 3) treatment with THC:CBD. Spasticity was rated using the Numeric Rating Scale (NRS). Patient’s experience with THC:CBD was assessed using the net promoter score (NPS) and treatment satisfaction questionnaire for medication (TSMQ-9) as captured through telephone survey or online assessment. Results: The mean dose THC:CBD were 5.5 daily actuations (range<1 to 20). Three subgroups of patients were identified: 1) high-dose daily use (≥ 7 daily actuations, 34%, n = 11), 2) low-dose daily use (< 7 daily actuations, 50%, n = 16), 3) infrequent use (< 1 daily actuation, 16%, n=5). Overall NPS was + 4.9 (values above 0 express a positive recommendation to fellow patients). Remarkably, patients with moderate to severe spasticity (NRS ≥ 4) reported a high recommendation rate (NPS: +29) in contrast to patients with mild spasticity (NRS<4; NPS: − 44). For the three main domains of TSQM-9 high mean satisfaction levels were found (maximum value 100): effectiveness 70.5 (±22.3), convenience 76.6 (±23.3) and global satisfaction 75.0 (±24.7). Conclusion: THC:CBD is used in a wide dose range suggesting that the drug was applied on the basis of individual patients’ needs and preferences. Contributing to this notion, moderate to severe spasticity was associated with an elevated number of daily THC:CBD actuations and stronger recommendation rate (NPS) as compared to patients with mild spasticity. Overall, treatment satisfaction (TSQM-9) was high. The results suggest that THC:CBD may serve as a valuable addition in the spectrum of symptomatic therapy in ALS. However, prospective studies and head-to-head comparisons to other spasticity medications are of interest to further explore the effectiveness of THC:CBD in the management of spasticity, and other ALS-related symptoms