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

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

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

Non‐invasive and tracheostomy invasive ventilation in amyotrophic lateral sclerosis: Utilization and survival rates in a cohort study over 12 years in Germany

Background and purpose: The aim of this study was to investigate utilization rates, treatment pathways and survival prognosis in patients with amyotrophic lateral sclerosis (ALS) undergoing non-invasive (NIV) and tracheostomy invasive ventilation (TIV) in a real-world setting. Methods: A prospective cohort study using a single-centre register of 2702 ALS patients (2007 to 2019) was conducted. Utilization of NIV/TIV and survival data were analysed in three cohorts: (i) non-NIV; (ii) NIV (NIV without subsequent TIV); and (iii) TIV (including TIV preceded by NIV). Results: A total of 1720 patients with available data were identified, 72.0% of whom (n = 1238) did not receive ventilation therapy. NIV was performed in 20.8% of patients (n = 358). TIV was performed in 9.5% of patients (n = 164), encompassing both primary TIV (7.2%, n = 124) and TIV with preceding NIV (2.3%, n = 40). TIV was more often utilized without previous NIV (25.7% vs. 8.3% of all ventilated patients), demonstrating that primary TIV was the prevailing pathway for invasive ventilation. The median (range) survival was significantly longer in the NIV cohort (40.8 [37.2–44.3] months) and the TIV cohort (82.1 [68.7–95.6] months) as compared to the non-NIV cohort (33.6 [31.6–35.7] months). Conclusions: Although NIV represents the standard of care, its utilization rate was low. TIV was mainly started without preceding NIV, suggesting that TIV may not be confined to NIV treatment escalation. However, TIV was pursued in a minority of patients who had previously undergone NIV. The survival benefit observed in the patients with NIV was equal to that reported in a controlled pivotal trial, but the prognosis with TIV is highly variable. The determinants of utilization of NIV/TIV and of survival (bulbar syndrome, availability of ventilation-related home nursing, cultural factors) warrant further investigation

Effects on the deformation-induced martensitic transformation in AISI 304 in external longitudinal turning

During the turning process of metastable austenitic steels, austenite is transformed into hard martensite by plastic deformation at low temperatures. This enables the production of components, which have both a hardened subsurface zone and a ductile core. Cryogenic cooling allows the subsurface zone to be hardened during machining, which leads to a shortening of the process chain. However, effects such as wear can make it challenging to adjust the properties of the subsurface zone during turning. By adjusting the tool microgeometry with a flank face modification, the wear condition can be kept constant for a certain period. In addition, the significance analysis with different tool microgeometries shows that only feed and initial temperature have a significant effect on the martensite formation. © 2021 The Author(s

Towards dry machining of titanium-based alloys : A new approach using an oxygen-free environment

In the current study, the potential of dry machining of the titanium alloy Ti-6Al-4V with uncoated tungsten carbide solid endmills was explored. It is demonstrated that tribo-oxidation is the dominant wear mechanism, which can be suppressed by milling in an extreme high vacuum adequate (XHV) environment. The latter was realized by using a silane-doped argon atmosphere. In the XHV environment, titanium adhesion on the tool was substantially less pronounced as compared to reference machining experiments conducted in air. This goes hand in hand with lower cutting forces in the XHV environment and corresponding changes in chip formation. The underlying mechanisms and the ramifications with respect to application of this approach to dry machining of other metals are discussed. © 2020, MDPI AG. All rights reserved