Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial.

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.

Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events.

Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

Indigenous mental healthcare and human rights abuses in Nigeria: The role of cultural syntonicity and stigmatization.

Background: Indigenous mental healthcare using traditional non-western methods termed "unorthodox approaches" has been observed in Nigeria historically. This has been largely due to a cultural preference for spiritual or mystical rather than biomedical formulations of mental disorder. Yet, there have been recent concerns about human rights abuses within such treatment settings as well as their tendency to perpetuate stigmatization. Aim: The aim of this review was to examine the cultural framework for indigenous mental healthcare in Nigeria, the role of stigmatization in its utilization and interrogate the issues of human rights abuses within a public mental health context. Methods: This is a non-systematic narrative review of published literature on mental disorders, mental health service utilization, cultural issues, stigma, and indigenous mental healthcare. Media and advocacy reports related to human rights abuses in indigenous mental health treatment settings were also examined. International conventions on human rights and torture, national criminal legislation, constitutional provisions on fundamental rights and medical ethics guidelines relevant to patient care within the country were examined in order to highlight provisions regarding human rights abuses within the context of care. Results: Indigenous mental healthcare in Nigeria is culturally syntonic, has a complex interaction with stigmatization and is associated with incidents of human rights abuses especially torture of different variants. Three systemic responses to indigenous mental healthcare in Nigeria include: orthodox dichotomization, interactive dimensionalization, and collaborative shared care. Conclusions: Indigenous mental healthcare is endemic in Nigeria. Orthodox dichotomization is unlikely to produce a meaningful care response. Interactive dimensionalization provides a realistic psychosocial explanation for the utilization of indigenous mental healthcare. Collaborative shared care involving measured collaboration between orthodox mental health practitioners and indigenous mental health systems offers an effective as well as cost-effective intervention strategy. It reduces harmful effects of indigenous mental healthcare including human rights abuses and offers patients a culturally appropriate response to their problems.

An analysis of emotions and the prominence of positivity in #BlackLivesMatter tweets.

Emotions are a central driving force of activism; they motivate participation in movements and encourage sustained involvement. We use natural language processing techniques to analyze emotions expressed or solicited in tweets about 2020 Black Lives Matter protests. Traditional off-the-shelf emotion analysis tools often fail to generalize to new datasets and are unable to adapt to how social movements can raise new ideas and perspectives in short time spans. Instead, we use a few-shot domain adaptation approach for measuring emotions perceived in this specific domain: tweets about protests in May 2020 following the death of George Floyd. While our analysis identifies high levels of expressed anger and disgust across overall posts, it additionally reveals the prominence of positive emotions (encompassing, e.g., pride, hope, and optimism), which are more prevalent in tweets with explicit pro-BlackLivesMatter hashtags and correlated with on the ground protests. The prevalence of positivity contradicts stereotypical portrayals of protesters as primarily perpetuating anger and outrage. Our work offers data, analyses, and methods to support investigations of online activism and the role of emotions in social movements.

War and reintegration for girls and young women in northern Uganda: A scoping review.

BACKGROUND: During the civil war in northern Uganda (1986-2006), thousands of girls were abducted into rebel and government forces. Most of the females who were not abducted lived in abhorrent conditions in camps for internally displaced people (IDP). As the war was drawing to a close, reintegration programs emerged and some continue today. OBJECTIVE: Using a feminist lens, we conducted a scoping review to examine the literature written about these girls and young women. The impetus for this research was to determine the breadth of literature available; compare how this population is represented in the academic, practitioner and popular literature and to analyse how this representation may be impacting reintegration programming. METHODS: Key words were entered into 14 academic databases, search engines and practitioner websites. Articles were included if they covered the recruitment, retention, return, and/or reintegration of formerly abducted and/or war-affected girls and women and if they were published between 2005 and 2019. A total of 112 articles were categorized and coded according to topics, themes and theoretical approaches. RESULTS: Based on the findings of this scoping review, it appears that many articles describe formerly abducted and war-affected young women from a deficit-based perspective, while relatively fewer articles are written with a strength-based, resiliency-focused lens. CONCLUSION: Based on our analysis, we argue for a more nuanced representation of women formerly engaged with armed groups, and argue for a gendered, inclusive approach to reintegration programming.

Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis.

BACKGROUND: The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS. METHODS: A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted. RESULTS: The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I2 = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I2: 87.91 to 99.62). LIMITATIONS: Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected. CONCLUSIONS: The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.

Forensic Anthropology in Investigations of Crimes Against Humanity: Global Dimensions and the Mid-19th-Century Ajnala (India) Massacre.

Heinous crimes and brutalities have decimated humanity throughout human history. In modern times, forensic anthropologists have helped to reconstruct the nature and mechanism, intent and purpose, manner, and circumstances of various inhumane instances of genocides and violent crimes. Anthropologists endeavor to bring closure and comfort to bereaved families by disseminating information about the location, exhumation, and identification of the remains of victims. The methodological armamentarium and scope of forensic anthropology have developed much beyond the realms of the traditional biological profiling casework to the scenarios of humanitarian concerns. Humanitarian forensics focuses on the excavation and identification of the remains of victims and facilitates the dignified burial of the deceased. This review article highlights and exemplifies the significant contributions of forensic anthropological expertise in revealing various crimes against humanity and human rights violations committed in the recent past as well as in some contemporary cases reported from around the globe. It includes cases such as Guatemalan, Cambodian, and Bosnian genocides, as well as other mass killings that illustrate the efficacy of anthropological evidence in reconstructing the nature, mechanism, and circumstances related to these incidences. Special emphasis is given to the Ajnala (India) skeletal remains excavated from an abandoned well - remains reportedly belonging to 282 Indian soldiers killed in 1857 whose corpses were dumped into the said disused well by sanitary workers - indicating the importance of forensic anthropology in authenticating the occurrence of events as mentioned in historical records. Analysis of different case histories reveals that forensic anthropologists have played a significant role in recovery and identification of the victims of the many war crimes, genocides, racial conflicts, and violent cruelties committed against mankind in modern history.

Satellites can reveal global extent of forced labor in the world's fishing fleet.

While forced labor in the world's fishing fleet has been widely documented, its extent remains unknown. No methods previously existed for remotely identifying individual fishing vessels potentially engaged in these abuses on a global scale. By combining expertise from human rights practitioners and satellite vessel monitoring data, we show that vessels reported to use forced labor behave in systematically different ways from other vessels. We exploit this insight by using machine learning to identify high-risk vessels from among 16,000 industrial longliner, squid jigger, and trawler fishing vessels. Our model reveals that between 14% and 26% of vessels were high-risk, and also reveals patterns of where these vessels fished and which ports they visited. Between 57,000 and 100,000 individuals worked on these vessels, many of whom may have been forced labor victims. This information provides unprecedented opportunities for novel interventions to combat this humanitarian tragedy. More broadly, this research demonstrates a proof of concept for using remote sensing to detect forced labor abuses.

The "Real" Chechen Man: Conceptions of Religion, Nature, and Gender and the Persecution of Sexual Minorities in Postwar Chechnya.

In March of 2017, the Russian LGBT Network received their first reports of police violence against individuals in Chechnya because of their perceived sexual orientation. In the following months, news spread of a campaign of forced disappearances and torture specifically targeting suspected homosexual men. Between December, 2018 and February, 2019, police carried out another wave of unlawful detentions of men on the basis of their sexual orientation. The reports of unlawful detentions and extrajudicial killings of queer men may seem surreal in a world that has slowly grown more progressive with regard to LGBT rights issues. And yet, this violence is the reality faced by gay and bisexual men in Chechnya under Ramzan Kadyrov, the hypermasculine Chechen leader. This paper explores the ways in which religious practice, imaginations of nature, and conceptions of gender have influenced Chechnya's current anti-LGBT climate.