Multiple sclerosis treatment underutilization predicts high risk for obstructive sleep apnea in patients with multiple sclerosis.

BACKGROUND: Obstructive sleep apnea (OSA) is more common in patients with multiple sclerosis (MS) than in the general population, which suggests MS may predispose patients to OSA. However, the relationships between MS treatment, disease activity, disease severity, fatigue, and OSA are unknown. OBJECTIVES: To evaluate the connections between OSA risk, MS fatigue, and MS severity, controlling for well-established risk factors for OSA in the general population. METHODS: We administered OSA and fatigue-related questionnaires to patients with MS and collected relevant demographic and clinical data. Then, we utilized multivariate logistic regression to examine relationships between OSA risk and MS disease severity. RESULTS: We identified an inverse correlation between medication possession ratio (MPR) and high OSA risk. Statistical models also demonstrated a positive correlation between fatigue and nonwhite race with high OSA risk, controlling for male sex, younger age, and body mass index (BMI). CONCLUSION: We identified disease-modifying therapy (DMT) underutilization, fatigue, and nonwhite race as predictors of high OSA risk in patients with MS. These findings support aggressive treatment of MS to avoid risk of comorbid OSA and MS-induced fatigue.

Amina: Shaking Boundaries of a Woman Inhabited by the Spirits (Senegal).

In this article, I present the individual ethnography of Amina, a Senegalese woman possessed by the spirits of her lineage. Amina's story shows the lacerations of a person who simultaneously inhabits two worlds: the traditional Lebou culture and the Western one. When her spirits manifest themselves, she is forced to choose between two different interpretations of her suffering: the traditional persecutory and the Western psychopathological. She chooses the former but refuses the healers imposed by the tradition and turns to a priest of her choice, who proves to be sensitive to her need to personally own the healing journey. Amina strategically manipulates the plasticity of the traditional belief system without abandoning it; she bends it to shake the boundaries of herself, and her group and lineage. She uses the disruptive potential of possession and the irruption of the invisible world in the visible to renegotiate her role and acquire a new status in her group. She uses the performative dispositive of possession to renegotiate and expand her spaces of agency and affirm her tenacious subjectivity of a permanently liminal person, one who inhabits, shakes and redraws the boundaries between different worlds of meaning.

The effects of multifactorial pharmacist-led intervention protocol on medication optimisation and adherence among patients with type 2 diabetes: A randomised control trial.

Background: Patient-related factors and limited medication adherence in patients with chronic diseases, are associated with poor clinical outcomes, long-term complications, and increased overall disease costs. Many methods have been tested with mixed results, and innovative approaches are needed to encourage patients to adhere to their prescribed drug regimens. Methods: This randomised controlled trial examined a new multifactorial pharmacist-led intervention protocol (MPIP), including a medication therapy management (MTM) program with face-to-face counselling, patient-specific medication booklets, and a mobile application, from July 2021 to September 2022 in the Oud Al Touba diagnostic and screening ambulatory centre in 192 patients with type 2 diabetes in the United Arab Emirates. Medication adherence was assessed using the fixed medication possession ratio of medication refills and the medication adherence questionnaire. Results: At 12 months follow-up, participants in the MPIP showed significant improvement in overall medication adherence with total (composite) medication possession ratio (MPRt) of mean (±SD) 0.95 (±0.09) compared to 0.92 (± 0.09) in the control group with mean difference of 0.03 (95%, CI 0.01-0.06), P =0.02. In addition, improvement trend was evident in the MPIP group for all medication regimens with P value <0.01. Comparable results were noticeable in adherence questionnaire scores at the end of the study, with 66 participants in the intervention group scored zero on the questionnaire, suggesting high adherence to medication compared to the control group (48 participants only). The MTM program performed 41 clinical interventions on drug-related problems, compared to six interventions in the control group, and the use of mobile application and medication booklet have increased to 45.7% compared to 21.4% before study exit. Conclusions: The pharmacy intervention protocol effectively improved medication adherence and optimised medication regimens in diabetic patients with chronic medication regimens in an ambulatory healthcare centre.

Evaluation of HIV antiretroviral treatment adherence in 2019 using anonymized data from the French national health insurance claims data base: The COCOVIH study.

OBJECTIVE: Adherence to antiretroviral treatment (ART) plays a key role in achieving viral suppression in people living with HIV. We aimed to quantify ART adherence in the entire French HIV-infected population treated in 2019 and to determine factors of influence. METHODS: People living with HIV were identified using HIV diagnosis according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria, HIV-specific laboratory tests, and prescription of antiretrovirals in 2019. Adherence was measured using the medication possession ratio (MPR; actual divided by theoretical number of tablets). Variables of interest included sex, age, type of ART, relevant comorbidities, and receiving supplementary universal health coverage for low-income citizens (CMUc). RESULTS: Of the n = 211 124 people living with HIV identified between 2006 and 2019, we included n = 140 607 on ART with two or more prescription fills in 2019 in this analysis. In total, 87.5% of people living with HIV were receiving ART in 2019. Mean ± standard deviation MPR was 82.5 ± 22.7%; 57% of people living with HIV had an MPR ≥90%, and 12.7% had an MPR <50%. Those with an MPR ≥90% significantly differed between males and females (59.1% and 52.8%, respectively; p < 0.001), and between CMUc recipients and non recipients (54.1% and 57.6%, respectively; p < 0.001). MPR ≥90% rate was lower for those with chronic nephropathy (50.2%), renal failure (46.6%), and tuberculosis (50.1%), and for those using psychoactive substances (52.3%). Factors associated with MPR ≥90% in multivariable analysis were older age, male sex, not receiving CMUc, more recent HIV diagnosis, and triple (vs. dual) ART. CONCLUSION: In 2019, the average MPR in people living with HIV was 82.5% according to the comprehensive French health care database. Besides sociodemographic variables such as older age, male sex, and not being a CMUc recipient (i.e. of low socioeconomic status), more recent HIV diagnosis and triple therapy were independently associated with better adherence, possibly reflecting advances in ART tolerability and dosing.

Enhancing security in digitized healthcare system using blockchain technology.

BACKGROUND: In the modern medical industry, sensors and other medical electronic equipment such as ECG, thermometers, etc. that measure vitals like blood pressure, body temperature, heartbeat, and blood cells are used to record patient data. The information gathered helps to create a patient profile, which in turn helps doctors treat patients appropriately and helps users gain insights into their health. But, the information collected is regionally specific and not worldwide. Thus, this may create problems in transparency, integrity, and much more. The medical details of patients collected are stored in a simple database which appears to be a centralized application that is prone to be modified or hacked by intruders and also suffers from fault tolerance. OBJECTIVE: This paper aims to solve this problem using Blockchain and Data Possession methodologies. METHODS: Blockchain helps to store multiple copies of data in a decentralized fashion. Thus, a secured model could be implemented using blockchain in which the patient's data can be securely sent to any medical professional, thus promoting transparency, security, and integrity. RESULTS: Provable Data Possession helps the users to verify that their information is intact and has not been tampered. It can be achieved using cryptography which encrypts the information of the patients stored. CONCLUSION: This paper will be beneficial for the medical department and the public such that it will be beneficial in terms of transparency, scalability, and security.

Rituals as Nature-Based Governance of reciprocity between people and nature.

The conventional approach to environmental governance, based on institutions, regulations, and interventions, has failed to stop the current ecological catastrophe. I suggest a radical alternative: Ritual as the core mode of 'nature-based governance' (NBG) that enacts deep and comprehensive reciprocity between people and nature. NBG grounds governance mechanisms in embodied more-than-human practices with normative force. I build on theories of embodiment to suggest a general concept of ritual that is inspired by but generalizes over Indigenous thought and is informed by East Asian ideas about ritual as the pivot of social order. Further, the embodiment framework recognises ritual as a kind of action humans and non-humans share as living beings. Therefore, rituals can be harnessed in workable governance mechanisms to create and sustain communities of multi-species cohabitation. I distinguish between two basic types of reciprocity corresponding to two types of governance: Disembodied reciprocity enacted by conventional human-only governance schemes and embodied reciprocity enacted by NBG. Embodied reciprocity creates relationality of people and nature. Equipped with these theoretical insights, I suggest practical applications in the context of NBG of Nature-based solutions, discussing three stylized models. These are the formation of urban multi-species communities in urban gardening and urban forests, the commoning of ecosystem services of animal populations in wildfire protection, and reconceptualizing eco-compensation as a reciprocal ritual of gift-giving.

Religion and mental health: an Eastern Mediterranean region perspective.

In the last decade, spirituality gained increasing recognition, with an individualized approach to the significance of symptoms and the purpose of treatment. Many psychiatrists started adopting the term "biopsychosocial-spiritual" management. Modern psychological therapies have drawn from the principles of ancient Eastern traditions. However, the spiritual beliefs within Islam and their impact on mental well-being have yet to be studied sufficiently. The Eastern Mediterranean region is largely Muslim and shares similar cultural beliefs. This paper explores some of these beliefs and their impact on perceptions of mental health and help-seeking behavior. The paper will focus primarily on the religious ideologies, the concepts of punishment and reward from Allah (God) in the context of the high stigma associated with mental illness in the region, and the knowledge, attitudes, and perceptions toward people with mental illness. We will explore cultural beliefs in possession, evil eye, and black magic and how they influence treatment adherence. Traditional and faith healers remain very popular in this part of the world and are often the first line of treatment for people presenting with mental illness. Suicide and self-harming are particularly sensitive areas due to their religious implications in life and death, as well as the afterlife. Despite the global interest in the Eastern Mediterranean region, there still is a shortage of research on the intercultural aspects of this region, especially regarding mental health assessments. In this regard, we will explore some published literature from Qatar and draw comparisons with regional findings.

Mental states via possessive predication: the grammar of possessive experiencer complex predicates in Persian.

Persian possesses a number of stative complex predicates with dâshtan 'to have' that express certain kinds of mental state. I propose that these possessive experiencer complex predicates be given a formal semantic treatment involving possession of a portion of an abstract quality by an individual, as in the analysis of property concept lexemes due to Francez and Koontz-Garboden (Language 91(3):533-563, 2015; Natural Language and Linguistic Theory 34:93-106, 2016; Semantics and morphosyntactic variation: Qualities and the grammar of property concepts, Oxford University Press, 2017). Augmented with an analysis of prepositional phrases introducing the target of the mental state and an approach to gradability in terms of measure functions (Wellwood in Measuring predicates, PhD dissertation, University of Maryland, College Park, 2014), the analysis explains various properties of possessive experiencer complex predicates, including the behavior of target phrases, the ability of the non-verbal element to be modified by a range of adjectives, the direct participation of the non-verbal element in comparative constructions, and the ability of degree expressions to modify both the non-verbal element and the VP containing the complex predicate. Theoretically, the analysis ties transitive mental state expressions to the grammar and semantics of property concept sentences, which are expressed via possessive morphosyntax cross-linguistically, and connects with syntactic proposals that independently argue for a universal underlyingly possessive morphosyntax for mental state predicates (Noonan in Case and syntactic geometry, PhD dissertation, McGill University, 1992; Hale and Keyser in Prolegomenon to a theory of argument structure, MIT Press, 2002). The work here also motivates modifications to Francez and Koontz-Garboden's original proposal, and opens new questions in the original empirical domain of the analysis of possessive predicating strategies for the expression of property concept sentences.

Correction criteria for the qualitative analysis of the prison population: drugs possession/consumption and gender violence.

Introduction: People with language difficulties cannot face challenges related to social skills. Those language disorders affect academic, work environments, and social interaction, leading to maladaptive and aggressive behaviors. Young inmates are at high risk of experiencing unrecognized language deficiencies. It is, therefore, necessary to analyze linguistic pathologies that can influence criminal behavior (drugs possession/consumption and gender violence crimes). There are many standardized tests to evaluate and detect language difficulties in adults in English. However, there are relatively few options in Spanish; there are no tests that evaluate language qualitatively and in depth. Most of the research is conducted with children and adolescents. Objectives: To propose a reliable coding system for the correction and interpretation of narratives (essays and narratives) from the Battery for the Evaluation of Writing Processes (PROESC) in the prisoners charged of drugs possession or consumption and gender violence crimes. Design: The sample was composed of 287 men. Main outcome measures: They completed the Demographic, Offense, and Behavioral Interview in Institutions, the International Personality Disorders Examination (IPDE), and PROESC. Results: We found that the proposed coding system presented high concordance, that is, high inter-rater reliability. Conclusion: The classification system for the correction and interpretation of narratives was shown to be reliable.

Scientists and scientific journals should adhere to ethical standards for the use and reporting of data from Indigenous people.

Internationally, governments and scientists are bound by legal and treaty rights when working with Indigenous nations. These rights include the right of Indigenous people to control the conduct of science with Indigenous nations. Unfortunately, in some cases, individual scientists and scientific teams working with biological and genetic data collected from Indigenous people have not respected these international rights. Here, we argue that the scientific community should understand and acknowledge the historical harms experienced by Indigenous people under the veil of scientific progress (truth) and implement existing standards for ethical conduct of research and sovereign control of data collected within Indigenous communities (reconciliation). Specifically, we outline the rationale for why scientists, scientific journals and research integrity and institutional review boards/ethics committees should adopt, and be held accountable for upholding, current international standards of Indigenous data sovereignty and ethical use of Indigenous biological samples.

Relationship between persistence with topical antiglaucomatous prescription and patient socioeconomic status at a tertiary university hospital in Jerez de la Frontera (Spain).

INTRODUCTION: To study the relationship between socioeconomic status and persistence with topical antiglaucomatous medication. METHODS: A retrospective epidemiological observational cohort study was conducted with a sample of 1563 patients. The main dependent variable was persistence (medication possession ratio), the independent variable was socioeconomic status (deprivation index). Additional independent variables were used for multivariate analysis: individual health card index, sex, age, pharmacological group, number of eye drops, preservatives, diagnosis and concurrent medications. Bivariate statistical analysis was obtained using non-parametric tests. Logistic regression was used for multivariate analysis. The level of statistical significance was set at p < 0.05. RESULTS: We obtained data showing greater persistence in the groups with a higher socioeconomic level (deprivation index 1 and 2), with medication possession ratio values of 79.97 and 75.30, respectively) as opposed to the groups at lower socioeconomic levels (deprivation index 4 and 5, with medication possession ratio values of 73.75 and 69.85, respectively. Logistic regression corroborated this difference, reaching a significant value (no persistence in deprivation index group 5 versus 1) with OR = 1.62; 95%CI: 1.13-2.31. Additionally, lower persistence was detected in males, under 60 years of age, undergoing treatment with alpha-agonists, and in patients with ocular hypertension. DISCUSSION: Low socioeconomic status of the patient was significantly associated with decreased persistence with topical antiglaucomatous therapy.

Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease.

BACKGROUND: Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. METHODS: This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. RESULTS: High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41-0.83], 0.49 [0.25-0.95], 0.57 [0.40-0.81], and 0.70 [0.55-0.88], respectively). Kaplan-Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). CONCLUSION: Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.

Match running performance is influenced by possession and team formation in an English Premier League team.

The aim of this study was to examine the possession (very low, low, high, and very high), team formation (3-5-2 and 4-3-3) and position (centre-backs, full-backs, centre midfielders, attacking midfielders, and centre forwards) on match load across two consecutive seasons in elite soccer. Twenty-seven English Premier League outfield players were recruited. Data was monitored through an 18 Hz Global Positioning System and a 25 Hz semi-automated camera tracking system, respectively, and all variables were analysed per minute. Main effects for formation on total distance (TD) (p = 0.006; η 2 = 0.010), high-speed running (HSR) (p = 0.009; η 2 = 0.009), number of high metabolic load (HML) efforts (p = 0.004; η 2 = 0.011) were observed. In addition, there were significant interaction effects with formation × possession on TD (p < 0.001; η 2 = 0.043), HSR (p = 0.006; η 2 = 0.018), sprinting (p < 0.001; η 2 = 0.030), HML efforts (p < 0.001; η 2 = 0.035), accelerations (p < 0.001; η 2 = 0.025). From the position-specific analysis, only the running performance of centre-backs was affected by formation or positional factors. These results indicate that formation and possession can have a significant impact on TD, HSR, and HML distance. Furthermore, players performed more high-intensity efforts in 3-5-2 than 4-3-3 formation. These findings suggest that coaches can evaluate running performance in the context of formation and possession and tailor tactical strategies to optimise physical performance.

Quantification of Oversupply of Chronic Disease Medications among Patients Aged ≥55 Years in Japan.

Medication waste may be caused by medication oversupply; however, the degree of medication oversupply in Japan is unclear. This study aimed to quantify the degree of oversupply of chronic disease medications per patient, the proportion of oversupplied patients, and the excess days and costs of the oversupplied medications in Japan. This retrospective nationwide cohort study using a large insurance claims database from Japan was conducted in patients aged ≥55 years who received one or a combination of the following five classes of medications dispensed in FY 2019: third-generation calcium antagonists, angiotensin 2 receptor blockers, statins, dipeptidyl peptidase-4 inhibitors, and biguanides. Medications with the same ingredient having the same specification were treated as the same medication. Medication oversupply was defined as a medication possession ratio (MPR) during persistence >1.0. The proportions of oversupplied patients and excessively oversupplied patients with ≥30 excess days/year were approximately 16 and 1-2% for all drug classes, respectively. Three-quarters of the oversupplied patients had fewer excess day (≤14/year), and the median oversupplied medication cost was less than 1000 yen/year for all classes. However, there was a patient with oversupplied medication estimated as 983 excess days per year and a patient with oversupplied medication costs of nearly 90000 yen per year. Using the MPR and excess days as indicators, it is necessary to accelerate estimation of the oversupply per patient, as well as the development of patient intervention strategies and a national system to reduce medication oversupply.

Investigating adherence to tyrosine kinase inhibitors in renal cancer.

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) have been used as the first-line treatment for many patients with renal cell carcinoma (RCC), the seventh most common cancer in the United Kingdom. However, suboptimal adherence to TKIs can result in poor clinical prognosis. This study quantified RCC patients' adherence to TKIs and explored factors associated with suboptimal adherence. METHOD: This retrospective cohort study was conducted at a specialist oncology tertiary hospital in Northwest England, using pharmacy dispensing records between November 2021 and March 2022. TKI prescriptions dispensed to patients with RCC were extracted to calculate the persistency gaps (≥7 or ≥14 days) and medication possession ratio (MPR). Multilevel regression analysis was conducted to associate MPR and persistency gaps with specific patient-related and TKI-related factors. This study did not require ethics approval. RESULTS: Of the 2225 prescriptions dispensed to 109 patients, 469 (23.4%) and 274 (13.7%) persistency gaps of ≥7 and ≥14 days were identified. About 75% and 92% of patients had a persistency gap of ≥7 days within the first 90 days and 180 days. The length of time since the first TKI prescription (p < 0.001) and the use of sunitinib(p = 0.003) were significantly associated with the number of prescription gaps of ≥7 days. Moreover, the median MPR was 95.6% (interquartile range: 90.7%, 100.1%). Similarly, the length of time since the first TKI prescription was dispensed (p < 0.001) and the use of sunitinib (p = 0.034) were significantly associated with MPR. DISCUSSION AND CONCLUSION: This single-centre study found that patients with RCC generally adhere to TKIs (MPR > 90%), but many patients experienced a persistency gap. The crucial window to mitigate TKI utilisation is within 180 days after the initial dispensing of TKIs. Further large-scale studies are required to comprehensively investigate other factors associated with adherence to TKIs and develop interventions to improve adherence and medication use problems.

Analysis of writing in personality disorders in prison population.

Abstract: Writing involves the activation of different processing modes than reading comprehension, and therefore the level of activation varies depending on the moment and the task. Objectives: to analyze the profiles in terms of the proposed coding from the PROESC in terms of personality disorders [Antisocial Personality Disorder (ASPD) with drugs possession and consumption crimes (DPCC) and Obsessive-Compulsive Personality Disorder (OCPD)] with gender violence crimes (GVC) in the prisoners. Design: The sample was composed of 194 men. The participants were divided into two groups. Group 1 (ASPD; DPCC) consisted of 81 men, and Group 2 (OCPD; GVC) consisted of 113 men. Main outcome measures: They completed the Demographic, Offense, and Behavioral Interview in Institutions, the International Personality Disorders Examination (IPDE), and Writing Processes Evaluation Battery (PROESC). Results: Group 2 made more mistake than Group 1 in narratives tasks. Conclusion: Participants know phoneme-grapheme correspondence rules, language disturbances of a reiterative and persistent nature may appear in those who show compulsive behavior.

Who holds the social power? The development of children's social power perceptions in China.

This study examined the development of social power perceptions among Chinese children aged 3-5 years (N = 105). After watching videos about various social power cues, such as resource possession, resource control, goal achievement, permission, giving orders, setting norms and popularity, the children were asked to identify the powerful agents (whom do you believe is the more powerful person?) in the videos and provide explanations (why do you think he (she) is a powerful person?). Three-year-olds can recognize powerful agents who can grant 'permission' to other agents. By the age of 4, children begin to associate 'popularity', 'resource possession' and 'goal achievement' with social power. Five-year olds demonstrated the ability to recognize agents who control resources as being more powerful. Analysis of the reasons the children provided for their judgements revealed that for almost every cue (except giving orders), more than 14% of the responses highlighted 'possession of material resources' as an indicator of power. For children aged 3-5 years, 'resource possession' cues may be their preferred basis for inferring and explaining power differences. These results would facilitate researchers to further unravel the mechanisms underlying the development of children's social power perceptions.

The impact of Wheelchair Rugby classification lineup structure on possession outcome.

OBJECTIVES: To investigate the impact that the structure and combination of athlete classification within lineups has on possession outcome in Wheelchair Rugby (WR). DESIGN: Retrospective. METHODS: Analysis was conducted using data from all 18 WR matches from the 2020 Tokyo Paralympic Games. Pearson's chi-squared analysis was conducted to investigate the effect of lineup structures on performance and a nested generalised logistic mixed model (GLMM) was fitted to the data to investigate the association between independent variables and the outcome of possessions. Specifically, the impact of offensive and defensive lineup structures on possession outcome and whether the offensive and defensive lineup structures matching or not impact possession outcome. RESULTS: There was a significant relationship between the offensive lineup structure and possession outcome. Balanced lineups had greater turnovers than expected. Balanced lineups also had fewer tries than expected, whilst high-low lineups had fewer than expected turnovers. There were no significant associations between the defensive lineup structure and possession outcome. Furthermore, no significant associations were found between whether the structure of the offensive and defensive lineup matched (or not) and the possession outcome. CONCLUSIONS: The findings suggest that the offensive team's lineup structure plays a more prominent role in impacting possession outcome, compared to the defensive team's lineup structure. The present results provide valuable insights into WR performance for coaches, practitioners, and researchers.

Traditional health practitioners' understanding of spirit possession in Gauteng province, South Africa.

Background: Traditional health practitioners (THPs) understand spirit possession as a cultural or religious spirit occupying a person, while the mental healthcare providers understand it as a mental illness. The different understanding is based on manifestations that mimic that of mental illness, such as seeing and hearing things that others cannot see or hear. Spirit possession holds different meanings in different cultures and religions that could be either beneficial or detrimental. Furthermore, spirit possession is understood as a channel of communication between the living and the dead or God or a supernatural phenomenon in which a spirit owns a person. Aim: This study explored and interpreted THPs' understanding of spirit possession in Gauteng province, South Africa. Method: Hermeneutic phenomenology study explored and interpreted the THPs' understanding of spirit possession in Gauteng province. In-depth individual interviews were conducted with 12 THPs who were selected through snowball sampling techniques. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps of the analytic approach. Results: The findings revealed that THPs understood spirit possession as spiritual illness, ancestral calling and demonic spirit or witchcraft. Conclusion: Traditional health practitioners' understanding of spirit possession could promote mental health and prevent mental illness by providing support to a spirit-possessed person and referral to mental healthcare services. Contribution: This study contributed that not all manifestations presented by persons with spirit possession are actual and clear-cut mental illness, but could be unwritten cultural and/ or religious illnesses that needs cultural and religious services also.

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio.

Eosinophilic esophagitis (EoE) disease activity can be caused by treatment non-adherence. Medication possession ratio (MPR) is an established metric of medication adherence. A higher MPR correlates with better outcomes in several chronic diseases, but MPR has not been investigated with respect to EoE. A retrospective cohort study was performed using an established EoE registry for the years 2005 to 2020. Treatment periods were identified, MPRs were calculated, and medical records were assessed for histologic remission (<15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period. In total, 275 treatment periods were included for analysis. The MPR in the histologic remission treatment period group was 0.91 (IQR 0.63-1) vs. 0.63 (IQR 0.31-0.95) for the non-remission treatment period group (p < 0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥ 0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% confidence interval 1.79-5.30) and significantly decreased odds of dysphagia (OR 0.27, 95% CI 0.15-0.45), food impaction (OR 0.26, 95% CI 0.11-0.55), stricture occurrence (OR 0.52 95% CI 0.29-0.92), and esophageal dilation (OR 0.29, 95% CI 0.15-0.54). Assessing MPR before repeating an esophagogastroduodenoscopy may decrease unnecessary procedures in the clinical management of eosinophilic esophagitis.