Yoga and Mental Well-being: A Qualitative Exploration of the Lived Experiences of Yoga Practitioners

Context

Participation in yoga has increased dramatically amongst all demographic groups in recent decades. While studies have explored the physical and mental benefits of yoga, few have focused on the lived experiences of those practicing yoga and why they continue their involvement.

Aims

The purpose of this study was to assess practitioners' views about the impact of yoga on mental well-being and explore how these benefits may support their continued practice.

Settings and Design

Semi-structured interviews were conducted with 22 individuals, the majority identified as female (M age = 44.25, standard deviation = 11.80). The majority of participants were White (86.36%) and had practiced yoga for an average of 8-10 years (40.91%).

Methods

A pragmatic qualitative approach was taken that included the adoption of a constructivist, narrative, meaning-making ontology, hermeneutic epistemology, and interpretivist axiology. Interviews were conducted on Zoom, recorded, and transcribed verbatim.

Analysis Used

Interviews were coded independently by two team members following reflexive thematic analysis procedures.

Results

Two major themes, structural and functional components, covered the five main subthemes that explained why yoga was beneficial for mental well-being and highlighted the self-sustaining nature of yoga practice: (1) the yoga environment, (2) personnel, (3) strengthening of mind and body during practice, (4) transfer of skills, and (5) giving back. The practitioners described how their yoga journeys supported their mental well-being and encouraged the long-term maintenance of their yoga practices. A conceptual model will be presented that incorporates the major themes and provides an explanation of why practitioners continue to practice yoga.

Conclusions

This study provides insight into how yoga's mental well-being benefits affect adherence, and ultimately, informs our understanding of yoga as a self-sustaining practice.

Design of value-added tax on medicines in 41 European countries

Background

Recently, among others due to the COVID-19 pandemic and the war in Ukraine, European countries have been experiencing rising inflation. Value-added taxes (VAT) on essential goods have gained public attention, and abolishing VAT for these goods has been discussed as a measure to prevent poverty and inequities. The study aims to investigate the relevance of value-added tax on medicines in European countries.

Methods

We collated information on medicines-specific and standard VAT rates in 41 countries of the WHO European Region (all 27 European Union Member States, Albania, Armenia, Iceland, Israel, Kazakhstan, Kyrgyzstan, Kosovo, Moldova, North Macedonia, Norway, Serbia, Switzerland, Turkey and United Kingdom). Data were reviewed from literature and were validated by national public authorities.

Results

In three countries (Albania, Kazakhstan and Malta), all medicines are exempt from VAT. 28 of the 38 countries with VAT on medicines impose a single VAT rate on all medicines, and in most of these countries (21 countries) the medicines-related VAT is lower than the standard VAT rate. Ten countries have differentiated VAT rates: In Ireland, Kyrgyzstan, Sweden and the UK defined medicines (e.g. oral medicines, prescription-only medicines) are exempt from VAT, whereas for the other medicines the standard VAT rate applies; six further countries have a lower VAT rate for some medicines (e.g. heparins, blood products, contraceptives or reimbursed medicines in general) compared to the remaining medicines, whose VAT rate equal the standard rate or is lower.

Conclusions

Some European countries apply specific mechanisms (exemptions, reduced rates) regarding the VAT for defined or all medicines. This may act as a protective measure for patients in case of non-reimbursed medicines and help public payers to ensure financial sustainability to funded medicines. Further medicines-specific research is needed to understand the impact of inflation.

Key messages

• Value-added tax is a relevant component of medicine prices.

• Lowering or abolishing the VAT on medicines can be an important policy espeically when patients pay out-of-pocket.

Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

BACKGROUND

There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability.

METHODS

For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria, France, Germany, Greece, Hungary, the Netherlands, Poland, Romania, Spain, Sweden, and the UK). Price data (public procurement prices in LATAM and ex-factory prices in Europe) in US dollar purchasing power parities (PPP) were analyzed per defined daily dose. Affordability was measured by setting medicines prices in relation to national minimum wages.

RESULTS

The prices of cancer medicines varied considerably between countries. In European countries with higher levels of income, PPP-adjusted prices tended to be lower than in European countries of lower income and LATAM countries. Except for one medicine, all surveyed medicines were considered unaffordable in most countries. In European countries of lower income and LATAM countries, more than 15 days' worth of minimum wages would be required by a worker to purchase one defined daily dose of several of the studied medicines.

CONCLUSIONS

The high prices and large unaffordability of cancer medicines call for strengthening pricing policies with the aim of ensuring affordable treatment in cancer care.

Measures to manage, reduce and prevent medicines shortages in European countries in 2020

Background

Several countries have seen an increase in medicines shortages that constitute a major public health threat as they can negatively impact the health outcomes of patients. The study aims to survey measures that European countries apply or consider introducing to address medicines shortages.

Methods

A questionnaire was sent to the public authorities, as involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network, in 47 countries, thereof 44 countries of the WHO European region. Respondents were asked to report measures in place or being discussed as of the first quarter of 2020.

Results

Preliminary data from 8 countries (Albania, Austria, Finland, Germany, Italy, the Netherlands, Romania, Sweden; further responses are expected) show that national registers to which manufacturers notify, usually on a mandatory basis, upcoming and existing shortages (including end dates and causes in some countries) are common (all countries but Albania). Medicine reserve supplies that have to be kept for defined medicines exist in Albania and Finland; they are being established the Netherlands and are under discussion in Germany and Sweden. Finland and Italy allow issuing export bans for targeted medicines; this possibility is before implementation in Austria, was planned and then withdrawn in Romania and is under discussion in the other countries (except Albania). Further measures include simplified import permits (with patient information leaflets in foreign language), working groups with relevant stakeholders and financial sanctions for manufacturers in case of non-supply.

Conclusions

Governments have been reacting to shortages by implementing appropriate measures and adapting existing ones. Actions taken differ with regard to stakeholders addressed, the degree of obligation and the focus (optimising the management of existing shortages vs. prevention of future supply limitations).

Key messages

A mix of measures to address medicine shortages is applied in European countries. Recently, the number of measures increased, and actions requested from stakeholders tend to have become mandatory.

Surveillance pouchoscopy for dysplasia: Cleveland Clinic Ileoanal Pouch Anastomosis Database

BACKGROUND

No formal guidelines exist for surveillance pouchoscopy following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis.

METHODS

All adults who had previously had IPAA for ulcerative colitis, and underwent a pouchoscopy between 1 January 2010 and 1 January 2020, were included.

RESULTS

A total of 9398 pouchoscopy procedures were performed in 3672 patients. The majority of the examinations were diagnostic (8082, 86·0 per cent; 3260 patients) and the remainder were for routine surveillance (1316, 14·0 per cent; 412 patients). Thirteen patients (0·14 per cent of procedures) were found to have biopsy-proven neoplasia at the time of pouchoscopy; seven had low-grade dysplasia (LGD) (0·07 per cent; all located in the anal transition zone), none had high-grade dysplasia (HGD) and six (0·06 per cent) had invasive adenocarcinoma (4 in anal transition zone and 6 in pouch). Of the six patients with adenocarcinoma, four had neoplasia at the time of proctocolectomy (2 adenocarcinoma, 1 LGD, 1 HGD); all six were symptomatic with anal bleeding or pelvic pain at the time of pouchoscopy, had a negative surveillance pouchoscopy examination within 2 years of diagnosis of adenocarcinoma, had palpable masses on digital rectal examination, and had visible lesions at the time of pouchoscopy.

CONCLUSION

Surveillance pouchoscopy is not recommended in asymptomatic patients because significant neoplasia following IPAA for ulcerative colitis is rare.

Personalised medicine as a challenge for public pricing and reimbursement authorities – A survey among 27 European countries on the example of trastuzumab

OBJECTIVES

To survey possible funding models and pricing practices as well as prices for the treatment package of trastuzumab and its accompanying diagnostic test in European countries, as an example of personalised medicines.

METHODS

Qualitative descriptive data on national pharmaceutical pricing and funding policies applied to trastuzumab and its accompanying diagnostic test were obtained from a survey among competent authorities from 27 European countries as of August 2011. Further, price data (for the years 2005-2013) of trastuzumab in the respective European countries were surveyed and analysed.

RESULTS

In 2011, testing and treatment mainly took place in hospitals or in specific day-care ambulatory clinics. In the European countries either both trastuzumab and the accompanying diagnostic test were funded from hospital budgets (n = 13) or only medicines were funded from the third party payers such social insurances and the test from hospital budgets (n = 14). Neither combined funding of both medicine and diagnostic test by third party payers was identified in the surveyed countries nor did the respondents from the competent authorities identify any managed entry agreements. National pricing procedures are different for trastuzumab versus its diagnostic test, as most countries apply price control policies for trastuzumab but have free pricing for the diagnostic test. The ex-factory price is, on average, €609 per 150 mg vial with powder in 2013; in nine countries the price of trastuzumab went down from 2005 till 2013.

CONCLUSION

The example of trastuzumab and its accompanying diagnostic test highlights some problems of the interface between different funding streams (out-patient and hospital) but also with regard to the interface between the medicine applied in combination with a medical device. The findings suggest a need for further developing and refining policy options to address the identified interface issues.

[Bouts of chest pain]

We report on a 46-year-old man with vasospastic angina. The differential diagnosis, the eventful course of the patient and in particular the clinical image with diagnostic approach, therapy and prognosis of vasospastic angina are discussed.

Water immersion is associated with an increase in aquaporin-2 excretion in healthy volunteers

Here, we report the alterations in renal water handling in healthy volunteers during a 6 h thermoneutral water immersion at 34 to 36 degrees C. We found that water immersion is associated with a reversible increase in total urinary AQP2 excretion.

Mechanisms of sodium and chloride transport across isolated sheep reticulum

1. 22Na+ and 36Cl- fluxes across isolated reticular epithelium of sheep were measured by using the Ussing-chamber technique. 2. Net NaCl absorption driven by Na(+)-K(+)-ATPase was observed under short-circuit conditions. 3. Evaluation of fluxes measured under voltage-clamp conditions indicated that Na+ absorption is mainly electroneutral. 4. Mucosal application of bumetanide, hydrochlorothiazide, or low dose amiloride (10(-4) M) produced no changes in Na+ transport whereas addition of higher doses of amiloride (> or = 10(-3) M) led to a reduction in net Na+ transport. Short chain fatty acids (SCFA) enhanced the amiloride-sensitive Na+ transport. 5. Alterations of JmsNa induced by inhibitors or by SCFA were always accompanied by qualitatively similar changes of JsmNa. Amiloride-sensitive JsmNa was also decreased at low mucosal Na+ concentration. 6. DIDS, SITS, and nitrate reduced both JmsCl and JsmCl. SCFA did not influence chloride transport. 7. It is concluded that Na+ transport is mediated by Na(+)-H+ exchange and by transport processes operating as Na+ self-exchange. Mucosal-to-serosal chloride transport seems partly to depend on anion exchange systems.

Short-chain fatty acids and CO2 as regulators of Na+ and Cl- absorption in isolated sheep rumen mucosa

Unidirectional 22Na+ and 36Cl- fluxes were determined in short-circuited, stripped rumen mucosa from sheep by using the Ussing chamber technique. In both CO2/HCO3(-)-containing and CO2/HCO3(-)-free solutions, replacement of gluconate by short-chain fatty acids (SCFA, 39mM) significantly enhanced mucosal-to-serosal Na+ absorption without affecting the Cl- transport in the same direction. Short-chain fatty acid stimulation of Na+ transport was at least partly independent of Cl- and could almost completely be abolished by 1 mM mucosal amiloride, while stimulation of Na+ transport was enhanced by lowering the mucosal pH from 7.3 to 6.5. Similar to the SCFA action, raising the PCO2 in the mucosal bathing solution led to an increase in the amiloride-sensitive mucosal-to-serosal Na+ flux. Along with its effect on sodium transport, raising the PCO2 also stimulated chloride transport. The results are best explained by a model in which undissociated SCFA and/or CO2 permeate the cell membrane and produce a raise in intracellular H+ concentration. This stimulates an apical Na+/H+ exchange, leading to increased Na+ transport. The stimulatory effect of CO2 on Cl- transport is probably mediated by a Cl-/HCO3- exchange mechanism in the apical membrane. Binding of SCFA anions to that exchange as described for the rat distal colon (Binder and Mehta 1989) probably does not play a major role in the rumen.

[Therapy goals from the viewpoint of patients: what is the role of partnership?]

The topic of this investigation is the significance of the real field of reference of psychosomatic patients in inpatient psychotherapy. Data on expected therapeutic results and changes experienced by patients with a steady partner were submitted to evaluation by content analysis. The greatest importance is attached in each case to individual growth, followed by symptoms and interpersonal relationships. All patients place more emphasis on the actual field of reference at the end than at the beginning of therapy; this difference is more strongly pronounced in patients without couples interviews. Evidently patients with couples interviews assess their partnership more realistically than those without them. Moreover, therapists have presumably developed "an ear for the partner" irrespective of whether or not the partner is included.

[Studies on the condition of marginal periodontium depending on the shape of the bridgework body]

Within an 8-years-longitudinal study 40 patients with 30 tangential and 28 open bridges were examined. The accumulation of plaque as well as the degree of inflammation of the gingiva adjacent to the bridgework binder and the bridgework bodies were determined by means of selected indices, and the data obtained were compared to those evaluated when the bridges were fitted in. The results show that the accumulation of plaque (on) with open bridge was slightly elevated as compared to tangential bridges whereas the inflammation of the gingiva was significantly increased with tangentially shaped bridgework bodies. For this reason open bridges should be used further more in areas, where aesthetics play only a secondary role.