Medical implications of controlled fasting

Comprehensive Care for Patients with Diabetes in Ramadan: A Module for Pharmacy Students and Pharmacists

Introduction

Prior studies show that many patients with diabetes whose health maybe impacted by fasting, choose to fast during Ramadan. This study describes the implementation and evaluation of an online module targeting bachelor of pharmacy (BPharm) and doctor of pharmacy (PharmD) students that aims to improve participants' knowledge, communication, and self-efficacy concerning proper care for patients with diabetes in Ramadan.

Methods

An online module consisting of two phases targeting both BPharm and PharmD students was implemented over two semesters in fall 2020 and spring 2021. Participants were directed to fill pre-module and post-module assessments to evaluate the change in their knowledge and self-efficacy using two scales. Pre- and post-survey data for participants’ knowledge and self-efficacy were analyzed for significance using paired sample t-tests. Qualitative data analysis was performed to assess participants’ responses to the open-ended question concerning what they liked and disliked about the module.

Results

All BPharm and PharmD students taking the lesson responded to both the baseline survey and the follow-up one resulting in 92 responses (participation rate of 100%). The average score for participants in the pre-module self-efficacy section was 1.5 (SD = 1) and increased post-module to 3.5 (SD = 0.7), t (91) = 20.2, p < 0.001. Further, the average score for participants in the pre-module knowledge section was 14 (SD = 3), which similarly increased to 22 (SD = 3) post-module t (91) = 19.7, p < 0.001. Qualitative analysis provided insights on how participants perceived the module design, content, and its impact on practice. Participants described the module as an informative one that addresses a much-needed issue they haven’t been exposed to before. They emphasized how the module addresses the cultural needs of patients in their communities. They particularly appreciated seeing instructor videos depicting real-life scenarios and the focus on their communication skills, but some preferred learning about this topic through live sessions.

Conclusion

An online module positively impacted both self-efficacy and knowledge in relation to caring for patients with diabetes considering fasting in Ramadan. Future studies should explore how different versions of this module can be integrated into educational activities for pharmacy students, pharmacists in different settings, and for other health care professionals.

How Is Religiousness Associated With Adolescent Risk-Taking? The Roles of Emotion Regulation and Executive Function

Existing literature has demonstrated an association between higher adolescent religiousness and lower risk-taking via higher self-regulation. This study sought to elucidate the roles of emotion regulation and executive function as parallel mediators in the link between religiousness and risk-taking in a sample of 167 adolescents (mean age = 14.13 years, 52% male, 82% White at Time 1). Longitudinal results across three waves utilizing structural equation modeling indicated higher religiousness was associated with higher emotion regulation, whereas religiousness was not associated with executive function. Subsequently, higher emotion regulation and executive function were associated with lower risk-taking. Emotion regulation mediated the association between religiousness and risk-taking. The findings highlight religiousness as a contextual protective factor for adolescents.

The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 10⁶/mm³) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm³). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.

The Effects of Ramadan Intermittent Fasting (RIF) on Spirometric Data of Stable COPD Patients: A Pilot Study

No previous study has raised the effects of RIF on lung function data of chronic obstructive pulmonary disease (COPD) patients. The objective of the present study was to assess the effects of RIF on spirometric data measured in male patients with a stable COPD. Sixteen patients with stable COPD (mean ± SD of age: 64 ± 7 years) who fasted during Ramadan volunteered to the study. Three sessions (Before-R, End-R, and After-R) were selected for spirometry tests that were consistently performed 2.5-4.5 hr before fasting break. Assessment sessions comprised: forced vital capacity (FVC), 1st s forced expiratory volume (FEV₁), FEV₁/FVC, peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEFx%). A reversibility test was performed only during the Before-Ramadan session. Spirometric data were expressed in percentages of local reference values. Findings were analyzed by applying repeated measures analysis of variance. The mean ± SD of the postbronchodilator FEV₁/FVC ratio and the FEV₁ were, respectively, 0.52 ± 0.14 and 48 ± 19%. The mean ± SD of FEV₁ (Before-R: 47 ± 19, End-R: 45 ± 18, After-R: 44 ± 19%), FVC (Before-R: 73 ± 18, End-R: 71 ± 16, After-R: 69 ± 17%), FEV₁/FVC (Before-R: 67 ± 16, End-R: 66 ± 16, After-R: 65 ± 16%), PEF (Before-R: 46 ± 19, End-R: 47 ± 22, After-R: 45 ± 21%), MMEF (Before-R: 19 ± 10, End-R: 18 ± 8, After-R: 18 ± 9%), FEF_25% (Before-R: 16 ± 6, End-R: 16 ± 5, After-R: 15 ± 5%), FEF_50% (Before-R: 21 ± 14, End-R: 20 ± 12, After-R: 20 ± 12%) and FEF_75% (Before-R: 27 ± 19, End-R: 27 ± 19, After-R: 27 ± 19%) were not significantly influenced by RIF. RIF did not bring about any significant changes in the spirometric data of stable COPD male patients fasting the 2016 holy month of Ramadan.

Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting

Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P < 0.05). In addition, those who fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P < 0.05). There was no relationship between severity of other gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

Emergency department attendance patterns during Ramadan

BACKGROUND

Patient attendance in the emergency department (ED) is inherently variable and unpredictable. Resources might be better allocated if use of the ER could be predicted during the month of fasting (Ramadan), healthy adult Muslims do not eat or drink from dawn to sunset and in the Middle East, social activities occur mostly during night. There is no published data that has reported changes in local ED attendance pattern during Ramadan.

OBJECTIVES

Determine if there are differences in tertiary care ed attendance during Ramadan compared to other times of the year.

DESIGN

Retrospective, using data from the hospital integrated clinical information system.

SETTING

Tertiary care institution in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

All ED visits during the Islamic calendar years of 1431-1434 (December 18, 2009-October 13, 2013) were analyzed.

MAIN OUTCOME MEASURES

Patient volume, acuity, demographics and admission rate variability between Ramadan and other months.

RESULTS

During the study period of 4 years, of 226075 ED patients, 129178 (57.14%) patients were seen during the day shift (07:00 to 18:59). During Ramadan, 10 293 (60%) patients presented during the night shift compared with the day shift (P < .0001). This trend was seen consistently with no statistically significant differences in admissions 7%, triage acuity or when compared with other months.

CONCLUSION

During Ramadan, ED attendance changes as more patients present during the night shift. In Saudi Arabia and possibly other Muslim countries, appropriate resources should be allocated during Ramadan to manage the nocturnal ED patient surge.

LIMITATIONS

We believe that the majority of our patients fast, but it is not known how many ED patients were actually fasting during the study period. This study was conducted in a tertiary care hospital and the patient population presenting to our ed is predominantly Muslim; therefore, the results may not be generalized to populations that are not predominantly Muslim.

Positive and Negative Associations between Adolescents' Religiousness and Health Behaviors via Self-Regulation

It has been proposed that self-regulation may be the explanatory mechanism for the relation between religiousness and positive health behaviors. However, different religious motivations have differential effects on a variety of health related outcomes, which may explain the adverse effects of religiousness found in some studies. The current study hypothesized that higher identification as religious motivation would be linked to higher health-promoting behavior and lower health-risk behavior through higher self-regulation, whereas higher introjection would be linked to lower health-promoting behavior and higher health-risk behavior through lower self-regulation. The sample included 220 adolescents (mean age = 15 years, 55% male) and their primary caregivers. Structural equation modeling results supported the hypotheses and indicated that adolescent self-regulation mediated the relations between their religious motivation and health behavior. The findings suggest that different types of religious motivation may be promotive or hindering for adolescents' health.

How do patients with asthma and COPD behave during fasting?

BACKGROUND-OBJECTIVE

Several factors might affect the adherence to treatment in patients with asthma and COPD. Among these factors, the effect of religious beliefs and behaviours has been less studied so far. In this study, the effect of fasting on drug use behaviours of patients with asthma and COPD were comparatively analysed.

METHODS

A total of 150 adult patients with asthma and 150 adult patients with COPD were consecutively enrolled into this cross-sectional study. The patients were asked whether they fast during Ramadan and if the answer was yes, they were kindly asked to respond to further questions related to use of inhaled medications during that particular time.

RESULTS

The majority of the cases from both groups [98 (65.3%) of asthma patients and 139 (92.6%) of COPD] were fasting during Ramadan. The majority of the patients with COPD (n=126; 90.6%) reported that they quitted their regular therapy basis during Ramadan. On the other hand, the majority of asthma patients used their controller inhaled medications during Ramadan and preferred to use them on iftar and sahur times (n=81, 82.6%).

CONCLUSION

Our results showed that in a Muslim population, the patients with asthma and COPD do not feel their diseases to be an inhibitory factor for fasting during Ramadan. However, fasting seems to be an important determining factor in medication compliance by modifying the drug use behaviours in each group in a different way. Therefore, the patients should be informed about the effects of fasting on their disease and the allowed drugs during fasting.