Stephen Andrew Margolis

Effect of Religious Practices of Ramadan on Sleep and Perceived Sleepiness of Medical Students

Background: Observant Muslims substantially alter their normal routines, including daytime fasting and day-night activity patterns during the month of Ramadan. Purpose: It is unknown whether observing the religious practices of Ramadan impacts negatively on daytime somnolence, a factor known to impair learning. Methods: A cross-sectional survey measuring self-reported sleep time and the Epworth Sleepiness Scale of observant Muslim medical students before, during, and after Ramadan. Results: There was no significant variation in sleep score pre-Ramadan (10.04 ± 3.47), during Ramadan (10.46 ± 3.57), and post Ramadan (9.73 ± 3.33), F(2, 355) = 1.278, p =. 280. Night sleep hours were significantly longer both before (6.22 ± 1.45) and after (6.22 ± 1.59) than during Ramadan (5.22 ± 1.85), F(2, 366) = 15.289, p <. 001. Daytime sleep hours pre-Ramadan (1.05 ± 1.36) and post Ramadan (0.70 ± 1.21) were significantly shorter than during Ramadan (1.48 ± 1.46; pre: z = 2.654, p =. 08; post: z = -4.940, p <. 001). Conclusion: Students successfully adapt and avoid a rise in daytime somnolence by increasing daytime sleep hours during Ramadan.

Institutionalized Older Adults in a Health District in the United Arab Emirates: Health Status and Utilization Rate

Background: Little is known about the rate of institutionalization and health status of nursing home (NH) type patients living in the Middle East. This study was set in the Al-Ain Medical District, a geographically discrete region of the United Arab Emirates, a country with a developing economy located on the shores of the Arabian Gulf. NH-type patients were defined as people aged 60 years and older who were admitted to a hospital or a long-term institutionalized setting for at least 6 weeks and with no evidence of an expectation of discharge at the time of the evaluation. Objective: To determine the clinical, functional, cognitive, and nutritional status of NH-type patients living in a defined community within a developing country. Method: Cross-sectional survey. Results: All NH-type patients were identified, and all were included in this study (n = 47, 100% participation rate). All were located within three public institutions, none of which was a dedicated NH facility. The rate of institutionalization was 7.0–14.0 per 1,000 people aged 65 or older. The age distribution was 30% (60–74 years), 49% (75–84 years), and 21% (85+ years). The length of stay was 3.8 years. The female:male ratio was 1.6. All except 1 had a neurological disorder, and 89% had dementia. The cognitive deficits were severe with only 61% alert, 41% able to speak, 17% orientated in place, and 15% orientated in time. The functional status was also poor: 98% received assistance with all instrumental activities of daily living, 85% received assistance with five activities of daily living, and 94% were bed bound. The nutritional status was also impaired with a mean body weight of 45 ± 14 kg and a mean albumin level of 3.1 ± 0.6 g/dl. When compared with the USA data from the National Center for Health Statistics, the study population was younger, had a longer length of stay, a lower female:male ratio, a higher rate of neurological diseases and dementia, and were far more dependent and disorientated. The rate of institutionalization was one sixth to one third of that in the USA. Conclusion: From these data we concluded that this region has a distinctly different population of institutionalized older people who demonstrate greater impairments in all domains of health status.

The health status of community based elderly in the United Arab Emirates

Little is known about the elderly in the United Arab Emirates (UAE), a country with both developing country features (high fertility rate, few elderly, strong traditional culture) and developed country characteristics (high-income economy, urbanized population, high growth rate of people aged 65+ years). In this cross sectional survey of 184 randomly chosen community based people aged 65+ years, the mean age was 71.8 +/- 6.3, 52% were female, 76% were married, 11% were literate, 89% lived in multi-generational households, 85% lived in households with servants and 15% had a personal servant. Health status was largely independent of age. Compared with the ambulatory aged USA population, the rate of functional independence in activities of daily living (ADL) (83%) was similar and chronic medical problems were less frequent, with the notable exception of diabetes (37% UAE, 10-12% USA). Almost all (95%) participants in this study rated their health as satisfactory or higher, compared with 82% of US ambulatory elderly. There appeared to be a significant under-diagnosis of psychological problems. In the presence of a high regard for traditional values, close family ties, universal practice of religion and high economic resources, the elderly in the UAE have a high level of health, which they maintain into their later years. There may be a need to substantially increase health care resources for aged care in the near future due to the high prevalence of diabetes, amount of hidden psychological morbidity and known demographic trends. Encouraging families to continue to provide home based long-term care may minimize the need for government intervention in this area.

Performance in reading radiographs: does level of education predict skill?

Introduction: Previous studies demonstrated lack of progress in electrocardiographic analysis skills with increasing levels of medical education. This study examined radiograph analysis skills, a similar cognitive task, across a range of educational experience: senior medical students (n = 23), family practice residents (n = 16), general practitioners (n = 41), and their family practice educators (n = 7). Methods: Written records of diagnosis or description of abnormalities were used to detect skill in interpreting radiographs. The instrument was 12 sets of radiographs: 2 normal and 6 abnormal chest radiographs and 2 normal and 2 greenstick radial fractures. Results: The mean score for correctly diagnosing all 12 sets of radiographs was 5.59 ± 1.68. and the mean score for correctly diagnosing the 4 normal radiographs as normal and the abnormal radiographs as abnormal was 8.76 ± 1.55. There was no statistically significant difference between the four groups of participants. Discussion: Skill level in interpreting radiographs did not appear to improve with additional experiential training and may require a more formal educational approach to address this issue.

Validation of additional domains in activities of daily living, culturally appropriate for muslims

Background: Measurement of activities of daily living (ADL) is an integral part of geriatric care. Prayer is a central part of the life of practicing Muslims. Objectives: To validate additional domains of ADL based on the functional capacity of Muslims to perform prayer, a culturally appropriate measure for those practicing the Islamic faith. Methods: Functional capacity was measured using 2 scales: an 8-domain scale (ADL-8) and a 3-component domain scale assessing the key components of Islamic prayer: washing for prayer, physical motion during prayer and the words spoken. A randomly selected sample of 132 community-based practicing Muslim people from Arabic-speaking countries, aged 65+ years were assessed. Results: The mean age ± standard deviation was 72.6 ± 7.0 with a female to male ratio of 0.97. The correlation between the summation scores for the prayer ADL and the ADL-8 was r = 0.922 (p < 0.001), while correlation with prayer ADL and each of the 8 components in the ADL-8 ranged from r = 0.806 (p < 0.001) to r = 0.906 (p < 0.001). There was a high level of construct validity with the reliability coefficient for the 3 components of the prayer ADL being 0.933 with a standardized item α of 0.935, with a range of 0.746–0.896 for the subscales. Conclusion: The prayer ADL domains provide an additional valid, short, simple and culturally orientated functional assessment for those of the Islamic faith.

Prescribing behavior for the elderly in the United Arab Emirates: psychotropic medication use remains low despite rising overall appropriate and inappropriate medication use.

Inappropriate prescribing, especially for psychotropic agents, is a common and significant cause of morbidity in older people. This cross sectional survey was conducted in the United Arab Emirates (UAE), a country with a rapidly developing economy. Prescribing behavior for people aged 65+ years acutely admitted via a university teaching hospital was examined for 1994 and 1999. All 474 patients (which resulted in 627 acute admissions; 194 in 1994 and 433 in 1999) were included. The patients had a mean age of 74.1 +/- 7.6, mean annual admission rate of 1.3 +/- 0.8 and a female:male ratio of 0.46 in 1994 rising to 0.73 in 1999 (P=0.04). Pre-admission use of five or more medications as recorded in the admission notes increased from 12% in 1994 to 23% in 1999 (P=0.001), while on discharge rose from 26 to 45% (P<0.001). There was a rise in low dose aspirin use, an indicator of appropriate prescribing, both pre-hospital (13-21%, P=0.03) and on discharge (19-29%, P=0.007). There was also a significant rise in pre-hospital inappropriate prescribing from 5 to 13% of patients demonstrating at least 1 of 144 inappropriate medications or combinations looked for (P=0.002) and at discharge from 9 to 19% (P=0.001). The rate of psychotropic medication usage (pre-hospital 0.1 per person: at discharge 0.25) was low compared to western countries and showed no significant change over time. These findings show rises in both appropriate and inappropriate prescribing with the exception of psychotropic medications during a 5-year period, which corresponded to rapid development in the health care system.