Religious involvement and psychological well-being in the Middle East.

OBJECTIVE: There is growing evidence that religious involvement is associated with better mental health in Christian Western countries. Whether the same is true in Middle Eastern countries whose populations are largely Muslim is less clear. The present study examined the association between religiosity and psychological well-being in the Middle East. METHODS: This cross-sectional study involved nationally representative samples of adults aged 18 or older in Egypt (n = 3496), Tunisia (n = 3070), and Turkey (n = 3019) (Wave 1 of Middle Eastern Values Panel Study). Data on psychological well-being (life satisfaction, happiness, and optimism) were available on 8835-8886 participants. Bivariate analyses and multivariate analyses were conducted, controlling for age, gender, education, employment status, marital status, financial satisfaction, economic class, country, and Muslim religious affiliation. Interactions with gender were also examined. RESULTS: Most participants (95%) reported a Muslim affiliation. Bivariate analyses indicated a positive association between overall religiosity (the primary predictor) and life satisfaction (r = .12), happiness (r = .13) and optimism (r = .19) (P < .0001). Multivariate analyses indicated a significant relationship between overall religiosity and life satisfaction (B = .046, SE = .005), happiness (OR = 1.03, 95% CI = 1.02-1.04), and optimism (B = .054, SE = .005). A significant interaction between gender and religiosity was found for life satisfaction (B = -.025, SE = .009, P = .007), such that the association was stronger in males than in females. For happiness and optimism, trends were in the same direction. CONCLUSIONS: Small but significant associations between overall religiosity (beliefs and practices) and psychological well-being were found in this largely Muslim Middle Eastern sample. Prospective studies are needed to determine the causal direction of this relationship.

The relationship between parental religiosity and school age children's dietary behavior in Ningxia Province, China: A cross-sectional study.

BACKGROUND: Studies have shown parental religious involvement was associated with better health behaviors of their children. However, the relationship between parental religiosity and child dietary behaviors remains unclear. OBJECTIVES: This study aimed to examine the relationship between parental religious involvement and the dietary behaviors of school-aged children in mainland, China. METHODS: Participants were selected from a northwest province of China using a multi-stage sampling process from July 2017 to October 2017. The frequency of parental religious activities and the importance of religion in life, along with the dietary behaviors of children, were collected using a questionnaire. Dietary pattern analysis coupled with multivariable linear regression was employed to test the association between parental religious involvement and children's dietary behavior. RESULTS: The regression model indicated no significant relationship between parental religious behaviors and children's dietary behaviors in the overall sample. However, the frequency of mother's religious attendance was inversely related to children's consumption of vegetables (ß = -0.40, P < 0.05) in the Hui subsample (vs. Han) when stratifying analyses by ethnicity. CONCLUSION: These findings suggest among those of Hui ethnicity, parental religious involvement may impact children's dietary behavior in a way that may affect their future health habits.

Religiosity, depression and telomere length in Chinese older adults.

BACKGROUND: The mechanism explaining how religiosity is linked to telomere length (TL) is unclear. The current study examines depression as a possible mediator. METHODS: In this cross-sectional study of 1,742 community-dwelling residents aged 55 or over, the Duke University Religion Index (DUREL) and Geriatric Depression Scale (GDS) were administrated during a routine health check. Peripheral blood leukocyte TL was determined using a q-PCR procedure. The Bootstrap methods PROCESS program was used to detect mediation. RESULTS: After controlling for sociodemographic variables, the religiosity was positively correlated with TL (p<0.05) and negatively correlated with depressive symptom (p<0.001). Depressive symptoms, in turn, was negatively correlated with TL (p<0.05) in the overall sample. Depressive symptoms significantly mediated the relationship between religiosity and TL (explaining 31.8% of the total variance) in the 65 years and older subgroup (p = 0.015). No significant mediation was found in the 55-64 age subgroup. LIMITATIONS: The cross-sectional design prevents making causal inferences. The non-random sampling method used in selecting participants may affect the external validity of the findings in terms of generalizing to Muslims throughout China or other religious groups. Potential mediators of the relationship between religiosity and TL and confounders such as physical health status, were not assessed. CONCLUSION: Religiosity was positively associated with TL in older mainland Chinese adults, and this association was partially mediated by depressive symptom in the 65 or older age group. This finding helps to explain why religiosity is related to cellular aging in older adults.

Cultural Adaptation, Validity, and Factor Structure of the Jalowiec Coping Scale in Iranian Women with Multiple Sclerosis: Which Coping Strategies Are Most Common and Effective?

BACKGROUND: The aims of this study were to evaluate the Jalowiec Coping Scale (JCS) psychometrically in Iranian women with multiple sclerosis (MS) and to identify the most frequent and efficacious coping strategies. METHODS: A total of 306 women with MS participated in a cross-sectional study. A demographics questionnaire, the JCS, and the Perceived Stress Scale were administered. Forward-backward translation was used to achieve a Persian version of the scale. Cronbach α and test-retest were assessed for reliability. Convergent and discriminant validity were tested using an item-scaling procedure. The association of the JCS with perceived stress was examined using multiple regression. The factor structure was also explored using rotated exploratory factor analysis. RESULTS: Participants had a mean (SD) age of 32.0 (6.6) years, and nearly half reported visual impairment as the first symptom of disease. Cronbach α for the scale was 0.898 and for the subscales ranged from 0.254 to 0.778. Relatively good convergent and discriminant validity were achieved (success rate ≥69%). Subscales assessing optimistic, fatalistic, and emotive coping predicted stress levels. A four-factor solution explained 30% of the total variance. Optimistic and supportive coping styles were the most common and effective styles, respectively, reported. CONCLUSIONS: The JCS may be useful in assessing coping strategies in Iranian women with MS. Further studies are needed to better understand how coping styles used in practice are similar to their theoretical constructs.

Religious involvement and tobacco use in mainland China: a preliminary study.

BACKGROUND: Cigarette smoking causes serious health, economic, and social problems throughout the world. Religious involvement is known to be an important predictor of health behaviors and substance use. The present study examines the correlation between religious involvements and tobacco use, and explores connections between religiosity and tobacco use in Muslims and non-Muslims in Western China. METHODS: Data were examined from a representative sample of 2,770 community-dwelling adults in the province of Ningxia located in Western China. Self-report smoking, past smoking, religious attendance and the importance of religious in daily life were measured. The WHO Composite International Diagnostic Interview was used to diagnose tobacco use disorders. Three separate logistic regression models were used to examine correlations between religious involvement and smoking status. RESULTS: In the overall sample, religious attendance was inversely associated with current smoking (p < 0.001), as was importance of religion (p < 0.05). Current smoking was also less common in those categorized as high on religious involvement. No association, however, was found between religious involvement and either past smoking or tobacco use disorders. In Muslims, both religion attendance and high religiosity were inversely associated with current smoking (p < 0.001), although no association was found in non-Muslims. CONCLUSIONS: Religious involvement is inversely related to current smoking in Western China, although this association depends on religious affiliation.

Prospective study of depression among dialysis patients in Saudi Arabia.

OBJECTIVES: The purpose was to determine the short-term course of depression among dialysis patients in Saudi Arabia and identify baseline characteristics that may influence course. METHODS: Thirty-nine dialysis patients in Jeddah, SA, were identified with subthreshold, minor, or major depressive disorders using the Structured Clinical Interview for Depression (SCID) and followed up at 6 and 12 weeks using the Longitudinal Interview and Follow-up Evaluation (LIFE) schedule. Depressive symptoms were tracked using the Hamilton Depression Rating Scale (HDRS). Patient characteristics measured at baseline included demographic, psychosocial, physical health, and treatment factors. RESULTS: Of the 20 patients with major or minor depressive disorder, eight (40 %) fully remitted by 6 weeks and an additional three patients remitted over the next 6 weeks, leaving 45 % with significant depressive symptoms persisting beyond 12 weeks. Subthreshold disorders followed a similar course (42 % with persistent symptoms). Few patients received treatment for depression. Those with more education, severe health problems, poorer psychological function, more severe depressive symptoms, or a family psychiatric history were less likely to remit. Similar factors predicted change in depressive symptoms assessed by HDRS, especially high medical co-morbidity, severe illness, and overall poor psychological functioning. CONCLUSIONS: Nearly one-half of depressed dialysis patients in Saudi Arabia continue to have significant symptoms beyond 12 weeks of follow-up, few of whom were treated. Specific characteristics at baseline identify depressed dialysis patients at greater risk of persistent symptoms who need treatment.

Religious involvement and health in dialysis patients in Saudi Arabia.

Patients on hemodialysis experience considerable psychological and physical stress due to the changes brought on by chronic kidney disease. Religion is often turned to in order to cope with illness and may buffer some of these stresses associated with illness. We describe here the religious activities of dialysis patients in Saudi Arabia and determined demographic, psychosocial, and physical health correlates. We administered an in-person questionnaire to 310 dialysis patients (99.4 % Muslim) in Jeddah, Saudi Arabia, that included the Muslim Religiosity Scale, Structured Clinical Interview for Depression, Hamilton Depression Rating Scale, Global Assessment of Functioning scale, and other established measures of psychosocial and physical health. Bivariate and multivariate analyses identified characteristics of patients who were more religiously involved. Religious practices and intrinsic religious beliefs were widespread. Religious involvement was more common among those who were older, better educated, had higher incomes, and were married. Overall psychological functioning was better and social support higher among those who were more religious. The religious also had better physical functioning, better cognitive functioning, and were less likely to smoke, despite having more severe overall illness and being on dialysis for longer than less religious patients. Religious involvement is correlated with better overall psychological functioning, greater social support, better physical and cognitive functioning, better health behavior, and longer duration of dialysis. Whether religion leads to or is a result of better mental and physical health will need to be determined by future longitudinal studies and clinical trials.

Depression in patients with chronic kidney disease on dialysis in Saudi Arabia.

OBJECTIVE: Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. METHODS: A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. RESULTS: The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. CONCLUSIONS: The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.

Tuberculous peritonitis associated with peritoneal dialysis.

Even though rare, tuberculous peritonitis (TBP) in patients on continuous ambulatory peritoneal dialysis (CAPD) is a perilous condition. Physicians worry about continuing treatment of their patients, whether to continue this modality of dialysis or switch to hemodialysis. A retrospective cohort study of 89 patients undergoing CAPD over a 12-year period was carried out for any episode of peritonitis with the objectives to find out the incidence of TBP in these patients, evaluation of patients' 3-year survival, possibility of retention of Tenckhoff catheter, and modality of dialysis post-infection. One hundred and three episodes of peritonitis occurred in our patients. Most of them were bacterial and occasionally fungal. We identified four cases of TBP, with one patient having concurrent bacterial infection in the peritoneal fluid. The clinical presentation was insidious with cloudy fluid in all cases. The diagnosis was established by the polymerase chain reaction (PCR) technique in one case, by positive peritoneal fluid culture for Mycobacterium tuberculosis in two cases, and clinically in the fourth one that responded well to anti-tuberculous therapy. All four patients survived their mycobacterial infection. Removal of catheter was necessary in all four patients and all were converted to hemodialysis. Three patients remained on hemodialysis thereafter, and one patient had to be re-implanted with a new catheter and was restarted on CAPD. TBP in patients undergoing CAPD in Jeddah remains a real concern, especially with the evidence of high prevalence of tuberculosis and with the emergence of drug-resistant tuberculosis. We recommend early initiation of anti-tuberculous therapy and removal of the Tenckhoff catheter for better survival. Most of these patients probably will require conversion to hemodialysis, but in a selected few CAPD can be restarted.

Increased risk of hypertension, proteinuria and preeclampsia in pregnant Saudi females with IgA nephropathy.

BACKGROUND: IgA nephropathy is fairly prevalent in Saudi Arabia. In this paper we examine the natural history of pregnancies and their impact on renal function in Saudi females affected by this condition. METHODS: We followed a series of 12 patients, documented to have IgA nephritis by kidney biopsy, during their gestation. We monitored their blood pressure, serum creatinine, creatinine clearance, 24-hour protein before conception and at the third trimester of pregnancy. We also documented any maternal or fetal complications. RESULTS: All patients had well-controlled blood pressure, normal renal function, and proteinuria of less than one gram per day prior to conception. During pregnancy, all patients (100%) developed hypertension-requiring treatment and three of them (25%) developed preeclampsia. One patient (8.3%) had hemolysis, elevated liver enzymes, and, low platelets syndrome. All patients had worsening of their proteinuria during pregnancy from 535.2 (101.4) to 2179.2 (636.6) mg/24 h (p < 0.01) with a decrease in creatinine clearance from 88.6 (7.6) mls/min to 77.4 (5.9) mls/min (p < 0.05). No fetal complications were observed. CONCLUSION: We conclude that pregnancies in patients, even with mild IgA nephritis, require close observation as there is an increased incidence of worsening hypertension and preeclampsia.

Cross-cultural comparison of the patient-centeredness of the hidden curriculum between a Saudi Arabian and 9 US medical schools.

BACKGROUND: The implicit "hidden curriculum" strongly influences medical students' perceptions of the importance of patient-centeredness. A new instrument, the Communication, Curriculum, and Culture Survey (C3), already used to assess this hard-to- access part of the curriculum in the US, has potential for use in cross-cultural comparisons. OBJECTIVE: To use the C3 to perform a pilot cross-cultural comparison of the patient-centeredness of the hidden curriculum between a Saudi medical school and 9 U.S. medical schools. DESIGN: Senior Saudi medical students completed the C3 and a second instrument, the Patient-Provider Orientation Scale (PPOS), which measured their attitudes toward patient-centered behavior. PARTICIPANTS: Senior Saudi medical students. RESULTS: 139/256 (54%) Saudis completed the C3; 122/256(48%) completed the PPOS. Means for 2 out of 3 of the C3's domains (0-100 scale) were lower for the Saudis than those for the Americans (95% confidence intervals in parentheses): 47 (45, 50) vs. 55 (53, 58); 54 (50, 58) vs. 68 (67, 70); they overlapped in the third: 60 (57, 63) vs. 62 (60, 63). The mean Saudi PPOS score was 4.0 (3.9, 4.1); for the American medical schools, 4.8 (4.8-4.8) (1-6, least to most patient-centered). CONCLUSIONS: In this preliminary study the data suggest that the patient-centeredness of the hidden curriculum differs in Saudi and US medical schools in 2 out of 3 domains. Cross-cultural use of instruments such as the C3 can highlight such important differences and help educators evaluate their curriculum from an international, as well as a local perspective. Use of instruments across borders is a growing trend and an indicator of the increasing globalization of medical education.

Simvastatin-induced rhabdomyolysis and acute renal injury.

Simvastatin is one of the most commonly prescribed CoA reductase inhibitors. The safety profile of this drug has been widely discussed in the medical and consumer advocacy communities. Like other statins, simvastatin can cause a serious and potentially life-threatening complication: rhabdomyolysis. We describe a case of simvastatin-induced rhabdomyolysis complicated by acute renal failure requiring urgent hemodialysis. The relative safety of simvastatin compared to other HMG-CoA reductase inhibitors and the conditions that can potentiate its toxicity are discussed. The clinical features of rhabdomyolysis, and subsequent acute renal failure, and their treatment modalities are presented.