"Tie your camel first, then rely on God": reconceptualizing Javanese Islamic values to support palliative care at home.

BACKGROUND: In the last decade, there has been a growing concern to make palliative care more culturally sensitive and contextually appropriate. This concern is also relevant in Indonesia, where the progress of palliative care, particularly in home-based care, has been slow. Like elsewhere in the world, there has been a growing awareness of the importance of shifting from a curative orientation towards a palliative one, especially in cases where further medical treatment is futile. In this paper we argue that the development of palliative care practices would benefit greatly from learning about the values that are important for patients, families, and health professionals. It is important to understand these values to support forms of care that aim to enhance quality of life. To demonstrate this, we analyse the care values people in rural Java evoke in their home palliative care practices. METHODS: We conducted an eight-month ethnographic study involving forty-nine patients, families, and health professionals. RESULTS: We identified three specific Javanese Islamic values: making an effort (ikhtiar), being sincere (ikhlas), and being in a state of surrender (pasrah). These values influenced the participants' activities in a palliative care setting. Based on our findings, we suggest three strategies to incorporate these values into palliative care practices and to better facilitate palliative care's integration into Javanese Muslim communities. The first strategy is to include efforts to reduce suffering and improve the quality of life using the concept of ikhtiar. The second strategy is to foster sincerity (ikhlas) to help patients and families accept the realities of their condition and provide care for patients at home. The last strategy is to clarify that palliative care is not synonymous with 'giving up' but can be seen as an act of pious surrender. CONCLUSIONS: Our study identified three Islamic-Javanese values that can be incorporated to strategies aiming at enhancing palliative care practices, resulting in care focused on improving quality of life rather than futile attempts at a cure.

Impact of Ramadan fasting on vision and headache-related quality of life in women with idiopathic intracranial hypertension: A prospective observational study.

BACKGROUND: Ramadan fasting is an obligatory religious practice for Muslims. However, research data on the effect of Ramadan on idiopathic intracranial hypertension (IIH) symptoms are lacking. This study aimed to study the effect of Ramadan fasting on the severity of headache and visual symptoms and related quality-of-life activities. METHODS: This prospective cohort study targeted females diagnosed with IIH (n = 102) who were eligible to fast for Ramadan in 2023. The patients were recruited from the Neurology Clinic in Beni-Suef University Hospital, Egypt. Body mass index (BMI), monthly headache days and intensity of headache attacks, six-item Headache Impact Test (HIT-6), and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores during Ramadan were compared to those during the (non-fasting) month of Shaaban, the preceding month to Ramadan. RESULTS: There was a significant increase in the BMI of patients with IIH in Ramadan compared to the (non-fasting) month of Shaaban, at a median (interquartile range [IQR]) of 30.5 (26.6-35.8) kg/m2 and 30.1 (26.6-35.2) kg/m2, respectively (p = 0.002). The median (IQR) value of monthly headache days was significantly increased during Ramadan in comparison to the (non-fasting) month of Shaaban, at 20 (11.5-30) vs. 15 (10-25) (p < 0.001). There was a statistically significant worsening in the visual analog scale (VAS) scores (median [IQR] 7 [5-8] vs. 6.5 [5-8]), HIT-6 scores (median [IQR] 61 [58-67] vs. 59 [53-61.5]), and NEI-VFQ-25 total scores (median [IQR] 1312.5 [1238.8-1435] vs 1290 [1165-1417.5]) during Ramadan in comparison to the (non-fasting) month of Shaaban (p < 0.001 for all comparisons). The change in BMI in Ramadan was positively correlated with the change in monthly headache days (r = 0.24, p = 0.014), VAS (r = 0.20, p = 0.043), HIT-6 (r = 0.25, p = 0.010) and NEI-VFQ-25 scores (r = 0.24, p = 0.016). CONCLUSION: Ramadan fasting had an aggravating effect on headache, visual symptoms, and related quality-of-life activities, which might be attributed to weight gain during this month. Whether proper nutritional management to prevent weight gain during Ramadan may help mitigate this worsening effect is a mission of future studies.

Testing a faith-placed education intervention for bowel cancer screening in Muslim communities using a two-group non-randomised mixed-methods approach: Feasibility study protocol.

BACKGROUND: Inequalities exist in uptake of bowel cancer screening in England with low uptake in areas with high deprivation and amongst certain ethnic and religious groups. Individuals from these groups are more likely to receive a late diagnosis of bowel cancer. Uptake in Muslim communities, for example, has been shown to be lower than in the general population. Culturally adapted interventions are needed to address these inequalities. This feasibility study aims to assess the acceptability and accessibility of an educational faith-placed bowel cancer screening intervention in the East of England, alongside its impact on bowel screening uptake. It was developed by the British Islamic Medical Association in partnership with community stakeholders and professionals. METHODS: Ethical approval was granted on the 27 October 2021, REC reference number 21/EE/0231. A two-group non-randomised feasibility mixed methods study will be conducted, using surveys, focus groups and semi-structured interviews. Participants eligible for bowel screening will be recruited through local mosques and community venues. We aim to recruit 100 participants to the intervention group and 150 to the comparison group (not receiving the intervention). Intervention group participants will complete a survey at baseline, post-intervention and at six-month follow up. Comparison group participants will complete a survey at baseline and at six-month follow up. Outcomes will include: intention to take up screening; actual screening uptake; knowledge, attitudes, barriers and facilitators towards screening. Regional screening hub records will be used to ascertain actual screening uptake at six-month follow-up. Quantitative survey data will be summarised using descriptive statistics (e.g., proportion), and exploratory univariate analysis will be undertaken (e.g., chi-squared test). Two focus group interviews will be conducted with intervention group participants (with up to 16 participants). Semi-structured interviews will be conducted with 10 clinicians delivering the intervention to explore the acceptability of the intervention, training, and delivery. All qualitative data will be subject to a general inductive analysis. DISCUSSION: The findings will inform how faith-placed interventions can be implemented to increase uptake of bowel cancer screening, and potentially other health promotion programmes, to address health inequalities in ethnically diverse communities in England.

Metabolomics of Ramadan fasting and associated risk of chronic diseases.

BACKGROUND: The dramatic change in lifestyle associated with Ramadan fasting raises questions about its effect on metabolism and health. Metabolites, as the end product of metabolism, are excellent candidates to be studied in this regard. OBJECTIVE: This study aims to investigate the effect of Ramadan fasting on the metabolic profile and risk of chronic diseases. METHODS: The London Ramadan study (LORANS) is an observational study in which 2 blood samples were collected from 72 participants a few days before and after the fasting month of Ramadan. We conducted metabolomic profiling using nuclear magnetic resonance spectroscopy to assess the change in individual metabolites from before to after Ramadan. Also, we generated metabolic scores (scaled from 0 to 100) for 7 chronic diseases in the UK Biobank and assessed the association of Ramadan fasting with these scores in LORANS. RESULTS: Of the 72 participants, 35 were male (48.6%); the mean (± standard deviation) age was 45.7 (±16) y. Ramadan fasting was associated with changes in 14 metabolites (1 inflammation marker, 1 amino acid, 2 glycolysis-related metabolites, 2 ketone bodies, 2 triglyceride, and 6 lipoprotein subclasses), independent of changes in body composition. Using data from 117,981 participants in the UK Biobank, we generated metabolic scores for diabetes, hypertension, coronary artery disease, renal failure, colorectal cancer, breast cancer, and lung cancer. The metabolic scores for lung cancer, colorectal cancer, and breast cancer were lower after Ramadan in LORANS (-4.74, 9.6%, 95% confidence interval -6.56, -2.91, P < 0.001), (-1.09, -2.4%, -1.69, -0. 50, P < 0.001), and (-0.48, -1.1%, -0. 81, -0.15, P = 0.006), respectively. CONCLUSIONS: Ramadan fasting is associated with short-term favorable changes in the metabolic profile concerning risk of some chronic diseases. These findings should be further investigated in future, larger studies of longer follow-up with clinical outcomes.

Sex Reassignment Surgery, Marriage, and Reproductive Rights of Intersex and Transgender People in Sunni Islam.

The traditional gender binary constitutes an integral aspect of Islamic social ethics, which has a pivotal role in shaping religious obligations, legal proceedings, and interpersonal judgments within Muslim communities. Within the familial sphere, this gender binary underscores fundamental responsibilities encompassing parenthood, filial duties, and inheritance rights. Recent years have witnessed a growing challenge to the traditional concept of the gender binary within Islamic societies. This shift is driven by increasing social libertarianism that emphasizes gender fluidity and individual choice. Hence, this article aims to critically scrutinize evolving discussions and controversies about the rights of intersex and transgender individuals, particularly issues relating to sex reassignment or gender-affirming surgery, marriage, and reproduction, from the perspective of the Sunni tradition of Islam. To support the various interpretations and insights presented here, a comprehensive and rigorous analysis is carried out on various religious texts and scholarly sources to elucidate the theological and jurisprudential positions on gender issues. It is thus concluded that Shariah offers greater flexibility in the treatment of intersex individuals compared to those with gender dysphoria because the intersex condition is viewed as a physical impairment that is not the choice of the afflicted individual. By contrast, in the case of individuals with gender dysphoria, they are willfully attempting to change their recognized biological sex, that God had naturally given to them at birth. Therefore, it is recommended that such transgender individuals deserve respectful psychological and social rehabilitation with help and guidance from religious authorities, their families, and communities.

Muslims and End-of-Life Healthcare in Non-Muslim Majority Nations: A Systematic Literature Review.

CONTEXT: As Muslim populations in non-Muslim majority nations grow and age, they will increasingly require culturally appropriate healthcare. Delivering such care requires understanding their experiences with, as well as preferences regarding, end-of-life healthcare. OBJECTIVES: To examine the experiences, needs, and challenges of Muslim patients and caregivers with end-of-life, hospice, and palliative care. METHODS: A systematic literature review using five databases (MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Library) and key terms related to Islam and end-of-life healthcare. Papers were limited to English-language empirical studies of adults in non-Muslim majority nations. After removing duplicates, titles, abstracts, and articles were screened for quality and reviewed by a multidisciplinary team. RESULTS: From an initial list of 1867 articles, 29 articles met all inclusion criteria. Most studies focused on end-of-life healthcare not related to palliative or hospice services and examined Muslim patient and caregiver experiences rather than their needs or challenges. Content analysis revealed three themes: (1) the role of family in caregiving as a moral duty and as surrogate communicators; (2) gaps in knowledge among providers related to Muslim needs and gaps in patient/family knowledge about advance care planning; and (3) the influence of Islam on Muslim physicians' perspectives and practices. CONCLUSION: There is scant research on Muslim patients' and caregivers' engagement with end-of-life healthcare in non-Muslim majority nations. Existing research documents knowledge gaps impeding both Muslim patient engagement with end-of-life care and the delivery of culturally appropriate healthcare.

Palliative team involvement in end-of-life care for Jewish and Muslim children in Jerusalem: A unique clinical and cultural context.

OBJECTIVES: Pediatric palliative care services improve the quality of life for children with life-limiting and life-threatening diseases, although little has been published about variation based on cultural and religious factors. This article sets out to describe clinical and cultural characteristics of pediatric end-of-life patients in a majority Jewish and Muslim country with religious and legal constraints around end-of-life care. METHODS: We conducted a retrospective chart review of 78 pediatric patients who died during a 5-year period and could potentially have utilized pediatric palliative care services. RESULTS: Patients reflected a range of primary diagnoses, most commonly oncologic diseases and multisystem genetic disorders. Patients followed by the pediatric palliative care team had less invasive therapies, more pain management and advance directives, and more psychosocial support. Patients from different cultural and religious backgrounds had similar levels of pediatric palliative care team follow-up but certain differences in end-of-life care. SIGNIFICANCE OF RESULTS: In a culturally and religiously conservative context that poses constraints on decision-making around end-of-life care, pediatric palliative care services are a feasible and important means of maximizing symptom relief, as well as emotional and spiritual support, for children at the end of life and their families.

Perception of Privacy: An Ethnocentric Study of Turkish Muslim Female Surgical Patients.

PURPOSE: This study aimed to investigate the perception of privacy among Turkish Muslim female patients who have undergone surgery. DESIGN: A descriptive-qualitative study design was employed. METHODS: In-depth interviews were conducted with 10 study participants. FINDINGS: The findings revealed three main themes and two subthemes. The main themes were physical privacy, the influence of culture, and responses to privacy violations. The subthemes pertained solely to responses to privacy violations and included behavioral and emotional responses. CONCLUSIONS: The participants' perception of privacy was primarily focused on the physical aspects of privacy. Muslim and Turkish cultures played a significant role in shaping the patients' perception of privacy. The participants reported experiencing emotional and behavioral responses when their privacy was violated. This study reveals the perception of privacy among 10 Turkish Muslim female patients, emphasizing the significance of understanding and considering this perception in nursing care.

"I'm not Alone; He will be There for Me": A Mixed-Method Approach Exploring the Impact of Spousal Support on Mammogram Utilization and Health Beliefs.

Regular mammogram screenings are effective for early breast cancer (BC) detection and decreased mortality rate. However, immigrant Muslim Arab women (IMAW) are less likely to adhere to these screenings although the rate of BC among IMAW is high. Recent studies have explored low mammogram screening rates among immigrant Muslim and/or Arab women from a limited perspective, overlooking the fact that husbands have an influence in IMAW's health behaviors toward cancer screenings. Thus, this mixed-method approaches were employed to (a) explore the association between spousal support and IMAW's health beliefs toward mammograms and their utilization, (b) to understand IMAW's experiences of spousal influence related to their mammogram use and health beliefs. The quantitative portion of the study, recruitment and data collection were conducted via online surveys in Arabic and English. Logistic regressions were used to explore relationships between perceived spousal support and IMAW's mammogram utilization and health beliefs. The qualitative portion of the study was conducted on a purposive sample of IMAW. A semi-structured interview guide in Arabic and English was used during one-on-one interviews. Arabic interviews were translated into English and transcribed by professionals. Interviews were analyzed by thematic analysis according to Braun and Clarke (2008). A total of 184 IMAW completed the survey with mean age of 50.4 (SD = 5.58, range = 45-60). Results revealed low mammogram screening rate among IMAW. Only 32.6% adhered to mammograms. Spousal support was positively associated with ever having obtained a mammogram and IMAW's adherence to mammogram. The 20 qualitative interviews, 16 in Arabic and four in English, produced rich description supporting results from the survey which includes, (a) types of spousal support, (b) impact of spousal support on participants' mammogram utilization and experience, and (3) impact of spousal support on participants' health beliefs toward mammograms. Findings from surveys and interviews show that a husband's support is positively associated with IMAW's mammogram utilization and health beliefs. Suggesting a new approach to integrate husbands in culturally appropriate interventions to increase mammogram screening rates among IMAW.

Barriers and opportunities for improving smoke-free area implementation in Banda Aceh city, Indonesia: a qualitative study.

OBJECTIVES: To investigate the challenges and opportunities for implementing smoke-free areas (SFAs) within eight area categories using the WHO Framework Convention on Tobacco Control as a framework for analysis. DESIGN: This study used qualitative methods (in-depth interviews and document reviews). All transcripts from the interviews and formal documents were coded using NVivo V.11 software and analysed using an inductive thematic analysis. SETTING: Banda Aceh, Indonesia. PARTICIPANTS: Seventy-three participants were interviewed, stratified by ages (18-59 years): policymakers (n=4), SFA implementers (n=33), SFA's non-compliance prosecutors (n=2), SFA observers (n=4), communities/respected figures (n=30); and 10 documents were reviewed. RESULTS: Barriers to the effective implementation of SFAs were identified: conflict of interests of Banda Aceh authorities in implementing SFA policies; inadequate monitoring, evaluation and implementation of SFAs among involved actors; inadequate public communication of SFAs to communities; and misunderstanding of 'enclosed areas' as SFAs. However, some important opportunities were identified: the Ministry of Education promotes SFA at schools; and smoking prohibition as part of sharia and other religions' recommendations. CONCLUSIONS: This research is the first study to examine SFAs to understand the challenges and opportunities for improving SFA policy implementation by interviewing various key respondents in Banda Aceh (religious leaders and respected figures). These key stakeholders' roles are crucial to enhance the implementation of SFA policies in Banda Aceh (currently suboptimal) and other populous Muslim areas in Indonesia or other countries because smoking contradicts Islamic teachings and other religions' tenets. Further, the findings propose policymakers and involved agencies strengthen public communication, execution, monitoring and evaluation, and enforcement of SFA policies in Aceh. Finally, the application of methods and results from this study to other local areas in Indonesia or other developing nations is necessary to facilitate further understanding more about the applicability, advantages and limitations of this study.

Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review.

BACKGROUND: Uptake for cervical cancer screening (CCS) is extremely low among immigrant women, particularly Muslim women, because of barriers related to religious values, beliefs, and fatalism. This scoping review aimed to summarize and analyze the findings of previous studies regarding perceived barriers to CCS among Muslim immigrant women. METHODS: A search of electronic databases of peer-reviewed articles, including MEDLINE, CINAHL, PubMed, and Scopus was conducted. The following criteria were used for the selection of the articles: (a) the study population consisted of immigrant Muslim women, (b) CCS barriers were the main focus of the study, (c) the articles were original research articles, (d) the research was conducted within the last 10 years, and (d) the study was reported in English language. RESULTS: Barriers included sociodemographic factors, economic, language, cognitive, and emotional reactions. The healthcare system was classified as a community barrier, whereas culture and religion were categorized as social barriers. Beliefs that becoming ill and dying is the will of Allah and that health problems are a punishment from God were considered to be major barriers to CCS among immigrant Muslim women. CONCLUSION: Access to health service centers and CCS among Muslim immigrant women is challenging. Information dissemination by health care workers is needed to increase awareness of CCS and access to CCS service points among immigrant Muslim women. Physician recommendations to attend CCS also play an important role.

Using a participatory approach to encourage uptake of breast, colorectal, and cervical cancer screening for Scottish Muslim women: a pilot qualitative study.

BACKGROUND: Muslim women use cancer screening less often than the general female population, which puts them at risk of delayed detection. We used an asset-based approach to co-design a faith-based intervention to increase uptake of breast, colorectal, and cervical screening in Scottish Muslim women. METHODS: In this pilot qualitative study, we recruited Muslim women (n=28) of Asian and Arab ethnicity, aged 25-74 years, through snowball sampling from community organisations in Glasgow and Edinburgh. Ten of these women participated in four online workshops in February, 2021, with the aim to codesign the intervention, underpinned by the socio-ecological model and the behaviour change wheel. The final intervention included health education delivered by doctors, testimonials by Muslim women sharing experiences of cancer or screening, and the perspective on cancer screening from a female religious scholar. The intervention was delivered to two groups of eight and ten Muslim women respectively, in March 2021. A week later, the 18 women participated in two focus groups to qualitatively evaluate the intervention. Analyses were conducted thematically. FINDINGS: Themes included barriers to screening, acceptability of content and delivery, attitudinal change, and intervention improvement. Participants believed that lack of awareness was an important barrier to screening. They found the intervention informative. They particularly liked the combination of multiple components, including spirituality, culture, and health education. They valued the faith-based element and highlighted how Islam could facilitate overcoming cultural barriers including social stigma, embarrassment, and modesty, although this could vary with different levels of religiosity. Participants also emphasised that faith-based approaches in isolation would not be enough. They appreciated input of trusted sources such as doctors and religious scholars and were especially drawn to personal narratives. Participants expressed preference for face-to-face delivery and advised using translators to overcome language barriers. INTERPRETATION: Barriers to screening are complex. Using faith as an asset, integrated with the socio-ecological model and behaviour change wheel, resulted in a holistic intervention tackling multiple barriers, which appealed to participants. Collaborating with communities and faith leaders can help to develop culturally sensitive interventions that harness positive aspects of faith for better health outcomes. Intervention effectiveness needs more robust investigation, which we are undertaking in a feasibility study with 200 Muslim women in northeast England and Scotland. FUNDING: Scottish Inequalities Fund, the Scottish Government.

Buddhism.

After Christianity, Judaism, and Hinduism, Buddhism is the 4th major religion of the world. The Pew Research Center estimates that as of 2020, about 500 million people (or 6.6% of the world's population) practice Buddhism. China has the largest Buddhist population at 254 million, followed by Thailand at 66 million, and then Myanmar and Japan at about 41 million.

Islam.

Islam is one of the religions of the book, others being Judaism, Christianity, and Sabianism. It is the second largest religion in the world, the first being Christianity.

The Role of Islamic Beliefs in Facilitating Acceptance of Cancer Diagnosis.

Although survival rates for patients with cancer have increased, this disease continues to affect couples significantly. Religion and culture seem to be part of the therapeutic process for people with cancer. Despite the abundance of the Arab Muslim community in Western countries, there is a lack of documented data on Arab Muslim couples experiencing cancer. A simple exploratory qualitative study was conducted through semi-structured interviews on six married couples (n = 12) identifying with the Arab Muslim culture and being affected by cancer. An iterative data analysis was performed. Results were reported under the following themes: accepting illness through coping strategies provided by Muslim religious beliefs and practices, experiencing problems with the expression of needs and feelings within the couple, experiencing closeness within the family, and experiencing illness in the hospital setting as Muslims. Our results show that Islamic beliefs can facilitate acceptance of a cancer diagnosis. It is also noted that religion seems to unite spouses in supporting each other and maintaining hope in a difficult context. Communication issues may persist between a couple due to stressors related to cancer. The results of this study could raise awareness about the importance of exploring religious and spiritual beliefs when supporting couples affected by cancer.

Exploring Factors Influencing Cervical Cancer Prevention Behaviors: Unveiling Perspectives of Conservative Muslim American Women in Virginia.

Understanding the complexities surrounding cervical cancer prevention methods and hesitancy among conservative Muslim American women is crucial in addressing health disparities. This qualitative study aimed to delve into the religious, behavioral, and socio-cultural factors influencing Muslim women's decisions regarding cervical cancer screening (CC-S) and HPV vaccination (HPV-V) in Virginia, USA. Through interviews with 10 Muslim women residing in Virginia, qualitative data were collected as part of a mixed-method cross-sectional study conducted between August and September 2021. Findings revealed that participants had limited knowledge about cervical cancer, CC-S, and HPV-V, with notable themes emerging, such as cultural influences, misconceptions, language barriers, and challenges posed by the intricate US healthcare system. Future research should focus on exploring these barriers to mitigate the impact of cervical cancer within the Muslim population.

"I Am Grateful for Every Day I Live": A Qualitative Study on the Spiritual Experiences of Women With Gynecological Cancer.

BACKGROUND: Considering the life-threatening nature of gynecological cancers, spirituality and religious beliefs may play a key role in the experiences of the patients during the disease process and their coping. OBJECTIVE: The aim of this study was to understand the spiritual experiences of Muslim women with gynecological cancer during the disease process. METHODS: A qualitative, phenomenological, and hermeneutic approach was followed in the research. Fourteen women with gynecological cancer in Turkey were interviewed individually. The thematic analysis approach of Braun and Clarke was used to evaluate the data. RESULTS: The results of the data analysis revealed 3 themes (consisting of 9 subthemes): (1) reaction to cancer: spiritual distress (fear of death, perception of punishment, fear of obscurity and uncertainty, and being a cause of spiritual distress in the family); (2) reaction to cancer: spiritual well-being (accepting whatever may come from Allah, strengthening the faith in Allah); and (3) spiritual resources for coping with cancer (religious practices, hobbies and complementary practices, and family support). CONCLUSIONS: The results of the study shed light on the cases that may cause spiritual distress and improve the spiritual well-being that is experienced by Muslim women with gynecological cancer during the disease process; they also reveal that religion has an effect on the experiences during the cancer process and the coping methods. IMPLICATIONS FOR PRACTICE: Healthcare professionals who care for Muslim women with gynecological cancer should plan spiritual care by being aware of the cultural characteristics and religious beliefs of these women and their families.

Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia.

BACKGROUND: Intermittent fasting (IF) is a popular dietary plan for weight loss. In fact, fasting is a common practice in different religions such as Buddhism, Hinduism, Judaism, Christianity, and Islam. During the month of Ramadan, more than 1.5 billion Muslims worldwide fast from dawn to sunset. Ramadan diurnal intermittent fasting (RDIF) has health benefits, including a reduction in cardiovascular disease (CVD) risk and an improvement in mood. However, little is known about the effects of RDIF on lifestyle behaviors, such as regular exercise, consuming healthy diet, and avoiding harmful substances, as well as mental stress, and academic performance in high school and university students. METHODS: In this prospective cohort study, two self-reported questionnaires were sent one week before and during the last week of Ramadan (April 2022; Ramadan 1443 in Hijri Islamic Calendar) to assess changes in lifestyle, perceived stress, and academic achievement of medical students at Taif University in Taif city, Saudi Arabia. Healthy lifestyle components data were collected to calculate healthy lifestyle scores, including body mass index, physical activity, adherence to a Mediterranean diet, smoking status, and sleep duration. RESULTS: RDIF was associated with a healthier lifestyle in both female and male participants (pre-RDIF mean score: 2.42 vs post-RDIF mean score: 2.74; statistical power = 0.99; P-value < 0.05). They were more active and adherent to the Mediterranean diet during RDIF. Additionally, the post-RDIF smoking rate declined by 53.4%. Male participants showed higher perceived stress scores during RDIF (pre-RDIF mean score: 19.52 vs post-RDIF mean score: 22.05; P-value < 0.01). No changes in academic performance were observed upon RDIF. CONCLUSION: Medical students show healthier dietary and lifestyle behaviors and their academic performance is not affected during RDIF. However, perceived stress is higher among male students.

Evaluation of the Urinary System Diseases Sections in the Book Cerrahiyetü'l Haniyye (Imperial Surgery) by Sabuncuoglu Serefeddin.

OBJECTIVES: Serefeddin Sabuncuoglu (1385-1465) is a medical scholar who wrote the first illustrated surgical book (Cerrahiyetü'l Haniyye [Imperial Surgery]) in the history of Turkish and Islamic medicine. Sabuncuoglu benefited from the books of medical scholars before him and translated the book et-Tasreef of Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis), which was the most important surgical book of its time. In this study, the urinary system disease sections of the textbook by Serefeddin Sabuncuoglu were examined. MATERIALS AND METHODS: Cerrahiyetü'l Haniyye and et-Tasreef were evaluated by comparative textual analysis methodology in terms of urinary system diseases and its treatments. RESULTS: The textbooks contain the same definitions of the cauterization of the kidney, cauterization of the urinary bladder, the treatment of urine retention, bladder irrigation with the syringe, and the forms of the instruments for the extraction of a stone from men and women. Serefeddin Sabuncuoglu made additions to the kidney and bladder cauterization and bladder irrigation sections. Colorful miniatures containing images of the procedures performed on the patients are found in Cerrahiyetü'l Haniyye. CONCLUSIONS: The urinary system disease section in Cerrahiyetü'l Haniyye is a translation of et-Tasreef in general, with some additional information and drawings. The surgical instruments and procedures described by both physicians have reached the present day with changes.

Commentary on "From the War on Terror to the Moral Crusade Against Female Genital Mutilation: Anti-Muslim Racism and Femonationalism in the United States".

I am a practicing urologist with expertise in female genital cutting. In this commentary, I respond to Dr Dina Bader's article "From the War on Terror to the Moral Crusade Against Female Genital Mutilation." I outline the current climate around genital cutting, the various actors shaping female genital cutting (FGC) legislation, and public perceptions surrounding the issue. I conclude that legislative changes sweeping across the United States to ban FGC have a variety of motivations. Some are to lift politicians' profiles; some are to prevent destination FGC cutting domestically. The possibility of increased racial profiling or increased Islamophobia is perhaps underrecognized by liberals, and perhaps a discreet and intentional agenda for conservative lawmakers. The effect of this legislation also increases attention on the genital alteration of all children, male, female, and intersex, which could be the greatest benefit of all.