Caring for patients during voluntarily stopping of eating and drinking (VSED): experiences of a palliative care team in Germany.

BACKGROUND: Health-care professionals are confronted with patients who wish to end their lives through voluntarily stopping eating and drinking (VSED). During VSED, symptoms such as agitation, thirst or psychological distress may arise, thus making close medical accompaniment necessary. Dealing with these symptoms can put a high burden on palliative care teams. Furthermore, divergent perceptions of the ethical classification of VSED may lead to moral distress. The aim of this study was to assess the influence of experience gained over time on the burden of palliative care professionals while accompanying patients during VSED and to assess the perceptions of coping strategies. METHODS: This is a prospective single-centre study conducted at the Interdisciplinary Centre for Palliative Care at University Hospital Duesseldorf, Germany. At two points in time (T1, T2) one year apart, team members of all professions who were actively involved in the accompaniment were eligible to complete a pretested questionnaire. RESULTS: Team members perceived the symptom complex of psychological distress, anxiety, and agitation to be the most burdensome symptoms for the patients (T1: 28/49, 57.1%; T2: 33/59, 55.9%). Thirst was the second most observed symptom (T1: 17/49, 34.7%, T2: 19/59, 32.2%). These were also the most burdensome symptoms for individual team members. Most team members found there were no general moral concerns. There was a decrease in the perceived importance of support strategies such as ethical counselling (85.7% versus 63.6%). CONCLUSIONS: Accompanying patients during VSED is a challenge for health-care professionals. When comparing T2 to T1, less emphasis lies on the importance of ethical counselling or psychiatric assessment to build a foundation for the accompaniment. Moral and ethical concerns seem to play a minor role. More in-depth studies covering a bigger sample size as well as qualitative studies are needed.

The Christian Orthodox Church Fasting Diet Is Associated with Lower Levels of Depression and Anxiety and a Better Cognitive Performance in Middle Life.

Lifestyle choices significantly influence mental health in later life. In this study we investigated the effects of the Christian Orthodox Church (COC) fasting diet, which includes long-term regular abstinence from animal-based products for half the calendar year, on cognitive function and emotional wellbeing of healthy adults. Two groups of fasting and non-fasting individuals were evaluated regarding their cognitive performance and the presence of anxiety and depression using the Mini Mental Examination Scale, the Hamilton Anxiety Scale, and the Geriatric Depression Scale (GDS), respectively. Data on physical activity, smoking, and vitamin levels were collected and correlated with mental health scoring. Negative binomial regression was performed to examine differences in the GDS scores between the two groups. Significantly lower levels of anxiety (7.48 ± 4.98 vs. 9.71 ± 5.25; p < 0.001) and depression (2.24 ± 1.77 vs. 3.5 ± 2.52; p < 0.001), along with better cognitive function (29.15 ± 0.79 vs. 28.64 ± 1.27; p < 0.001), were noticed in fasting compared to non-fasting individuals. GDS score was 31% lower (Incidence Rate Ratio: 0.69, 95% Confidence Interval: 0.56-0.85) in the fasting group compared to the control, while vitamin and ferrum levels did not differ. The COC fasting diet was found to have an independent positive impact on cognition and mood in middle-aged and elderly individuals.

Fasting inhibits aerobic glycolysis and proliferation in colorectal cancer via the Fdft1-mediated AKT/mTOR/HIF1α pathway suppression.

Evidence suggests that fasting exerts extensive antitumor effects in various cancers, including colorectal cancer (CRC). However, the mechanism behind this response is unclear. We investigate the effect of fasting on glucose metabolism and malignancy in CRC. We find that fasting upregulates the expression of a cholesterogenic gene, Farnesyl-Diphosphate Farnesyltransferase 1 (FDFT1), during the inhibition of CRC cell aerobic glycolysis and proliferation. In addition, the downregulation of FDFT1 is correlated with malignant progression and poor prognosis in CRC. Moreover, FDFT1 acts as a critical tumor suppressor in CRC. Mechanistically, FDFT1 performs its tumor-inhibitory function by negatively regulating AKT/mTOR/HIF1α signaling. Furthermore, mTOR inhibitor can synergize with fasting in inhibiting the proliferation of CRC. These results indicate that FDFT1 is a key downstream target of the fasting response and may be involved in CRC cell glucose metabolism. Our results suggest therapeutic implications in CRC and potential crosstalk between a cholesterogenic gene and glycolysis.

ERP correlates of cognitive control and food-related processing in normal weight and severely obese candidates for bariatric surgery: Data gathered using a newly designed Simon task.

Although there have been suggestions that altered cognitive control and food reward sensitivity contribute to overeating in obese individuals, neurophysiological correlates of these mechanisms have been poorly investigated. The current study investigated event-related potentials (ERP) in 24 severely obese and 26 normal weight individuals in fasting condition, using a novel Simon task with food and object distractors. The study showed that conflict in the Simon task for the food distractor increased with hunger in both groups but was larger with respect to a neutral condition only in the obese individuals. ERP showed higher N1amplitudes in both groups for food distractor, reflecting early food processing. The P2 latency was delayed and the effect of distractors on N2 amplitude was smaller in the obese subjects, reflecting altered neural mechanisms associated with selective attention and cognitive control, all contributing hypothetically to delay response selection of these individuals faced with food distractor.

Cloning, expression profiling, and effects of fasting status on neuropeptide Y in Schizothorax davidi.

To better comprehend the mechanism that neuropeptide Y (npy) regulates feeding in Schizothorax davidi, we cloned and identified the full-length cDNA sequence of the npy gene in this species using RACE technology. Subsequently, we explored the npy mRNA distribution in 18 tissues and investigated the expression of npy mRNA at postprandial and fasting stages. We found that the npy full-length cDNA sequence is 803 bp. Moreover, npy mRNAs extensively expressed in all detected tissues, with the highest expression in hypothalamus. In postprandial study, the expression of npy mRNA in the hypothalamus was significantly decreased after eating (p < 0.01). In addition, the expression of the npy gene was significantly increased on the fifth day after fasting (p < 0.05). However, after refeeding, the expression of the npy gene was decreased significantly on days 9, 11, and 14 (p < 0.01). Our research suggest that npy may have an orexigenic role in S. davidi. PRACTICAL APPLICATIONS: S. davidi, a coldwater fish native to China, has high economic value, and it has gained great popularity. To date, there is still no large-scale breeding of S. davidi in China. How to strengthen the production performance of S. davidi is a hot research area. Neuropeptide Y (NPY), a 36-amino-acid single-chain polypeptide, is one of the main appetite regulation factors. However, to date, no studies have reported on the biological function of npy in the feeding of S. davidi. In our study, we revealed that the trend of hypothalamic npy expression during the postprandial and fasting stages. The results suggested that npy might be an appetite-promoting factor in this species. Overall, we provide the theoretical basis for how to strengthen the production performance of S. davidi through appetite regulation.

Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement / Estudo comparativo do esvaziamento gástrico entre uma solução isotônica e um suplemento nutricional por meio da ultrassonografia

Abstract Background and objectives: Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2 hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. Methods: In a prospective, randomized, blind study, 34 healthy volunteers ingested 200 mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L-1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L-1, and 300 kcal. After 2 hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w-1), whose value above 1.5 mL.kg-1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. Results: There was a significant difference between all parameters evaluated 2 hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2 hours after ingestion. Only one patient had vol.w-1 <1.5 mL.kg-1 2 hours after ingestion of nutritional supplementation; and only one had vol.w-1 >1.5 mL.kg-1 after ingestion of isotonic solution. Conclusion: This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2 hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.

Resumo Justificativa e objetivos: O jejum pré-operatório pode levar a efeitos indesejáveis no paciente cirúrgico, em que há um estimulo à ingestão de líquidos sem resíduos até 2 horas antes da anestesia. O objetivo deste estudo foi avaliar o esvaziamento gástrico de duas soluções diferentes por meio da ultrassonografia. Métodos: Em um estudo prospectivo, randomizado, cego, 34 voluntários saudáveis ingeriram 200 mL de duas soluções sem resíduos, em duas etapas: uma solução isotônica com carboidratos, eletrólitos, osmolaridade de 292 mOsm.L-1 e 36 kcal; e outra suplementação nutricional, com carboidratos, proteínas, eletrólitos, osmolaridade de 680 mOs.L-1 e 300 kcal. Após 2 horas, fez-se ultrassonografia gástrica com avaliação da área do antro e volume gástrico e relação do volume gástrico sobre o peso (vol.p-1), cujo valor acima de 1,5 mL.kg-1 foi considerado risco para broncoaspiração. Considerou-se p< 0,05 como estatisticamente significativo. Resultados: Houve diferença significativa entre todos os parâmetros avaliados 2 horas após a ingestão de suplementação nutricional em relação ao jejum. O mesmo ocorreu quando foram comparados os parâmetros entre solução isotônica e suplementação nutricional 2 horas após a ingestão. Apenas um paciente apresentou vol.p-1< 1,5 mL.kg-1 2 horas após a ingestão de suplementação nutricional; e apenas um apresentou vol.p-1 > 1,5 mL.kg-1, após a ingestão de solução isotônica. Conclusão: Este estudo demonstrou que o esvaziamento gástrico de volumes iguais de diferentes soluções depende de sua constituição. Aqueles com alto valor calórico e alta osmolaridade, e com proteínas presentes, 2 horas após a ingestão, aumentaram os volumes gástricos, compatíveis com o risco de aspiração gástrica.

Why do women fast during breast cancer chemotherapy? A qualitative study of the patient experience.

BACKGROUND: Why do patients practice fasting? The effects of fasting before treatment with chemotherapy for cancer in humans are currently unknown. However, there is an apparent enthusiasm for fasting among cancer patients. This qualitative study provides data on the motivations to fast and the experience of fasting among a population of women with breast cancer. METHOD: Sixteen semi-structured interviews were conducted, and two researchers independently performed a thematic analysis. To ensure the internal validity of the study, patients had the possibility to rate their agreement with the study results through a satisfaction questionnaire. RESULTS: Six main themes were identified in this study: main reasons to fast, alternative authorities to the oncologist, adapting the fast to social and lifestyle constraints, fasting effects felt during chemotherapy, barriers and facilitators of fasting during chemotherapy, and seeking for a more integrative medicine. Patients' primary motivation to fast was to lower the negative side effects of chemotherapy. Fasting was also reported as a coping strategy to give them a greater sense of control over their treatment and to reduce their anxiety. CLINICAL IMPLICATIONS: Results from the study suggest that, if discouraged from fasting, patients may turn to complementary health care practitioners for support. Medical professionals may thus not know of patients' fasting practice. Health psychologists could play a key role fostering the dialogue between different health professionals and the patient. They could also help to meet patients' needs during cancer treatment to reduce treatment anxiety. Statement of contribution What is already known on this subject? Fasting diet in cancer treatment has become an important topic since Raffaghello et al. published their study on mice in 2008. While the (positive) effects of fasting in humans remain to be proven, there has been a significant enthusiasm for this practice among patients in the last few years. However, patients' motivations to fast remain unclear to the scientific community and clinicians. What does this study add? This study is the first to investigate patients' motivations to fast and patients' experience of fasting in a cancer population. Patients' primary motivation to fast was to lower the side effects of chemotherapy. Fasting acts as an active coping strategy that helps to reduce anxiety. Unsupported patients may turn to complementary health care practitioners.

Perception of Hunger/Satiety and Nutrient Intake in Women Who Regain Weight in the Postoperative Period After Bariatric Surgery.

OBJECTIVE: To investigate the perception of hunger and satiety and its association with nutrient intake in women who regain weight in the postoperative period after bariatric surgery. METHODS: Cross-sectional study of adult women divided into three groups: weight regain (n = 20), stable weight (n = 20) (both at least 24 months after Roux-en-Y gastric bypass surgery), and non-operated obesity (n = 20). A visual analogue scale measured hunger/satiety perception while fasting, immediately after finishing a test meal, and 180 min after finishing the test meal. The incremental area above or under the curve was calculated. Food intake was analyzed by 3 days of food recall and adjusted for intraindividual variation. To make between-group comparisons, Mann-Whitney, ANOVA, Kruskal-Wallis, and independent-samples T tests and Pearson's correlation were used. RESULTS: There were no between-group differences in incremental areas of hunger/satiety, but protein intake was significantly lower among patients who regained weight compared with those who had stable body weight (0.99 ± 0.23 g/kg body weight vs. 1.17 ± 0.21 g/kg body weight, p = 0.047). In the group that regained weight, satiety was correlated positively with usual dietary protein density (r = 0.541; p = 0.017) and negatively with usual carbohydrate intake (r = - 0.663; p = 0.002). CONCLUSION: Women who regained weight presented similar perceptions of hunger/satiety to those of patients without weight regain and with non-operated obesity. In patients who regained weight postoperatively, satiety perception was correlated positively with usual dietary protein density and inversely with usual carbohydrate intake.

Effects of overnight fasting on handgrip strength in inpatients / Efeitos do jejum noturno sobre a força muscular em pacientes internados

ABSTRACT Objective: To investigate the effects of overnight fasting on handgrip strength of adult inpatients. Methods: A prospective clinical study enrolling 221 adult patients. The endpoints were handgrip strength obtained by dynamometry in three time points (morning after an overnight fasting, after breakfast and after lunch) and the cumulative handgrip strength (mean of handgrip strength after breakfast and lunch) in the same day. The mean of three handgrip strength measures was considered to represent each time point. A cut-off for the mean overnight fasting handgrip strength at the 50th percentile (35.5kg for males and 27.7kg for females) was used for comparisons. We registered the age, sex, current and usual weight (kg), weight loss (kg), diagnosis of cancer, nutritional status, elderly frequency, digestive tract symptoms, type of oral diet, and the amount of dinner ingested the night before handgrip strength (zero intake, until 50%, <100% and 100%). Results: Handgrip strength evaluated after an overnight fasting (31.2±8.7kg) was lesser when compared with handgrip strength after breakfast (31.6±8.8kg; p=0.01), and with cumulative handgrip strength (31.7±8.8kg; p<0.001). Handgrip strength was greater in patients who ingested 100% (33.2±9.1kg versus 30.4±8.4kg; p=0.03) and above 50% of dinner (32.1±8.4kg versus 28.6±8.8kg; p=0.006). Multivariate analysis showed that ingesting below 50% of dinner, severe malnutrition, and elderly were independent factors for handgrip strength reduction after overnight fasting. Conclusion: The muscular function was impaired after an overnight fasting of adult patients hospitalized for medical treatment, especially for those with low ingestion, malnourished and elderly.

RESUMO Objetivo: Investigar os efeitos do jejum noturno na força muscular de pacientes adultos internados. Métodos: Estudo clínico prospectivo realizado com 221 pacientes adultos. Os desfechos observados foram a força de preensão palmar avaliada pela dinamometria em jejum, após o desjejum, após o almoço, e acumulada (média da força de preensão palmar após desjejum e almoço). Foi considerada a média das três medidas da força de preensão palmar para representar cada momento. O ponto de corte para a média da força de preensão palmar em jejum categorizada no percentil 50 (35,5kg para homens, e 27,7kg para mulheres) foi usado para as comparações. Investigaram-se idade, sexo, peso atual e habitual (kg), perda de peso (kg), diagnóstico de câncer, estado nutricional, frequência de idosos, sintomas do trato digestório, tipo de dieta oral e quantidade ingerida no jantar no dia anterior à mensuração da força de preensão palmar (ingestão zero, até 50%, <100 e 100%). Resultados: A força de preensão palmar após o jejum noturno foi menor que a força após o desjejum (31,1±8,7kg versus 31,6±8,8kg; p=0,01) e quando foi considerada a força acumulada (31,7±8,8kg; p<0,001). A força de preensão palmar em jejum foi maior para os pacientes que ingeriram 100% (33,2±9,1kg versus 30,4±8,4kg; p=0,03) e >50% do jantar (32,1±8,4kg versus 28,6±8,8kg; p=0,006). A análise multivariada mostrou que ingerir menos da metade do jantar, desnutrição grave e ser idoso foram fatores independentes para redução da força de preensão palmar em jejum. Conclusão: A função muscular ficou comprometida após jejum noturno em pacientes adultos internados para tratamento clínico, especialmente nos casos de baixa ingestão alimentar, desnutridos e idosos.

Association of weight control behaviors with body mass index and weight-based self-evaluation

Objective: To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation. Methods: Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years). Results: The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting. Conclusion: The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Does fasting influence preload responsiveness in ASA 1 and 2 volunteers? / O jejum influencia a responsividade à pré-carga em voluntários ASA I e II?

Abstract Introduction: Preoperative fasting was long regarded as an important cause of fluid depletion, leading to hemodynamic instability during surgery should replenishment is not promptly instituted. Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting. Methods: We designed an observational, analytic, prospective, longitudinal study in which 31 ASA 1 and ASA 2 volunteers underwent an echocardiographic examination both before and after a fasting period of at least 6 hours (h). Data from both static and dynamic preload indices were obtained on both periods, and subsequently compared. Results: Static preload indices exhibited a markedly variable behaviour with fasting. Dynamic indices, however, were far more consistent with one another, all pointing in the same direction, i.e., evidencing no statistically significant change with the fasting period. We also analysed the reliability of dynamic indices to respond to known, intentional preload changes. Aortic velocity time integral (VTI) variation with the passive leg raise manoeuvre was the only variable that proved to be sensitive enough to consistently signal the presence of preload variation. Conclusion: Fasting does not appear to cause a change in preload of conscious volunteers nor does it significantly alter their position in the Frank-Starling curve, even with longer fasting times than usually recommended. Transaortic VTI variation with the passive leg raise manoeuvre is the most robust dynamic index (of those studied) to evaluate preload responsiveness in spontaneously breathing patients.

Resumo Introdução: O jejum no pré-operatório é há muito tempo considerado uma importante causa de depleção de líquidos, leva a instabilidade hemodinâmica durante a cirurgia, caso a reposição não seja prontamente instituída. Recentemente, esse ponto de vista tradicional tem sido progressivamente desafiado e um número crescente de autores agora propõe uma abordagem mais restritiva para o controle de líquidos, embora permaneçam dúvidas quanto à verdadeira influência hemodinâmica do jejum no pré-operatório. Métodos: Estudo observacional, analítico, prospectivo e longitudinal, no qual 31 voluntários ASA I e II foram submetidos a exame ecocardiográfico antes e após um período de jejum de no mínimo seis horas. Os dados dos índices de pré-carga tanto estáticos quanto dinâmicos foram obtidos em ambos os períodos e subsequentemente comparados. Resultados: Os índices estáticos de pré-carga mostraram um comportamento acentuadamente variável com o jejum. Os índices dinâmicos, entretanto, foram bem mais consistentes entre si, todos apontam na mesma direção; isto é, não evidenciam alteração estatisticamente significativa com o período de jejum. Analisamos também a confiabilidade dos índices dinâmicos para responder a alterações pré-carga intencionais conhecidas. A variação da integral de velocidade-temo (VTI) aórtica com a manobra de elevação passiva dos membros inferiores foi a única variável que mostrou sensibilidade suficiente para sinalizar de forma consistente a presença de variação na pré-carga. Conclusão: O jejum não pareceu causar uma alteração na pré-carga de voluntários conscientes nem alterou substancialmente a sua posição na curva de Frank-Starling, mesmo com tempos de jejum mais prolongados do que o normalmente recomendado. A variação do VTI transaórtico com a manobra de elevação passiva dos membros inferiores foi o índice dinâmico mais consistente (dos estudados) para avaliar a capacidade de resposta a variações da pré-carga em pacientes que respiram espontaneamente.

Association of weight control behaviors with body mass index and weight-based self-evaluation.

OBJECTIVE:: To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation. METHODS:: Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years). RESULTS:: The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting. CONCLUSION:: The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Effect of Ramadan fasting on fatigue, mood, sleepiness, and health-related quality of life of healthy young men in summer time in Germany: A prospective controlled study.

Muslims around the world fast during the lunar month of Ramadan. The month consists of 29 or 30 days, which vary in length depending on geographic location and the time of year. During this month, Muslims abstain from food, drink, smoking, and sex from dawn until sunset. In 2015, Ramadan fell during the summer. As a result, Muslims in Germany fasted 19 h a day. Previous research has shown associations between fasting and mood enhancement. This study aimed to determine the effect of fasting on young, healthy males who fasted in Germany during Ramadan 2015. In particular, this study examined the impact of fasting on mood, fatigue, and health-related Quality of Life (QoL). This study had 2 groups: fasting group (FG; n = 25), and non-fasting group (NFG; n = 25). In FG, participants were assessed at four different points: one week before Ramadan (T1), mid Ramadan (T2), the last days of Ramadan (T3), and one week after Ramadan (T4). In NFG, participants were assessed only at T1 and T3. The results revealed that there were no significant differences between the participants in the FG and the NFG at T1 or T3 for any of the outcomes. However, participants in the FG demonstrated significant improvement from T2 to T4 in fatigue (visual analogue scale p < 0.01; fatigue severity scale:p < 0.01), mood (Beck's Depression Index-II; ANOVA; p < 0.05), and sleepiness during day time (Epworth Sleepiness Scale: ANOVA; p < 0.01). Participants in the FG also experienced significant loss of body weight (ANOVA; p < 0.001), body mass index (ANOVA; p < 0.001), skeletal muscle mass (ANOVA; p < 0.01) and fat free mass (ANOVA; p < 0.01). Findings demonstrate that Ramadan fasting did not significantly influence mood, fatigue and QoL, when compared to NFG. Even, it gives benefit to fasting group with regard to these parameters.

Caregivers' reactions to preoperative procedures in outpatient pediatric surgery.

OBJECTIVE:: To identify pediatric caregivers' reactions in outpatient surgery settings. METHODS:: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. RESULTS:: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. CONCLUSION:: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels. OBJETIVO:: Identificar as reações dos acompanhantes de crianças submetidas à cirurgia ambulatorial. MÉTODOS:: Estudo survey descritivo/ exploratório, de caráter quantitativo, realizado em dois hospitais com 62 acompanhantes que responderam um questionário semiestruturado. RESULTADOS:: Constatou-se que a maioria dos acompanhantes era formada por mães (88,7%) e permaneceu em jejum junto das crianças. Todos os acompanhantes referiram sentimentos identificados como nervosismo, ansiedade e preocupação. CONCLUSÃO:: A orientação médica aos procedimentos pré-operatórios foi de grande importância, não somente para o cuidado da criança, mas também do acompanhante, visando diminuir ao máximo o estresse vivenciado por eles.

Caregivers' reactions to preoperative procedures in outpatient pediatric surgery / Reações do acompanhante diante dos procedimentos pré-operatórios em cirurgia pediátrica ambulatorial

ABSTRACT Objective: To identify pediatric caregivers' reactions in outpatient surgery settings. Methods: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. Results: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. Conclusion: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels.

RESUMO Objetivo: Identificar as reações dos acompanhantes de crianças submetidas à cirurgia ambulatorial. Métodos: Estudo survey descritivo/ exploratório, de caráter quantitativo, realizado em dois hospitais com 62 acompanhantes que responderam um questionário semiestruturado. Resultados: Constatou-se que a maioria dos acompanhantes era formada por mães (88,7%) e permaneceu em jejum junto das crianças. Todos os acompanhantes referiram sentimentos identificados como nervosismo, ansiedade e preocupação. Conclusão: A orientação médica aos procedimentos pré-operatórios foi de grande importância, não somente para o cuidado da criança, mas também do acompanhante, visando diminuir ao máximo o estresse vivenciado por eles.

Intermittent fasting modulates IgA levels in the small intestine under intense stress: a mouse model.

Intermittent fasting prolongs the lifespan and unlike intense stress provides health benefits. Given the role of the immunoglobulin A (IgA) in the intestinal homeostasis, the aim of this study was to assess the impact of intermittent fasting plus intense stress on secretory IgA (SIgA) production and other mucosal parameters in the duodenum and ileum. Two groups of six mice, with intermittent fasting or fed ad libitum for 12weeks, were submitted to a session of intense stress by a bout of forced swimming. Unstressed ad libitum fed or intermittently fasted groups were included as controls. After sacrifice, we evaluated intestinal SIgA and plasma adrenal hormones, lamina propria IgA+ plasma-cells, mRNA expression of polymeric immunoglobulin receptor, α- and J-chains in the liver and intestinal mucosa, as well as pro- (tumor necrosis factor-α, interleukin-6 and Interferon-γ) and anti- (interleukin-2, -4, -10 and transforming growth factor-ß) inflammatory cytokines in mucosal samples. Under intense stress, intermittent fasting down- or up-modulated the levels of most parameters in the duodenum and ileum, respectively while up-regulated corticosterone levels without affecting epinephrine. Our data suggest intermittent fasting plus intense stress elicited neuroendocrine pathways that differentially controlled IgA and pIgR expression in duodenum and ileum. These findings provide experimental foundations for a presumable impact of intermittent fasting under intense stress on the intestinal homeostasis or inflammation by triggering or reducing the IgA production in ileum or duodenum respectively.

Comparison of Ramadan-specific education level in patients with diabetes seen at a Primary and a Tertiary care center of Karachi-Pakistan.

AIMS: To compare Ramadan-specific education level in fasting patients with diabetes at a Primary and a Tertiary care center. METHODOLOGY: An observational study was conducted in the Outpatient departments of a Primary care center and a Tertiary care center in Karachi-Pakistan. Recruitment of patients started at the end of Ramadan 2011 and continued till three months after Ramadan 2011. All patients with diabetes who observed fast during the month of Ramadan 2011 were included in the study. In Primary care center, patients were attended by physicians only, while at Tertiary care center patients were seen by physicians, diabetes educator and dietician. For data collection, standardized questionnaire based interview was conducted on one to one basis by trained healthcare professionals. Same questionnaire was used at both the centers. RESULTS: A total of 392 and 199 patients with diabetes recruited at Primary and Tertiary care centers, respectively. Ramadan-specific diabetes education received by 213 (55%) and 123 (61.80%) patients with diabetes at Primary and Tertiary care centers, respectively. Compared to Primary care center, patients at Tertiary care centers were more aware about components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan (p<0.05). CONCLUSION: It was observed that Ramadan-specific education level of patients at Tertiary care center was significantly better compared to patients at Primary care center.

The behavior of Turkish cancer patients in fasting during the holy month of Ramadan.

OBJECTIVE: Fasting during the holy month of Ramadan is one of the major obligations for all adult Muslims. We performed a survey of Turkish Muslim cancer patients to examine the extent of their fasting status and to compare various clinical characteristics of fasting and non-fasting cancer patients during the month of Ramadan. METHODS: This study was conducted on 701 adult cancer patients who attended ambulatory patient care units answered the questionnaires. RESULTS: The population comprised 445 women (63.5%), and the median age was 54 years. Before diagnosis of cancer, 93.1% of the patients used fast consists of completely (78.3%) and partial (14.8%). However, 15% of cases were fasting on the day of interview, either partially (7.4%) or completely (7.6%) with equal distributions. Patients who were females, those with good performance status, those without any comorbid disease, who had non-metastatic disease, those with history of surgery, those treated with radiotherapy and those being treated with oral chemotherapeutic agents were more likely to be fasting than others. The fasting ones had more prevalent among patients with lymphoma, urogenital cancer and breast cancer; conversely, the rate of fasting status among patients with lung and gastrointestinal cancer was quite low. Only 20.8% of all patients asked their physician whether it was alright for them to fast and physicians generally had a negative attitude towards fasting (83.2%). CONCLUSIONS: Majority of cancer patients are not fasting during the month of Ramadan, and a small part of patients consult this situation to their physician.

Eating behaviors and negative affect in college women's everyday lives.

OBJECTIVE: A growing body of research seeks to understand the relationship between mood and eating behaviors. Ecological Momentary Assessment (EMA) methods provide a method for assessing these processes in natural settings. We used EMA to examine the relationship between mood and eating behaviors in everyday life among women with subclinical disordered eating behaviors. METHOD: Participants (N = 127, age M = 19.6 years, BMI M = 25.5) completed five daily EMA reports on palmtop computers for 1 week. Assessments included measures of negative affect (NA) and eating-related behavior during eating (eating large amounts of food, loss of control over eating, and restricting food intake) and noneating episodes (skip eating to control weight/shape). Time-lagged multilevel models tested mood-eating behavior relationships. RESULTS: Higher NA did not precede any unhealthy eating and weight control behaviors. However, NA was higher when women reported eating large quantities of food, losing control over eating, and restricting food intake during their most recent eating episode, but not after skipping eating to control weight/shape. DISCUSSION: These findings elucidate the processes in daily life that may influence the development and maintenance of unhealthy eating and weight control behaviors that, in turn, can inform interventions.

Interleukin-6 contributes to early fasting-induced free fatty acid mobilization in mice.

Contracting muscle releases interleukin-6 (IL-6) enabling the metabolic switch from carbohydrate to fat utilization. Similarly, metabolism is switched during transition from fed to fasting state. Herein, we examined a putative role for IL-6 in the metabolic adaptation to normal fasting. In lean C57BL/6J mice, 6 h of food withdrawal increased gene transcription levels of IL-6 in skeletal muscle but not in white adipose tissue. Concomitantly, circulating IL-6 and free fatty acid (FFA) levels were significantly increased, whereas respiratory quotient (RQ) was reduced in 6-h fasted mice. In white adipose tissue, phosphorylation of hormone-sensitive lipase (HSL) was increased on fasting, indicating increased lipolysis. Intriguingly, fasting-induced increase in circulating IL-6 levels and parallel rise in FFA concentration were absent in obese and glucose-intolerant mice. A causative role for IL-6 in the physiological adaptation to fasting was further supported by the fact that fasting-induced increase in circulating FFA levels was significantly blunted in lean IL-6 knockout (KO) and lean C57BL/6J mice treated with neutralizing IL-6 antibody. Consistently, phosphorylation of HSL was significantly reduced in adipose tissue of IL-6-depleted mice. Hence, our findings suggest a novel role for IL-6 in energy supply during early fasting.