Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

BACKGROUND: There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries' cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women. METHODS: A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders. RESULTS: Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya's healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity. CONCLUSIONS: Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya

Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project

Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD. Methods Data were collected from consecutive patients attending IBD outpatient appointments at 12 UK hospitals. A predefined questionnaire was used to collect data including patient demographics, IBD history, opioid use in the past year (>2 weeks) and opioid-use mitigation techniques. Additionally, consecutive IBD-related hospital stays leading up to July 2019 were reviewed with data collected regarding opioid use at admission, discharge and follow-up as well as details of the admission indication. Results In 1352 outpatients, 12% had used opioids within the past 12 months. Over half of these individuals were taking opioids for non-IBD pain and less than half had undergone an attempted opioid wean. In 324 hospitalised patients, 27% were prescribed opioids at discharge from hospital. At 12 months postdischarge, 11% were using opioids. Factors associated with opioid use in both cohorts included female sex, Crohn’s disease and previous surgery. Conclusions 1 in 10 patients with IBD attending outpatient appointments were opioid exposed in the past year while a quarter of inpatients were discharged with opioids, and 11% continued to use opioids 12 months after discharge. IBD services should aim to identify patients exposed to opioids, reduce exposure where possible and facilitate access to alternative pain management approaches

Fasting during the month of ramadan for people with diabetes: Medicine and fiqh united at last

AbstractFasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, a few groups are exempt from fasting such as being “sick” as judged by an experienced doctor. Recent collaboration between the International Islamic Fiqh Academy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observe fasting. The new guidance categorized people with diabetes into 4 groups according to their risk. Group 1 and 2 are exempted from fasting as they have risk from fasting. These included patients with poor glycemic control or with complications and serious coexisting illnesses in addition to type 1 patients and pregnant women with diabetes. Patients in groups 3 and 4 are those with moderate to low risk of harm from fasting. These are exemplified by uncomplicated patients with stable control on oral drugs not associated with excess risk of hypoglycemia. These groups of patients have no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast in line with these recommendations. The advice should be Fasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, a few groups are exempt from fasting such as being “sick” as judged by an experienced doctor. Recent collaboration between the International Islamic Fiqh Academy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observe fasting. The new guidance categorized people with diabetes into 4 groups according to their risk. Group 1 and 2 are exempted from fasting as they have risk from fasting. These included patients with poor glycemic control or with complications and serious coexisting illnesses in addition to type 1 patients and pregnant women with diabetes. Patients in groups 3 and 4 are those with moderate to low risk of harm from fasting. These are exemplified by uncomplicated patients with stable control on oral drugs not associated with excess risk of hypoglycemia. These groups of patients have no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast in line with these recommendations. The advice should be given with no complacency with the potential health risks but with great sensitivity to the patients religious feelings.</jats:p