Quality of life

2. Quality of life in diabetic patients Islamic view 1- Effect of praying By Megahid Abuelmagd Mansoura Diabetes and Endocrinology Unit 2004

3. Medical community interest in HRQOL 40 medical literatures 1966 - 1974 10.000 literatures 1968 - 1994

4. HRQOL Patients perspective on health, disease & medical treatments The concept of HRQOL remains ambiguous and poorly defined, and the number of different instruments that purport to assess the various aspects of this dimension is over helming

5. - To overcome these problems it is important to become precise in defining HRQOL. - In truth, the quality of one’s life refers to the broadest range of human experience. - In addition to the influence of health, it includes personal finance, job, housing, personal relationship, political and cultural climate, traffic, environmental considerations and much more.

6. HRQOL is primarily concern with only particular aspect of QOL. How it may be affected by health and disease.

7. Physical Social Psychological HRQOL Overall HRQOL Disease specific Patients sense of his own health. Patients sense of how the disease in question is compromising their well-being in: Patients sense of well being (physical psychological – social functioning) Health-status is a secondary concert. Function Single questionare ×

8. HRQOL Intrinsic impairment Attributional impairment Direct burden of the disease or some of its aspects. The disease is perceived as being responsible for distress - physical psychological - social functioning.

9. Diabetes Patients perception of how diabetes affects his or her physical -psychological-social functioning Burden some Frustrating Demand of self care Over helming Severe Impact of long term complication Disabling Depressing Anger Perception of the disease & adjustment to it. Loneliness Frustration Guilt Negative emotional response Denial

10. 1- How diabetes can compromise physical functioning? Vision loss Long-term complication Kidney impairment Significant heart disease Erection problems Peripheral neuropathy Autonomic neuropathy Less able to work Significant drop to perceive quality of life To complete important tasks Enjoy pleasurable activities

11. 2- How diabetes can compromise physical functioning? Short-term complication Elevated blood sugar Increased fatigue Sleep problems More frequent infections High glycemic control unwanted wt gain-more frequent hypos

12. 3- How diabetes can compromise physical functioning? Life-style changes Dietary limitations Losing one’s license to drive Unpleasant side effects of medications Long life adherence to dietary regimens-drugs- medical follow up

13. How diabetes can compromise physical functioning? Chronically frustrated Feel hopeless Problem of perceiving diabetes Insulin therapy initiation Depressive mood for fear of chronic complication

14. How diabetes can compromise social functioning? Change of daily habits to manage diabetes effectively Friends or families begin to push him for self care- changes even when the patient is unwilling Loved ones being acting like “diabetes police” Feeling alone- different and unsupported .. etc

15. The Diabetes Quality of life Measure (DQOL)? (DCCT) 46 score items (10 additional items for adolescents) Four major dimension Treatment satisfaction Treatment impact Worry about long term complication Worry about social issues

16. Lower scores of the DQOL have been found to be associated with more frequent and severe long term complications and with poor glycemic control

17. The Diabetes-Specific Quality of life Scale (DSQOLS)? 64 items 10- Treatment goals 10- Treatment satisfaction 44- perceived burden of diabetes 6 dimensions Social relations Leisure time restriction & flexibility Physical complaints Worries about the future Diet restriction Dully hassles

18. The Diabetes Quality of life Clinical Trial Questionnaire 57 items scale 8 dimensions: Physical function Fatigue / energy Health distress Mental health Satisfaction Treatment satisfaction Treatment flexibility Frequency of symptoms

19. The Appraisal of Diabetes Scale (ADS) 7 items scale To assess patients feeling and attitude about diabetes

20. The ATT-39 9 items

21. Why is quality of life important in diabetes? WHO(health) Absence of disease & infirmity Presence of physical mental and social well being Diabetes Decrease self care Decrease self confidence In turn leads to poor glycemic control Increased risk of complication

22. Effect of praying on diabetic control Catecholamines Gluconeogenesis Glycolysis Insulin secretion and action Praying leads to أمراص القلب النفسية د. محمد أحمد نابلسى صـ10 العلاج النفسى بالصلاة المؤتمر الأول للإعجاز الطبى فى القرآن والسنة

23. فى تجارب أجراها الدكتور أحمد القاضى فى أمريكا أثبت ان للقرآن أثراً إيجابياً مؤكداً لتهدئة التوتر ظهر على شكل تغييرات فى التيار الكهربى فى العضلات وتغييرات فى قابلية الجلد للتوصيل الكهربائى وتغييرات فى الدورة الدموية وما يصحب ذلك من تغير فى عدد ضربات القلب وكمية الدم الجارى فى الجلد ودرجة حرارة الجلد. ويقول الدكتور أحمد القاضى إن كل هذه التغيرات تدل على تحسن ملموس فى وظائف الجهاز العصبى التلقائى (AutonomicN.S). د. أحمد القاضى. نشرة الطب الإسلامى. العدد الثالث – أعمال المؤتمر العالمى الثالث عن الطب الإسلامى من صـ290-294

24. Impact of praying on diabetic Complication

25. Diabetic foot problems has been found to affect 6% of the studied groups. This is in contrast to the result of Robertoson (1979), who reported foot problem in one out of six diabetics. Levin and Neal, (1982),found that 20% to 25% of all diabetics who enter the hospital are suffering from feet problems. Frequent washing of exposed parts and feet during ablution were analyzed in many studies. There was lesser percentage of diabetic foot problems (grade 1, 2) among those on regular 5 times ablutions/day. Refaie (1994) stated that ablution 5 times a day could decrease infections even those of unusual forms and sites in predisposed diabetics. Samad Shira (1994) & Bouton (1994) stated that diabetic foot problems are less frequent among Moslems.

26. Edmonds and Foster (1991) stated that wearing tight shoes for a long period is the most common precipitating factor for foot ulceration in predisposed feet.

27. الوضوء ينظف الأجزاء المكشوفة من جسم الإنسان وقد أثبت علماء الجراثيم وجود أعداد هائلة من الجراثيم على كل سنتيمتر مربع من الجلد الطبيعى وفى المناطق المكشوفة يتراوح العدد بين (1-5) مليون جرثومة فى كل سنتيمتر مربع واحد.

28. ربما يفوق عدد الجراثيم المختلفة على الجلد الطبيعى عدد سكان الأرض قاطبة وقد أثبت البروفيسور فايندوف فى دراسته أن الاستحمام الواحد يزيل عن جلد الإنسان اكثر من مائتى مليون جرثومة.

29. يقول رسول الله- صلى الله عليه وسلم- (حق لله على كل مسلم أن يغتسل فى كل سبعة أيام يغسل رأسه وجسده).رواه الشيخان واللفظ لمسلم

30. Ablution and mouth cleaning • تستقر فى الفم اعداد وأنواع كثيرة من الجراثيم تزيد على (100 نوع) يتراوح عددها ما بين (500-5000) مليون جرثومة فى المليمتر الواحد من اللعاب.

31. Ablution 5 times a day could decrease infections even those of unusual forms and sites e.g. malignant otitis externa gingivitis and periodontal disease and tooth decay: Rifaire, Diabetes 1994.

35. In the same article M.R Rifaie stated that mucormycosis is extremely rare, this is may be due to repeated snuffing the nose with water or to climate or genetic predisposition or lack of alcohol intake.

38. Fournier’s gangrene of the scrotum, perineum and penis is also very uncommon. Ablution is better preceded by washing the perineum and external genitalia.

41. أجرى فريق من أطباء جامعة الاسكندرية بحثاً عن فوائد الوضوء الصحية: - يكون باطن الأنف عند غالبية من لا يتوضئون شاحب اللون دهنى الملمس وكان شعر الأنف متلاصقاً تعلوه القشور وأظهر الفحص المجهرى وجود أعداد كبيرة من المستعمرات الجرثومية (العنقودية والعقدية والمكورات الرئوية وغيرهم) فى أنوف من لا يصلون. أما الذين يتوضئون باستمرار فلم تظهر المزارع عندهم أى مستعمرات من الجراثيم.

42. The act of prayers

43. The diabetic hand syndrome or limited joint mobility has been observed in 30-50% of cases of type-1 diabetes and in up to 75% of type-2 diabetes (Starkman et al., 1986).

44. Diabetic periarthritis of the shoulder known as frozen shoulder or adhesive capsulitis. It occurs in 10-33% of diabetics (Gray & Gotlieb, 1976). The only way to prevent development of frozen shoulder is active exercise of the shoulder joint (Rene Cailliat, Shoulder Pain 1981 P. 82-87).

45. Carpal tunnel syndrome (CTS) commonly occurs in diabetic patient up to 15% of all patients with CTS will have diabetes. (Starling G, 1997, In Rheumatology secrets P. 285).

46. Diffuse idiopathic skeletal hyperostosis (DISH) occurs up to 20% of type 2 diabetes. Patients present with neck and back stiffness associated with loss of motion. Treatment is usually by active exercise of the affected parts (Gray & Gotlieb, semin orthitis rheum 6(1): 19-34, 1976).4

48. The physical activation of praying at least 17 times a day could be of great value in diminishing limited joint mobility, adhesive capsulitis, hand shoulder syndrome (Rifaie, 1994).

49. ومما لا شك منه أن الصلاة تؤدى إلى الاسترخاء والطمأنينة ”ألا بذكر الله تطمئن القلوب“ فى دراسة حديثة نشرت فى مجلة Archives ofinternal medicine أن الرجال سريعى التوتر والغضب أكثر عرضة من نظرائهم الأكثر هدوءاً للإصابة بأزمة قلبية بحوالى ثلاث مرات. ويعتقد الباحثون أن لذلك علاقة بالانطلاق المفرط لهرمون الادرينالين والنورادرينالين. روى البخارى فى صحيحه أن رجلاً قال للنبى صلى الله عليه وسلم أوصنى قال ”لا تغضب“ فردد مراراً قال ”لا تغضب“.

50. وقد أظهرت دراسة حديثة فى مجلة JAMA فى 22 أكتوبر 2003 أن الغاضبين والذين يتصفون بالعدوانية هم أكثر عرضة للإصابة بارتفاع ضغط الدم بنسبة الضعفين.