Labor market effects of intrauterine exposure to nutritional deficiency: Evidence from administrative data on Muslim immigrants in Denmark

This paper examines whether nutritional disruptions experienced during the stage of fetal development impair an individual's labor market productivity later in life. We consider intrauterine exposure to the month of Ramadan as a natural experiment that might cause shocks to the inflow of nutrients essential for fetal development. Specifically, we use administrative data from Denmark to investigate the impact of exposure to Ramadan in utero on labor market outcomes of adult Muslim males, including employment status, annual salary, hourly wage rate, and hours of work. Our findings indicate that potential exposure to nutritional disruptions during a critical stage of fetal development is likely to have scarring effects on the fetus expressed as poor labor market outcomes later in life. Specifically, exposure to Ramadan around the 7th month of gestation results in a lower likelihood of employment and, to a lesser extent, a lower salary, and reduced labor supply. For example, the 7th month intrauterine exposure to Ramadan is associated with a 2.6 percentage points reduction in the likelihood of employment among Muslim males. We do not find an impact on the wage rate. Finally, we also document suggestive evidence that these results may partially be driven by increased disability and to a lesser extent by poor educational attainment among those who were exposed to Ramadan during this particular period in utero.     

Introducing Computer-Based Testing in High-Stakes Exams in Higher Education: Results of a Field Experiment

The introduction of computer-based testing in high-stakes examining in higher education is developing rather slowly due to institutional barriers (the need of extra facilities, ensuring test security) and teacher and student acceptance. From the existing literature it is unclear whether computer-based exams will result in similar results as paper-based exams and whether student acceptance can change as a result of administering computer-based exams. In this study, we compared results from a computer-based and paper-based exam in a sample of psychology students and found no differences in total scores across the two modes. Furthermore, we investigated student acceptance and change in acceptance of computer-based examining. After taking the computer-based exam, fifty percent of the students preferred paper-and-pencil exams over computer-based exams and about a quarter preferred a computer-based exam. We conclude that computer-based exam total scores are similar as paper-based exam scores, but that for the acceptance of high-stakes computer-based exams it is important that students practice and get familiar with this new mode of test administration.     

The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: Evidence from the Indonesian Family Life Survey

Many pregnant Muslim women fast during the Muslim holy month of Ramadan. A number of studies have reported negative life outcomes in adulthood for children who were prenatally exposed to Ramadan. However, other studies document minimal to no impact on neonatal indicators. Using data from the Indonesian Family Life Survey consisting of 45,246 observations of 21,723 children born to 9771 mothers, we contribute to the current discussion on prenatal exposure to Ramadan by examining the effects on stature (height-for-age Z-scores, weight-for-age Z-scores, and body-mass-index-for-age Z-scores: HAZ, WAZ, and BAZ, respectively) from early childhood to late adolescence (0–19 years of age). We introduce an objective mother’s religiosity indicator to improve the intention-to-treat estimations. Children were classified into three groups based on their mother’s religion-religiosity: religious Muslims, less-religious Muslims, and non-Muslims. Using cluster-robust mother fixed-effects, we found negative effects on stature for children born to religious Muslim mothers. The effects were age-dependent and timing-sensitive. For example, children born to religious Muslim mothers were shorter in late adolescence (15–19 years of age) compared to their unexposed siblings if they were prenatally exposed in the first trimester of pregnancy (HAZ difference = −0.105 SD; p-val. <0.05). Interestingly, we found positive effects on stature for exposed less-religious Muslim children that peak in early adolescence (10–14 years of age) and negative effects on stature for exposed non-Muslim children that occur only in early childhood (0–4 years of age). We nuance our discussion of health and socioeconomic factors to explain these surprising results.     

The Effects of Intermittent Fasting during the Month of Ramadan in Chronic Haemodialysis Patients in a Tropical Climate Country

Background

Chronic kidney disease is an emerging problem in the majority Muslim countries. Despite the uncertainties of the risks involved, some Muslim patients undergoing chronic haemodialysis choose to observe intermittent fasting during the month of Ramadan. This study aims to investigate the effect of Ramadan fasting in haemodialysis patients residing in a tropical climate country.

Methods

This prospective cross sectional study recruited Muslim patients on regular haemodialysis from three haemodialysis centres in Kuala Lumpur from 15^th July 2011 to 29^th August 2011. Patients who fasted for any number of days were included (n = 35, 54% female, age 54±11 years). 89% of patients fasted for more than 15 days and 49% were diabetics. Dialysis parameters and blood samples were obtained one week prior to Ramadan and during the last week of Ramadan. The differences in dialysis parameters and biochemical values pre- and end-Ramadan were examined using paired t-test.

Results

Both pre- and post-dialysis weight were significantly decreased during Ramadan fasting compared to the month prior (p = <0.001). There was a significant decrease in the amount of ultrafiltration (p = 0.002). There were no significant differences in dry weight, inter-dialytic weight gain, mean urea reduction ratio or blood pressure measurements comparing pre- and end of Ramadan fasting. There was a significant increase in serum albumin level (p = 0.006) and decrease in serum phosphate level (p = 0.02) at the end of Ramadan.

Conclusion

Ramadan fasting is associated with reduced weight, improved serum albumin and phosphate level in our population of haemodialysis patients. A larger multi-centre study will allow us to understand more about the effects of fasting in this population.     

Intraday Blood Rheological Changes Induced by Ramadan Fasting in Sickle Cell Trait Carriers

The goal of the present study was to test whether fasting during the holy period of Ramadan may disturb blood rheology in sickle cell trait (SCT) carriers more than in a group of subjects with normal hemoglobin. Twenty African male students participated in the study: 10 SCT carriers and 10 subjects with normal hemoglobin (CONT). Biochemical parameters (plasma glucose and lipids levels), hematocrit, blood viscosity, and urine specific gravity were measured in the two groups on the 14th day of the Ramadan period (Ramadan condition) and 6 wks after the end of Ramadan (baseline condition). All the measurements were performed twice for each experimental day to measure intraday variation: 8:00 and 18:00?h. Plasma glucose level and lipid profile were not significantly different between the two groups. Although Ramadan did not affect the lipid profile, the plasma glucose concentration was lower during the Ramadan period compared with the baseline condition in the two groups. Hematocrit and urine specific gravity did not differ between the two groups and was greater in the evening than in the morning, independently of the condition. SCT carriers had higher blood viscosity than the CONT group. However, whereas blood viscosity remained unchanged through the day in the CONT group, whatever the condition, SCT carriers were characterized by a large increase of blood viscosity in the evening during the Ramadan period, indicating higher risk for microcirculatory blood flow impairments. Specific medical recommendations are needed for SCT carriers engaged in religious fasting.     

Student retention of course content is improved by collaborative-group testing

We recently reported that collaborative testing (i.e., group test taking) increased student performance on quizzes. It is unknown, however, whether collaborative testing improves student retention of course content. Therefore, this study was designed to test the hypotheses that collaborative-group testing improves student retention of course content. To test this hypothesis, our undergraduate exercise physiology class of 38 students was randomly divided into two groups: group A (n = 19) and group B (n = 19). During exam 1, students from both groups answered questions in the traditional format as individuals. Immediately after completing the exam as individuals, students from group A answered a randomly selected subset of questions from exam 1 in groups of two (1 group had 3 students) to test the effectiveness of collaborative-group testing on test performance and level of student retention. On the next exam (exam 2, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 1. The subset of questions was analyzed to determine the level of retention of the original test material. In addition, immediately after completing the exam as individuals, students from group B answered a randomly selected subset of questions from exam 2 in groups of two (1 group had 3 students). Finally, on the next exam (exam 3, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 2. This protocol followed a randomized crossover design to control for time and order effects. Student retention of course content was reduced when students completed the original examinations individually. In sharp contrast, student retention was improved (P < 0.05) when students completed the original examinations in groups. Results suggest that collaborative testing is an effective strategy to enhance learning and increase student retention of course content.     

Does a delayed school start time cause students to exercise less? Evidence from South Korea

A delayed school start time (DSST), achieved by removing zero period, could change students’ other time use during school as well as other forms of human capital accumulation. Using difference-in-differences, we find evidence that a DSST in South Korea reduced the time students spent in gym class without worsening students’ health status. Combined with previous studies that provided evidence that DSSTs increased students’ test scores, our results imply that a DSST can increase students’ academic achievement without reducing other forms of human capital accumulation, although schools might change students’ other time use.     

Impact of Ramadan intermittent fasting on cognitive function in trained cyclists: a pilot study

This study assessed selected measures of cognitive function in trained cyclists who observed daylight fasting during Ramadan. Eleven cyclists volunteered to participate (age: 21.6±4.8 years, VO₂max: 57.7±5.6 ml kg⁻¹·min⁻¹) and were followed for 2 months. Cognitive function (Cambridge Neuropsychological Test Automated Battery (CANTAB), Reaction Time index (RTI) and Rapid Visual Information Processing (RVP) tests) and sleep architecture (ambulatory EEG) were assessed: before Ramadan (BR), in the 1st week (RA1) and 4th week of Ramadan (RA4), and 2 weeks post-Ramadan (PR). Both cognitive tests were performed twice per day: before and after Ramadan at 8-10 a.m. and 4-6 p.m., and during Ramadan at 4-6 p.m. and 0-2 a.m., respectively. Training load (TL) by the rating of perceived exertion (RPE) method and wellness (Hooper index) were measured daily. If the TL increased over the study period, this variable was stable during Ramadan. The perceived fatigue and delayed onset muscle soreness (DOMS) increased at RA4. Sleep patterns and architecture showed clear disturbances, with significant increases in the number of awakenings and light sleep durations during Ramadan (RA1 and RA4), together with decreased durations of deep and REM sleep stages at PR. RTI (simple and multiple reaction index) reaction and movement times did not vary over the study period. The RVP test showed reduced false alarms during Ramadan, suggesting reduced impulsivity. Overall accuracy significantly increased at RA1, RA4 and PR compared to baseline. At RA4, the accuracy was higher at 0-2 a.m. compared to 4-6 p.m. Despite the observed disturbances in sleep architecture, Ramadan fasting did not negatively impact the cognitive performance of trained cyclists from the Middle East.     

The effects of Ramadan intermittent fasting on the underlying mechanisms of force production capacity during maximal isometric voluntary contraction

The aim of the present study was to investigate the effects of Ramadan intermittent fasting (RIF) on the underlying mechanisms of force production capacity during maximal voluntary isometric contraction (MVIC) using the superimposed twitch technique. Ten healthy male physical education students performed three MVIC of the knee extensor superimposed with nerve electrical stimulation during four testing phases: one week before Ramadan (BR), at the end of the first week of Ramadan (R-1), during the fourth week of Ramadan (R-4) and two weeks after Ramadan (AR). This study was performed during Ramadan 2016. MVIC values, voluntary activation level (VAL), potentiated resting twitch and electromyography signals were recorded during each MVIC. The French version of the Profile of Mood States questionnaire (POMS-f) was used to evaluate the subjective mood states in each testing session. The results showed that MVIC values (890.57 ± 67.90 vs. 816.46 ± 54.72 N) and VAL (87.73 ± 3.27 vs. 77.32 ± 7.87%) decreased at R-1 compared to BR (p < 0.001). However, the neuromuscular efficiency and the potentiated resting twitch remained unchanged during Ramadan (R). Results showed that depression (p < 0.01; 6.3 ± 1.57 vs. 4.7 ± 1.25), fatigue (p < 0.001; 9.2 ± 1.93 vs. 4.6 ± 2.01) and anxiety (p < 0.001; 6.4 ± 1.51 vs. 11.8 ± 1.23) scores of POMS-f were higher during R-1 compared to BR. In conclusion, RIF-related impairment of maximal muscle force seems to be related to nervous alterations of the VAL, whereas the RIF did not adversely affect peripheral mechanisms.

Abbreviations’ List: ANOVA: Analysis of variance; AR: After Ramadan; BMI: Body-mass index; BR: Before Ramadan; EMG: Electromyography; ER: End of Ramadan; MF: Mean frequency; M_max: Peak-to-peak M-wave amplitudes; MVIV: Maximal voluntary isometric contraction; NES: Nerve electrical stimulation; NME: Neuromuscular efficiency; POMS-f: French version of the Profile of Mood States questionnaire; R: Ramadan; R-1: First week of Ramadan; R-4: Fourth week of Ramadan; RF: Rectus femoris; RIF: Ramadan intermittent fasting; RMS: Root mean square; VAL: Voluntary activation level; VL: Vastus lateralis; VM: Vastus medialis.     

Conducting an Acute Intense Interval Exercise Session During the Ramadan Fasting Month: What Is the Optimal Time of the Day?

This study examines the effects of Ramadan fasting on performance during an intense exercise session performed at three different times of the day, i.e., 08:00, 18:00, and 21:00?h. The purpose was to determine the optimal time of the day to perform an acute high-intensity interval exercise during the Ramadan fasting month. After familiarization, nine trained athletes performed six 30-s Wingate anaerobic test (WAnT) cycle bouts followed by a time-to-exhaustion (T_exh) cycle on six separate randomized and counterbalanced occasions. The three time-of-day nonfasting (control, CON) exercise sessions were performed before the Ramadan month, and the three corresponding time-of-day Ramadan fasting (RAM) exercise sessions were performed during the Ramadan month. Note that the 21:00?h session during Ramadan month was conducted in the nonfasted state after the breaking of the day's fast. Total work (TW) completed during the six WAnT bouts was significantly lower during RAM compared to CON for the 08:00 and 18:00?h (p?<?.017; effect size [d]?=?.55 [small] and .39 [small], respectively) sessions, but not for the 21:00?h (p?=?.03, d?=?.18 [trivial]) session. The T_exh cycle duration was significantly shorter during RAM than CON in the 18:00 (p < .017, d?=?.93 [moderate]) session, but not in the 08:00 (p?=?.03, d?=?.57 [small]) and 21:00?h (p?=?.96, d?=?.02 [trivial]) sessions. In conclusion, Ramadan fasting had a small to moderate, negative impact on quality of performance during an acute high-intensity exercise session, particularly during the period of the daytime fast. The optimal time to conduct an acute high-intensity exercise session during the Ramadan fasting month is in the evening, after the breaking of the day's fast. (Author correspondence: abdul_rashid_aziz@ssc.gov.sg)     

Effect of Ramadan fasting on feelings,dietary intake,rating of perceived exertion and repeated high intensity short-term maximal performance

The present study was designed to investigate the effect of Ramadan fasting on feelings, dietary intake, rating of perceived exertion (RPE) and repeated high-intensity short-term maximal performance. Thirteen physically active men (age: 21.2 ± 2.9 years, height: 175.6 ± 5.6 cm, body-mass: 72.4 ± 8.6 kg) performed a 5-m shuttle run test (6 × 30-s + 35-s of recovery in-between) during five experimental periods: fifteen days before Ramadan (BR), the first ten days of Ramadan (FR), the last ten days of Ramadan (ER), ten days after Ramadan (AR10) and 20 days after Ramadan (AR20). The study was carried out in Tunisia during the 2016 Ramadan month. During the 5-m shuttle run test, higher distance (HD), total distance (TD) and fatigue index (FI) were recorded. RPE was determined after a 5-min warm-up and after each repetition of the 5-m shuttle run test (the mean RPE score during the test was calculated). Moreover, a feelings scale (FS) was used after the warm-up and after the end of the 5-m shuttle run test. During the five experimental periods, dietary intake was assessed. The results showed that HD, TD and FI during the 5-m shuttle run test were not affected by Ramadan observance (p > 0.05). Likewise, FS scores recorded after the warm-up and the 5-m shuttle run test were not affected by Ramadan fasting (p > 0.05). However, mean RPE scores during the 5-m shuttle run test were significantly lower at ER (4.06 UA), AR10 (3.86 UA) and AR20 (3.71 UA) in comparison to BR (4.51 UA) (p < 0.05). The results showed also that Ramadan fasting has no adverse effect on energy intake, protein (g and %), fat (g and %) and carbohydrate (g). However, the fractional contribution of carbohydrate was significantly higher AR10 than FR (53.1% vs. 45.8%) and ER (53.1% vs. 46.5%) and AR20 than FR (5.92% vs. 45.8%) (p < 0.05). In conclusion, Ramadan fasting has no adverse effect on feelings, dietary intake, and short-term maximal performance. However, the RPE during repeated high intensity short-term maximal exercise was reduced AR20 in comparison to ER.

Abbreviations:

AR: After Ramadan; AR10: Ten days after Ramadan; AR20: Twenty days after Ramadan; BR: Fifteen days before Ramadan; ER: Last ten days of Ramadan; FI: Fatigue index; FR: First ten days of Ramadan; FS: Feelings scale; HD: Higher distance; PSQI: The Pittsburgh Sleep Quality Index; RPE: Rating of Perceived Exertion Scale; TD: Total distance     

Conducting an acute intense interval exercise session during the ramadan fasting month: what is the optimal time of the day?

This study examines the effects of Ramadan fasting on performance during an intense exercise session performed at three different times of the day, i.e., 08:00, 18:00, and 21:00?h. The purpose was to determine the optimal time of the day to perform an acute high-intensity interval exercise during the Ramadan fasting month. After familiarization, nine trained athletes performed six 30-s Wingate anaerobic test (WAnT) cycle bouts followed by a time-to-exhaustion (T(exh)) cycle on six separate randomized and counterbalanced occasions. The three time-of-day nonfasting (control, CON) exercise sessions were performed before the Ramadan month, and the three corresponding time-of-day Ramadan fasting (RAM) exercise sessions were performed during the Ramadan month. Note that the 21:00?h session during Ramadan month was conducted in the nonfasted state after the breaking of the day's fast. Total work (TW) completed during the six WAnT bouts was significantly lower during RAM compared to CON for the 08:00 and 18:00?h (p?相似文献   

Ways of coping as predictors of satisfaction with curriculum and academic success in medical school

The purpose of the present study was to determine the coping strategies of medical students and to investigate the effects of coping strategies on student satisfaction and academic achievement with different instruction methods. A total of 152 medical students was followed throughout the first 2 yr of medical education between 2008 and 2010. Students completed a sociodemographic questionnaire and revised form of the Ways of Coping questionnaire both at the beginning of the first year and at the end of the second year. These forms provided data about the characteristics and main coping strategies (problem focused or emotion focused) of the students and revealed the change over time. At the end of the second year, participants also completed a satisfaction questionnaire asking their satisfaction with lectures, problem-based learning, and practicals. The authors used block, problem-based learning, and practical exam scores of the students attained in the past 2 yr as academic achievement indicators. No sociodemographic variable was related to coping strategy. The majority of students (80.9%) adopted problem-focused coping. A shift occurred in the main coping strategies of some students in both sides. Problem-focused coping scores decreased over time. Problem-focused coping positively correlated with satisfaction with practicals and practical exam scores, whereas emotion-focused coping showed the same correlation negatively. The main coping strategy also predicted satisfaction and exam success in practicals. In conclusion, a main coping strategy may be helpful to predict student satisfaction and academic achievement with some student-centered instruction methods. Determining undesired coping strategies may provide an opportunity for intervention to prevent relevant dissatisfaction and failure.     

Effect of Ramadan on the Diurnal Variation in Short‐Term High Power Output

This study examined the effects of Ramadan fasting on anaerobic performances and their diurnal fluctuations. In a balanced and randomized study design, 12 subjects were measured for maximal power (P_max; force‐velocity test), peak power (P_peak), and mean power (P_mean) with the Wingate test at 07:00, 17:00, and 21:00 h on four different occasions: one week before Ramadan (BR), the second week of Ramadan (SWR), the fourth week of Ramadan (ER), and two weeks after Ramadan (AR). There was an interval of 28 h between any two successive tests. Oral temperature was measured before each test. Under each condition, the results showed a time‐of‐day effect on oral temperature. Analysis of variance revealed a significant (Ramadan×time‐of‐day of test) interaction effect on P_max. This variable improved significantly from morning to evening before Ramadan (1.1±0.2 W · kg^?1), during the second week of Ramadan (0.6±0.2 W · kg^?1), and two weeks after the end of Ramadan (0.9±0.2 W · kg^?1). However, daily fluctuations disappeared during the fourth week of Ramadan. For P_peak and P_mean, there was no significant Ramadan×test‐time interaction. These variables improved significantly from morning to evening before Ramadan ([1±0.3 W · kg^?1] for P_peak and [1.7±1.6 W · kg^?1] for P_mean) and in the second week of Ramadan ([0.9±0.6 W · kg^?1] for P_peak and [1.7±1.5 W · kg^?1] for P_mean). However, they were not affected by time‐of‐day in the fourth week of Ramadan. Considering the effect of Ramadan on anaerobic performances, in comparison with before Ramadan, no significant difference was observed during Ramadan at 07:00 h. The variables were significantly lower in the second week of Ramadan and in the fourth week of Ramadan at 17:00 h and 21:00 h. P_mean was not affected during the second week of Ramadan. In conclusion, the time‐of‐day effect on anaerobic power variables tends to disappear during Ramadan. In comparison with the period before Ramadan, anaerobic performances were unaffected in the morning but impaired in the evening during Ramadan.     

Effect of Ramadan on the diurnal variation in short-term high power output

This study examined the effects of Ramadan fasting on anaerobic performances and their diurnal fluctuations. In a balanced and randomized study design, 12 subjects were measured for maximal power (P_max; force-velocity test), peak power (P_peak), and mean power (P_mean) with the Wingate test at 07:00, 17:00, and 21:00 h on four different occasions: one week before Ramadan (BR), the second week of Ramadan (SWR), the fourth week of Ramadan (ER), and two weeks after Ramadan (AR). There was an interval of 28 h between any two successive tests. Oral temperature was measured before each test. Under each condition, the results showed a time-of-day effect on oral temperature. Analysis of variance revealed a significant (Ramadan×time-of-day of test) interaction effect on P_max. This variable improved significantly from morning to evening before Ramadan (1.1±0.2 W · kg^-1), during the second week of Ramadan (0.6±0.2 W · kg^-1), and two weeks after the end of Ramadan (0.9±0.2 W · kg^-1). However, daily fluctuations disappeared during the fourth week of Ramadan. For P_peak and P_mean, there was no significant Ramadan×test-time interaction. These variables improved significantly from morning to evening before Ramadan ([1±0.3 W · kg^-1] for P_peak and [1.7±1.6 W · kg^-1] for P_mean) and in the second week of Ramadan ([0.9±0.6 W · kg^-1] for P_peak and [1.7±1.5 W · kg^-1] for P_mean). However, they were not affected by time-of-day in the fourth week of Ramadan. Considering the effect of Ramadan on anaerobic performances, in comparison with before Ramadan, no significant difference was observed during Ramadan at 07:00 h. The variables were significantly lower in the second week of Ramadan and in the fourth week of Ramadan at 17:00 h and 21:00 h. P_mean was not affected during the second week of Ramadan. In conclusion, the time-of-day effect on anaerobic power variables tends to disappear during Ramadan. In comparison with the period before Ramadan, anaerobic performances were unaffected in the morning but impaired in the evening during Ramadan.     

Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans?

Muslims must refrain from eating, drinking, smoking, and sexual relations from sunrise to sunset during the month of Ramadan. Serum concentrations of melatonin, steroid hormones (cortisol, testosterone), pituitary hormones (prolactin, LH, FSH, GH, TSH) and thyroid hormones (free thyroxin and free triiodothyronine) were documented around the clock at six 4-hourly intervals before Ramadan began and on the twenty-third day of Ramadan (daytime fasting). Time series were analysed with repeated measures ANOVA. Statistically significant differences were found in some variables: the nocturnal peak of melatonin was diminished and may have been delayed; there was a shift in the onset of cortisol and testosterone secretion; the evening peak of prolactin was enhanced, FSH and GH rhythmic patterns were affected little or not at all by Ramadan fasting and only the serum TSH rhythm was blunted over the test time span. These data show that daytime fasting, modifications in sleep schedule and psychological and social habits during Ramadan induce changes in the rhythmic pattern of a number of hormonal variables.     

Listening to Music during Warming-Up Counteracts the Negative Effects of Ramadan Observance on Short-Term Maximal Performance

Aim

The aim of the present study was to examine whether listening to music during warming-up might influence short-term maximal performance (STMP), cognitive anxiety, self-confidence, and enjoyment during Ramadan, and whether these affects might predict STMP.

Methods

Nine male physical education students (age: 21 ± 1.1 years; height: 1.8 ± 0.04 m; body mass: 83 ± 5 kg) volunteered to participate in the present study. A within-subjects design consisted of four experimental sessions: Two sessions occurred one week before Ramadan and two others took place during Ramadan. They were scheduled at 5 p.m. and were conducted as follows: After a 10-minute warm-up either with or without listening to music, each participant performed a 5-m multiple shuttle run test, after which he was asked to answer items intended to assess his affective state during the experimental task.

Results

Our findings revealed that STMP was lower during Ramadan than before Ramadan in the no-music condition. Additionally, it was found that STMP was higher in the music condition than in the no-music condition during Ramadan, and that STMP measured before Ramadan did not differ from that measured during Ramadan in the music condition. Regarding affects, the findings revealed that enjoyment was lower during Ramadan than before Ramadan in the music condition, and that cognitive anxiety was lower in the music condition than in the no-music condition before Ramadan. Self-confidence was not influenced by the experimental conditions.

Conclusion

This study showed that listening to music during warming-up not only would be beneficial for STMP in Ramadan fasters, but also would counteract the negative effects of Ramadan observance on STMP.     

Improving Education in Medical Statistics: Implementing a Blended Learning Model in the Existing Curriculum

Background

Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics.

Methods

This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013–14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course.

Results

Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001).

Conclusion

This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics.