Validation of Beck Cognitive Insight Scale - Arabic version in a Tunisian sample.

OBJECTIVES: Cognitive insight reflects cognitive processes concerning patients' capacity of distancing from and reevaluation of anomalous beliefs and misinterpretations. The purpose of the present study was to examine the reliability and validity of the Arabic version of the Beck Cognitive Insight Scale. METHODS: The English language version of the Beck Cognitive Insight Scale was translated into Literary Arabic. A total of 150 patients with and without psychosis completed the Arabic version of Beck Cognitive Insight Scale and additional evaluations to assess psychopathology. Psychometric properties including content validity, construct validity using confirmatory factor analysis, discriminant validity and reliability were assessed for this translated measure. RESULTS: Our results revealed that the Arabic version of the Beck Cognitive Insight Scale showed adequate psychometric properties that permitone to assess impairments of cognitive insight in patients with psychosis and in patients without psychotic features. The fit indices of the confirmatory factor analysis supported the validity of the two-factor structure corresponding to self-reflectiveness and self-certainty subscales. Psychotic patients were significantly more confident in their beliefs compared with non-psychotic patients. Scores of self-certainty were significantly higher in psychotic patients. Cronbach's alpha reliability indicator of the Arabic version was equal to 0.60. Cronbach's alpha coefficients were 0.60 and 0.53 for the self-reflectiveness sub-scale and the self-certainty sub-scale, respectively. CONCLUSIONS: The Arabic version of the Beck Cognitive Insight Scale is valid and reliable for the assessment of cognitive insight. It may improve the detection and the prevention of impairments in cognitive insight.

Prevalence of and factors associated with smoking among students in Sousse, Tunisia.

Within the framework of the fight against tobacco among young people, we conducted a descriptive cross-sectional study in 2013 to estimate the prevalence of smoking and to identify associated factors among students in Sousse. A questionnaire was administered to a representative sample of 556 students in 5 academic institutions in Sousse randomly drawn. The age of the participants was between 17 and 35 years. The prevalence of tobacco consumption in the past 12 months was 22.1% and consumption during the past 3 months was 65.3%. The average age of starting smoking was 17 years. Smoking prevalence was significantly higher for males (P < 0.001) and those aged over 25 years (P = 0.002). Students from 2 of the institutions were using more tobacco than their colleagues in the other institutions (P = 0.027). The high prevalence of smoking found among the students means that prevention measures are essential; this requires increasing self-esteem and evaluating intervention programmes implemented before smoking the first cigarette.

[Parvovirus B19 seroprevalence in a group of schizophrenic patients]. / Séroprévalence du Parvovirus B19 dans un groupe de patients schizophrènes.

BACKGROUND: Schizophrenia is a highly disabling chronic mental illness. It is considerded as a neurodeveloppemental illness resulting from the interaction of genetic and environmental factors. Growing evidence supports the major role of prenatal infections and inflammation in the genesis of schizophrenia. The hypothesis including viral infections has been the subject of several studies and the role of parvovirus B19 (PB19) in the onset of the disease has been suggested. However, there is, up till now, no seroepidemiological evidence of his involvement. OBJECTIVE: To determine the prevalence of parvovirus B19 (PB19) in schizophrenic patients and in control subjects and to examine clinical associations between viral prevalence, risk factors of infectious disease and clinical features. METHOD: We carried out a case-control seroepidemiological study in the Psychiatry department of Farhat-Hached general hospital of Sousse (Tunisia). We recruited108 schizophrenic patients and 108 healthy controls free from any psychotic disorder and matched for age and sex. We collected sociodemographic data, medical history, axis I comorbid disorders and infectious risk factors. We assessed patients for psychopathology and severity of illness using respectively the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions (CGI). For each study participant, blood sample was collected and levels of IgG and IgM anti-PB19 were measured using the ELISA technique. RESULTS: The prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls (73.1% vs 60.2%; P=0.04). There were no statistical differences between the two groups regarding the prevalence of IgM antibodies to PB19. No association was found between viral prevalence and sociodemographic data, risk factors for infection or clinical characteristics. The presence of PB19 antibodies was associated with a lower score on the PANSS negative subscale (P=0.04). No other signficative association were found. CONCLUSIONS: In our study, prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls. This finding supports the hypothesis of the involvement of PB19 in schizophrenia. Further studies including both virological and immunological aspects are needed to better clarify the etiopathogenic mechanisms of schizophrenia which would challenge the management of this disease.

[Prevalence and correlates of major depressive episodes in Sousse primary care setting: assessment with the Tunisian version of CIDI]. / Prévalence et facteurs associés des épisodes dépressifs majeurs : Evaluation par la version tunisienne du CIDI dans les structures de première ligne de Sousse.

BACKGROUND: Major depression is a mental disorder that is associated with high morbidity and significant mortality. It is common among primary care attenders. Few is known about major depression prevalence and associated factors, which would prevent general practitioners from diagnosing it in primary care centres and treating it adequately. AIM: To determine prevalence and correlates of major depressive episodes (MDE) in a representative sample of primary care attenders in the area of Sousse (Tunisia). METHODS: A random and representative sample of primary care attenders was obtained by a two-stage sampling procedure. First, 30 primary care centres (20 urban and 10 rural) were selected, with stratification according to residency location. Second, 1246 consenting participants were systematically recruited among those centres attenders. Participants were screened, by trained interviewers, with Tunisian version of « Composite International Diagnostic Interview ¼ CIDI.2.1. After data entry in ishell program, MDE diagnosis was obtained according to ICD-10 criteria. RESULTS: Mean age in our sample was 43.4 ± 17.62 years, with feminine (70.9 %) and urban (67.8 %) predominance. MDE was found in 26.4 % of participants. Associated factors were female gender, marital statute of widowed or divorced and rural residency. CONCLUSION: This study provided data about high prevalence of MDE in the area of Sousse primary care centres and its correlated factors.

[Mycological and epidemiological aspects of tinea capitis in the Sousse region of Tunisia]. / Aspects mycologiques et épidémiologiques des teignes du cuir chevelu dans la région de Sousse (Tunisie).

AIM: Tinea capitis continues to be considered a public health problem in Tunisia. The purpose of our study was to investigate trends in the incidence and the mycological and epidemiological aspects of tinea capitis in the Sousse region (Central Tunisia). METHOD: Our work is a retrospective study concerning all scalp samples taken by the parasitology laboratory of the Farhat Hached Hospital in Sousse, Tunisia, over a 26-year period (1983-2008). RESULTS: A total of 10,505 specimens were examined. Of these, 5593 were positive with positive direct examination and/or positive culture. The average incidence was 215 cases per year. Patients were aged under 12 years in 89.3% of cases. A total of 175 cases of tinea capitis in adults were diagnosed. Ten dermatophyte species were isolated: Trichophyton (T.) violaceum (66.7%), Microsporum (M.) canis (29.3%), T. schoenleinii (1.6%), T. mentagrophytes (1.1%), T. verrucosum (0.6%), T. tonsurans (0.2%), T. rubrum (0.2%), M. gypseum (0.1%), M. audouinii (0.03%) and M. nanum (0.01%). CONCLUSION: Our study showed a decrease in the annual incidence of tinea capitis over the study period with an evident decrease in trichophytic tinea and disappearance of favus giving way to microsporic and inflammatory tinea.

[Respiratory morbidity in family practice in the region of Sousse, Tunisia]. / La morbidité respiratoire en médecine générale dans la région de Sousse (Tunisie).

We determined the profile of respiratory morbidity in family practice in the region a cross-sectional study in 86 primary health care centres in Souse over 1 year (2002-03). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data. Respiratory diseases ranked first both for reason for consultation (8397/24 882, 33.7%) and for diagnosis made (7788/18 097, 43.0%). Of the 7715 respiratory complaints, cough was the most common complaint (54.8%). Of respiratory diagnoses, 37.1% were acute tonsillitis, 26.5% acute bronchitis and 21.6% were acute respiratory tract infection. Children under 5 years were most affected by acute upper respiratory tract infections (44.5%). Acute bronchitis was the primary diagnosis for patients aged over 45 years.

[Diagnosed morbidity in primary health care in the sanitary region of Sousse (Tunisia)]. / La morbidité diagnostiquée en première ligne dans la région sanitaire de Sousse (Tunisie).

Primary health care is one of the pillars of the Tunisian health care system. However, we have very little information about the specificities of general practice and the patterns of the morbidity encountered in this field. This study was interested on the diagnosed morbidity in primary health care settings. We aimed to illustrate the patterns of morbidity in general practice and identify the main diagnoses which are established by the general practitioners (GPs). The study design was descriptive and cross-sectional. 85 (out of 92) primary health centres of the province of Souse (Tunisia) have been included during one year, from June 2002 to May 2003. We have targeted a representative sample of 16.271 encounters in these primary care settings. On the methodological plan, we proceeded by a poll to two degrees; the first concerned the weeks within every season: 3 weeks were drawn out by lot; the second interested the encounters, proceeding by a systematic pull and the step of poll was fixed to 5. The International Classification of Primary Care (ICPC) was used to code recorded data. The main results of this study showed that among the 16.271 patient-doctor encounters we registered 24.882 reasons for encounter (RFE) (1.9 +/- 0.8 per encounter), 18.097 diagnoses (1.3 +/- 0.5 per encounter), and 40.190 procedures (3.2 +/- 1.9 per encounter). In this paper we have only explored the results of encounters related to the decision of general practitioners, i.e. the diagnosed morbidity. With regard to sex distribution there was a predominance of females (62%). The study population was relatively young as 50% were aged less than 25 years. According to ICPC chapters, we found that respiratory diseases were the main established diagnoses (43%) followed by digestive (10.1%), locomotive (8.9%) cardiovascular affections (8.7%) and skin diseases (8.4%). These five affections constituted alone about 80% of the total.

[Attitudes of Tunisian medical students to medical practice: gender differences]. / Attitudes des étudiants tunisiens en médecine vis-à-vis de la pratique médicale: différences en fonction du sexe.

To better understand the impact of gender change in medical practice on health care in Tunisia, we conducted a cross-sectional study on the attitudes of 512 medical students (40% female) to medicine and medical practice in the Faculty of Medicine, Sousse. Female students attached more value than males to the intrinsic aspects of a physician's job, such as the desire to help others and to work with people. Regarding the dimensions of comprehensive care (psychosociological aspects of care, health education, patient-centred approach and medical prevention), there were wide differences between men and women. At the end of their training cycles, both male and female students ascribed less importance to these aspects than in the beginning.

[Humane professional attitudes of doctors in the health region of Sousse (Tunisia)]. / Les attitudes professionnelles humaines des médecins de la région sanitaire de Sousse (Tunisie).

The new chronic and multi-factorial morbidity, the limited efficiency of classical medicine, as well as the preponderant position currently occupied by an individual in social life have imposed a patient-oriented approach as an ideal model of medical practice. The objective of this work is to evaluate physicians' listening skills, their empathy and their participation with patients in the health region of Sousse. It is a descriptive and transversal study on a collective of 133 practitioners working in the Sousse region in both the liberal and public sectors of care. Data were collected during the year 1999 through an auto-managed questionnaire. Among the main results: 28% of doctors declared having had difficulties while communicating with their patients and 31% of those asked do not give a great deal of importance to the psycho-social aspects of their patients. Only 31% of practitioners were in favour of patients participating in the decision-making process. This survey demonstrates that the domination of the bio-medical model of care, as much in teaching field as in medical practice, has weakened the basic competencies necessary for humanitarian medical practice based on the respect and the implication of the patient. Reforming the medical teaching curriculum with a focus on the person suffering and orientating the professional environment towards the community are both indispensable in order to reach a reconciliation between the patient's needs and the care available.

[Contraceptive use prevalence in a suburban zone around Sousse (Tunisia)]. / La prévalence contraceptive dans une zone périurbaine de la ville de Sousse (Tunisie).

A contraceptive prevalence survey was conducted among 1277 women of reproductive age, to explore knowledge of and attitudes to contraceptive use and study factors influencing contraceptive use. We found that family planning methods were generally well known. The prevalence of modern contraceptive use was 53.6%, IUDs being the most commonly used followed by sterilization and pills. The public sector was the main source for obtaining contraceptives although pills and condoms tended to be obtained from the private sector. There was a significant correlation between contraceptive use and urban residence.

[Mother-child transmission of hepatitis B virus in the Tunisian Sahel]. / Etude de la transmission mère-enfant du virus de l'hépatite B dans le Sahel tunisien.

In order to assess the importance of mother-child transmission of the hepatitis B virus (HBV) in the Tunisian Sahel, 81 HBsAg-positive mothers have been selected at delivery in a representative sample of 1940 who delivered in maternities of this region. Each HBsAg-positive mother was matched for age and parity particularly with two HBsAg-negative mothers. Children born to these 66 HBsAg+ and 120 HBsAg- mothers were traced at 28 months and tested by ELISA for HBV serologic markers (HBsAg, anti-HBs and anti-HBc). The distribution of these markers was significantly different according to the maternal status for HBsAg. The overall prevalence rate of HBV markers was higher in children born to HBsAg+ mothers as compared to children born to HBsAg- mothers (33.3% vs 13.3%, OR = 2.5, 95% CI:1.4-4.2). For HBsAg, the figures were 27.3% and 9.2% respectively (OR = 2.9, 95% CI: 1.5-5.9). Given the prevalence rate of HBsAg in mothers (4.2%), the role of mother-child transmission in the spread of HBV infection and the intensity and precocity of horizontal transmission, systemic vaccination against HBV at birth should be recommended in the Tunisian Sahel in the context of the EPI. However this decision should take into account, in terms of cost/efficacy ratio, the other public health problems concerning this area.

[Risk factors in cardiovascular diseases in a semi-urban community of the Tunisian Sahel]. / Facteurs de risque des maladies cardiovasculaires dans une communauté semiurbaine du Sahel Tunisien.

Cardiovascular diseases are the leading cause of mortality in the western countries at the same time they are beginning to appear with increasing frequency in developing countries. An epidemiologic study was carried out at Kalaa Kebira (Sousse-Tunisia) to determine the prevalence of the different risk factors of cardiovascular diseases. The study was performed on a representative sample of 555 adults of 20 years and more (response rate of 76%). There was a high proportion of adult males smokers (66%). The prevalence of hypertension varied from 15% to 25%, those of diabetes was 6.5%. An hypercholesterolemia greater than 6.2 mmole/l was observed for 12% of the sample and obesity for 20%.