Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design.

BACKGROUND: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. PURPOSE: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. RESULTS: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms (P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. CONCLUSION: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

Age estimation at death by the study of chest plate radiographs: establishing a Tunisian male score.

We aim to establish a Tunisian score for age estimation through the study of chest plate's radiographs of a Tunisian male sample. We have focused on the study of 128 chest plate radiographs of Tunisian male individuals. We have established a score of eight criteria. The total score ranges from 8 to 32. Three observers scored double-blind the X-ray films. We studied the correlation of each criterion as well as the total score with chronological age for each observer. We also tested the reproducibility and the repeatability of criteria and total score. We calculated the estimated age for each score. We studied the relationship between the estimated age and the chronological age. The correlation between the total score and the chronological age has been good for the three observers (0.746, 0.756 and 0.742). The total score gives an estimation of age with a standard deviation of ± 5.88 years and a confidence interval of 95%, the interval's width increases gradually from 6.9 years to 23 years.

[Smoking cessation attitudes among adult smokers]. / Les attidute envers l'arrêt du tabac chez les fumeurs adultes.

AIM: The failure of attempts to quit smoking was the cause of stagnation even the increasing prevalence of smoking in Tunisia. The aim of our study was to describe the previous quit attempts among smokers, the degree of motivation to the next stop and analyze the associated factors. METHODS: We carried out a survey based on an anonymous selfadministered questionnaire on tobacco, targeting smokers who participated in awareness sessions conducted in public places and universities in the city of Monastir. RESULTS: Nine hundred fourteen smokers had participated in our study. More than 2/3 of them (70 %) had at least one quit attempt, which lasted longer than 6 months for 81 patients (9%) and the last attempt dated for over 6 months for 486 smokers (53%). These previous attempts were unaccompanied and non-medicalized in 97 % of cases. 2/3 of smokers (67%) had a very strong desire to quit smoking, and 41% had a very strong self-confidence to succeed in their attempts. According to multivariate analysis, the presence of previous quit attempts to stop was statistically related to the importance of quitting smoking (OR=2.20,95% CI [1.23 - 3.96]). Selfconfidence to successfully stop was statistically related to the duration of smoking (OR=1.03 , 95% CI [1.01 - 1.06] ) , the strong dependence (OR=0.53 ;95% CI [ 0.29 - 0.97 ]) , and having at least one smoking member of the family (OR = 0.36 , 95% CI [0.15 - 0.86]). CONCLUSION: These results show that the strong physical dependence is a major factor related to the failure of attempts to quit, to the loss of self-confidence to succeed new attempts among smokers and thus, maintain a fairly high smoking prevalence in a country like Tunisia.

[Quality of the medical record notification in primary health care]. / Qualité de notification sur le dossier medical en première ligne.

BACKGROUND: The medical record is a very important tool for organizing, the planning and tracking of care. Her outfit is considered as one of the major criteria for care quality. AIM: compare, the degree of given collected notification on the Structured Medical Record (SMR) in Subjective, Pre-appreciation, Objective, Appreciation and Post-appreciation (SPOAP) and on Not Structured Medical Record (NSMR). METHODS: It is a retrospective, analytic study, including 910 DM. Executed in four primary health centers, at Monastir governorate in 2010. As regards methodology, we conducted a sampling at 3 degrees. The first draw of the month, the second on the weeks, the third is systematic type of medical records with a step of sounding of 2. We collected information about patient's socio-demographic characteristics, the contact patterns, clinical examination of the data, assumptions and diagnostics procedures. We used chi2 test to compare the distribution between SMR and NSMR at the Threshold of 5 %. RESULTS: Four hundred and one SMR (44 %) and 509 (56 %) NSMR were included. The contact patterns was noted on 44 % of NSMR and 93% of SMR (< 10-4). The physical examination had been noted on 67 % of SMR and 8% of NSMR (p < 10-4), the hypotheses diagnoses on 72 % of SMR and 31 % of NSMR (p < 10-4). The conducts had been noted on 98 % of SMR and 95% of NSMR (p < 0,045). The distribution of the motives for contacts, physical acts, hypotheses diagnoses and therapeutic families were different between SMR and NSMR. The medical records was adequate in 52 % of SMR and in 2% of NSMR (p < 10-4). CONCLUSION: The use of SMR improves the notification and the care continuity.

[From demand to decision: Not programmed contact for adult family medicine]. / De la demande à la decision: Contact non programmé de l'adulte en medicine de famille.

BACKGROUND: the study of contact patterns, diagnostics assumptions, physical acts performed and procedures in primary care services orient the training of future GPs. AIM: describe the elements of the contact in the Basic Health Centers. METHODS: It is a transverse study, describing the elements of contact without appointment, the population served by 4 primary health centers, in Monastir governorate. Days of the survey were identified from the list of working days by taking two weeks per month and per season by excluding the days of chronic diseases. Contacts analyzed have been identified by a systematic random sampling with a step of sounding on two. RESULTS: in the term of this study, we brought together 910 contacts. The mean age of consultants was 36 years, the sex-ratio H/F 0,38. The respiratory, ostéo-articular, digestive, neurological and general chapter's complaints represented 74% of motives for contacts. The cough and the complaints of throat represented 25% of the reasons for consultation. The lung examination, Oto-rhino laryngeal and cardiovascular represented 80% of physical examinations. The pharyngitis, the infections of the superior respiratory tracts, acute bronchitises, flu and allergic rhinitis represented the half of the assumptions. Antibiotics, anti-inflammatory and the antipyretic/analgesic accounted for 69% of prescriptions. CONCLUSION: this study allowed us to show the lack of preventive measures in the health center base and highlight the training of future family physicians must be based systems the most prevalent in primary care.

[Nicotine dependance and carbon monoxide intoxication among adult smokers]. / La dépendence nicotinique et l'intoxication au monoxide de carbone chez les fumeurs adultes.

BACKGROUND: The high nicotine dependence is one of the contributing factors to failure of attempts to quit. Moreover, the carbon monoxide (CO) intoxication, proportional to the intensity of smoking, is the basis of cardiovascular complications. OBJECTIVES: To describe tobacco consumption and the degree of CO intoxication, as well as to assess nicotine dependence and identify its determinants in a population of adult smokers. METHODS: This is a descriptive cross-sectional study, based on a selfadministered questionnaire and a dosage of CO in expired air among smokers who participated in awareness sessions conducted in public places and academic institutions in the city of Monastir. Multivariate analysis was based on a binary logistic regression. RESULTS: A total of 914 smokers participated in our survey whose mean age was 29.5 ± 12.4 years. More than 2/3 of cases (68.7 %) were strongly addicted to nicotine. Heavy smokers (consumption > 20 cigarettes / day) accounted for 28 % of subjects aged under 30 and 59% of older adults (p < 10-4). Determinants of strong tobacco dependence were age of first cigarette ( OR = 0.912 ) , duration of tobacco consumption (OR = 1.059 ) , alcohol consumption (OR = 1.764 ) , sedentarity (OR = 2.024 ) and the rate expired CO (OR = 1.059 ) . The mean rate of exhaled CO was 13.1 ± 11.1 ppm. It was positively correlated with Fagerström score (r = 0.5, p < 10-4) and the number of cigarettes smoked before dosing CO (r = 0.6, p < 10-4). In the contrary, it was negatively correlated to the time elapsed between the last cigarette and the test (r = - 0.2, p = 0.001). CONCLUSION: The results of this study focused on smoking addiction and its determinants. They encourage us to strengthen efforts for effective implementation of the WHO Framework Convention of Tobacco control in Tunisia.

[Predictors of smoking relapse among adult in smoking cessation]. / Les facteurs prédictifs de rechute tabagique chez les adultes bénéficiaires d'aide au sevrage.

BACKGROUND: Smoking is a public health problem in Tunisia. The smoking cessation assistance is one of means against this epidemic. Few smokers require this need to quit. PURPOSE: this study aimed at identifying the predictive factors associated to the smoking relapse at the adult. METHOD: We carried out a prospective cohort study, during a period of 18 months, at the smoking cessation center of the University hospital of Monastir (Tunisia). The population study consisted of adult abstinent in smoking cessation interventions. Baseline contained a questionnaire investigating the smoking history, the nicotine dependence and the anxiety / depression state and information of the medical examination at follow-up visits. A phone survey was realized, 21 months after the inclusion beginning, to estimate the rate of smoking abstinence, the deadline average of relapse and these predictors. A multivariate Cox regression was used to identify predictors of smoking relapses. RESULTS: A total of 143 adults were included in our study with a mean age of 44 ± 14 years. The median consumption was 30 cigarettes/ day. The median of initial carbon monoxide expired was 13 ppm. The median period of the medical treatment was 4 weeks. In the survey 74 patients relapse (51,7%) : IC95% [44 -60], with a median deadline of relapse of 11 weeks IC95% [9,1-12,9]. In the multivariate analysis, smoking relapse was associated with a period of treatment less than 4 weeks OR: 2,53: IC95 [1,48-4,32], and with a perception, less than 2 benefits, at the medical examination at follow-up visits OR: 1,54: IC95 [1,02-2,66]. CONCLUSION: The results of this study give us important clarifications, on profits offered by the adult smoking cessation interventions.

[The clinical breast examination. An experience in general medicine]. / L'examen clinique des seins. Une expérience en médecine générale.

BACKGROUND: A Tunisian woman from 27 will be affected by breast cancer between 0 and 74 years of her life. Evolution of this cancer is relatively short. Its mortality is 10% when not detected. The regular practice of clinical breast examination is one of the tools of awareness and adherence to screening women for breast cancer. AIM: To describe the results and the obstacles to the realization of the early diagnosis of the breast cancer for the clinical examination by the general practitioner. METHODS: A forward-looking study realized over 9 months which concerned 105 women of more than 24 years old, consulting for the other motive, in a basic health center. The appropriate statistical tests had been used at the risk of 5 %. RESULTS: The rate of participation was 12 %. The age mean was 46.4 ± 10 years old. An abnormal clinical examination, was identified at 36.2% of the women. The multi parity decreases the risk of developing a breast clinical abnormality, with OR= 0.14 (IC 95 % [0.035-0.580]) while histories favoring the breast cancer increase this risk with an OR=2.79; (IC 95 % [1.09-7.13]). The general practice had asked for a radiological examination for 67.5 % of the women. His request was influenced by the result of the clinical examination (OR= 20.42 (IC 95 % [7.01-59.49])). Four cases of malignant tumors had been diagnosed. CONCLUSION: We recommend giving the general practitioners responsibilities for the women gynecological health and for the coordination between the different actors, via a weekly day of prevention.