Dairy products and colorectal cancer in middle eastern and north African countries: a systematic review.

BACKGROUND: This systematic review was conducted to explain the association between dairy products and colorectal cancer (CRC) risk in Middle Eastern and North African countries (MENA). METHODS: The database consulted were PubMed, Clinical Trials, and Cochrane to extract the relevant studies published till the 31stof December 2016, using inclusion and exclusion criteria according to Prisma Protocol. The characteristics of these studies comprised the consumption of all types of dairy products in relation to CRC risk. RESULTS: Seven studies were included in this review. For dairy products overall, no significant association was found. Regarding modern dairy products, included studies found controversial results with OR = 9.88 (95% CI: 3.80-24.65) and ORa = 0.14 (95% CI: 0.02-0.71). A positive association was reported between traditional dairy products and CRC risk, to OR = 18.66 (95% CI: 3.06-113.86) to OR = 24 (95% CI: 1.74-330.82) to ORa = 1.42 (95% CI: 0.62-3.25), ptrend = 0.03. Calcium was inversely associated with the CRC risk with ORa = 0.08 (95% CI: 0.04-0.17). CONCLUSION: This is the first systematic review which illustrated the association between dairy consumption and CRC risk in MENA region. The results were inconsistent and not always homogeneous. Further specified studies may be warranted to address the questions about the association between CRC and dairy products in a specific context of MENA region.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey.

BACKGROUND: Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. METHODS: A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. RESULTS: A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. CONCLUSIONS: The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study.

BACKGROUND: Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students. METHODS: From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria. RESULTS: A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use. CONCLUSIONS: The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.

Prevalence and distribution of Helicobacter pylori cagA and vacA genotypes in the Moroccan population with gastric disease.

Helicobacter pylori infection is the etiologic agent of various gastric pathologies. The severity of disease outcome has been attributed to some H. pylori genotypes, which varies geographically. In Morocco, there are no data regarding the pattern of H. pylori genotypes; therefore, this is the first prospective study conducted in our country to investigate the genotype profiles (vacA and cagA) of H. pylori in patients with gastric pain. Endoscopic biopsies were obtained in patients attending the gastroenterology department of the Hospital University Hassan II of Fez for gastric pain and were directly used for H. pylori detection and genotyping by polymerase chain reaction (PCR). The SPSS software program was used to study the genotype correlation to different clinical outcomes. A total of 429 patients were included in this study, with an infection rate of 69.9%. cagA was detected in 42.3% of cases. However, vacA genotyping reveal a large predominance of s2m2. Infection with multiple strains was detected in 10.8% of cases and incomplete vacA was observed in 31.5%. In Morocco, vacA s1m1 was significantly associated to peptic ulcer diseases, while s2m2 was associated to gastritis. Moroccan H. pylori vacA genotype profiles differ from the Latin American, European, and South African profiles, with more similarities to the North African profile. Because of the small number of cases with gastric cancer, no correlations with H. pylori have been studied, so, further studies will be required in order to highlight the effects of those genes on this disease.

Cross-cultural adaptation and validation of the knee and hip health-related quality of life (OAKHQoL) in a Moroccan Arabic-speaking population.

The aim of this study was to adapt the knee and hip osteoarthritis quality of life questionnaire (OAKHQoL) into Moroccan Arabic and to determine its psychometric properties. After translation, back-translation and pretesting, the translated version was submitted to an expert committee. The psychometric properties were tested on patients with hip or knee osteoarthritis. Internal consistency was tested using Cronbach's alpha coefficient (α), and the test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining item-convergent and divergent validity and by comparing the average scores between age groups and walk perimeter groups. The study was conducted on 131 patients (115 with osteoarthritis of the knee and 16 with osteoarthritis of the hip). The "physical activities" (α = 0.93), "mental health" (α = 0.84) and "pain" (α = 0.88) dimensions of the Arabic version were internally reliable. The ICC were adequate to good; 0.83 for "physical activities", 0.65 for "mental health" and 0.70 for "pain" dimensions. The instrument demonstrated good construct validity; all items exceeded the 0.4 criterion for convergent validity, except items 13 and 41 and most of the correlations between items and their own scale were significantly higher than their correlations with other scales. A semantically equivalent translation has been developed with cultural adaptation of OAKHQoL. It is quite reliable and a valid measure of the effect of osteoarthritis on the quality of life on Moroccan patients.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco.

OBJECTIVE: In Morocco, the association between obesity/overweight and socio-demographic and lifestyle factors is poorly understood. The present study aimed to investigate this association in a representative sample of the Moroccan population aged 18 years and above. DESIGN: This is a cross-sectional study using a questionnaire including demographic, socio-economic and physical activity items. Height and weight were measured and BMI was computed. The association between obesity (BMI ≥ 30.0 kg/m2) or overweight (25.0 ≤ BMI < 29.9 kg/m2) and the other variables was analysed using multiple binomial logistic regression, separately in men and women. SETTING: The whole Moroccan territory. SUBJECTS: A total of 2891 subjects took part in the survey (1430 men and 1461 women). RESULTS: The prevalence of obesity was 20.9 % in women and 6.0 % in men (P < 0.0001). The prevalence of overweight was 32.9 % in women v. 26.8 % in men (P < 0.0001). In women, the risk of obesity and overweight increased with age, with the highest risk being in individuals aged 45-54 years (OR = 3.02, 95 % CI 2.06, 4.44) compared to individuals <35 years old. Married women were more prone to obesity and overweight (OR = 2.42, 95 % CI 1.50, 3.91) than single women. In men, the risk of obesity and overweight increased with average family income (OR = 2.62, 95 % CI 1.40, 4.87 for family income ≥5000 MAD/month compared to <2000 MAD/month) and in married persons (OR = 3.75, 95 % CI 1.78, 7.81) compared to single individuals. CONCLUSIONS: These results contribute to target groups in whom prevention programmes could be implemented.

Knowledge and attitude about antismoking legislation in Morocco according to smoking status.

Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 32.3% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation.

Burden of smoking in Moroccan rural areas.

The aim of this study was to estimate the prevalence and characteristics of current smoking among rural Moroccans. The population study included 3438 individuals aged 15 years and above from both sexes. The crude prevalence of current smoking (currently smoked and had smoked > 100 cigarettes in lifetime) was 16.9% in the adolescent and adult rural population: 31.0% among men and 1.1% among women. The majority of smokers 74.4% of men and 68.8% of women) began smoking before age 20 years. Multiple logistic regression analysis showed that age, sex, marital status, occupation and region of residence were the strongest determinants of current smoking. These results showed a high prevalence of smoking among males in the rural population of Morocco.

Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19.

The 2019-20 coronavirus pandemic (COVID-19) has led to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, no drugs have demonstrated safety and efficacy in randomized controlled trials for patients with COVID-19. Although the association between Hydroxychloroquine and Azithromycin efficacy lack of solid evidence-base, several governments have adopted it for all virology confirmed Covid-19 cases even for those who are asymptomatic. In the following, we aim to discuss some of the ethical issues associated with the use of this treatment association. We mainly tried to discuss the following controversial questions: Is it ethical not to treat a patient while a treatment exists and is used for other indications than Covid-19 for which it's not proven yet? If yes, is a randomized controlled trial to prove the hydroxychloroquine for the Covid-19 treatment, necessary, in the context of covid-19 pandemic? If no, is it the government's right to decide the hydroxychloroquine treatment for all covid-19 patients? And what should be the physicians' attitudes? Finally, what are the government, physicians, and patient's rights and responsibilities? The paper conclude that, since health authorities in some countries recommended this off-label use treatment, physicians are challenged by the requirement of veracity while providing care to their patients and the implications of such a requirement; they are facing the challenge of balancing this guideline and their own conviction. Furthermore, the fundamental principles of beneficence and non-maleficence, and respect for persons should underlie any reflection process to address this dilemma. In addition, in a pandemic context, the limits between the government's, practitioner's and patient's rights and obligations are not clear which could significantly endanger the universal ethical principles in clinical practice. It could also undermine any attempt to develop serious clinical trials to prove the considered off-label drug.

La pandémie de coronavirus 2019-2020 (COVID-19) conduit au syndrome respiratoire aigu sévère coronavirus 2 (SRAS-CoV-2). À ce jour, aucun médicament n'a démontré son innocuité et son efficacité dans des essais contrôlés randomisés pour les patients atteints de COVID-19. Bien que l'association entre l'hydroxychloroquine et l'azithromycine manque de preuves solides, plusieurs gouvernements l'ont adoptée pour tous les cas de Covid-19 confirmés, même pour ceux qui sont asymptomatiques. Dans ce qui suit, nous discutons certains des problèmes éthiques associés à l'utilisation de cette association thérapeutique. Nous avons principalement essayé de discuter les questions controversées suivantes: est-il éthique de ne pas traiter un patient alors qu'un traitement existe et est utilisé pour d'autres indications que le Covid-19 pour lequel il n'est pas encore prouvé ? Si oui, un essai contrôlé randomisé pour prouver l'hydroxychloroquine pour le traitement Covid-19 est-il nécessaire dans le contexte de la pandémie Covid-19 ? Si non, le gouvernement a-t-il le droit de décider du traitement à l'hydroxychloroquine pour tous les patients de Covid-19 ? Et quelles devraient être les attitudes des médecins ? Enfin, quels sont les droits et responsabilités du gouvernement, des médecins et des patients ? Le document conclut que, puisque les autorités sanitaires de certains pays ont recommandé ce traitement hors AMM, les médecins sont confrontés aux challenges de l'exigence de véracité de l'efficacité du traitement tout en prodiguant des soins à leurs patients et aux implications d'une telle exigence ; ils sont confrontés au défi d'équilibrer ces exigence et leur propre conviction. En outre, les principes fondamentaux de bienfaisance et de non-malfaisance, et le respect des personnes devraient sous-tendre tout processus de réflexion pour résoudre ce dilemme. Enfin, dans un contexte de pandémie, les limites entre les droits et obligations du gouvernement, du praticien et du patient ne sont pas toujours claires, ce qui pourrait mettre en danger de manière significative les principes éthiques universels dans la pratique clinique. Cela pourrait également saper toute tentative de développer des essais cliniques sérieux pour prouver le médicament hors AMM considéré.

Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results.

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

[Cross-cultural adaptation difficulties in health quality of life scales for developing countries: example of St-George respiratory questionnaire validation in Morocco]. / Difficultés de l'adaptation transculturelle des échelles de mesure en santé dans les pays du sud : exemple de la validation du St-George Respiratory Questionnaire au Maroc.

BACKGROUND: In developing countries, quality of life (QoL) is becoming an increasingly relevant question. The use, in these countries, of the validated English scales could resolve an important problem of a lack of QoL tools noted in southern countries. However, this approach raises methodological problems of cross-cultural adaptation. This paper underlines the principal difficulties related to cross-cultural adaptation of QoL measurement scales based on the example of St-George Respiratory Questionnaire (SGRQ) translation from English to the Moroccan Arabic language. METHODS: The SGRQ, initially designed in English, was translated into dialectical Arabic by four translators following the recommended stages of translation and cultural adaptation: translation with conceptual and linguistic evaluation, back translation, comparison of the source and target versions and verification of the new instrument. RESULTS: During this cross-cultural adaptation process, some items were modified to adapt the original questionnaire to the Moroccan culture. Because of the great diversity of the Moroccan dialectal language, some words were, sometimes, translated into two or more equivalents which were put in the brackets in the final version of the SGRQ(m). Some questions were not applicable to all the Moroccan population such as a question about sports that did not concern women. On the other hand, some questions involving the same items posed differently in different dimensions, gave rise to confusion or the impression of repetition in the Moroccan Arabic version. CONCLUSION: The cross-cultural adaptation process, even if carried out in a rigorous way, does not always lead to the best target version and suggests it would be useful to develop new scales specific to each culture and at the same time, to think about the Trans cultural adaptation.

Inequalities in smoking profiles in Morocco: the role of educational level.

BACKGROUND: Cigarette smoking is increasingly associated with lower socio-economic status, indicated by lower educational levels. This association has never been investigated in Morocco. OBJECTIVE: The MARTA survey was undertaken to assess tobacco use in the Moroccan population according to level of education and other socio-demographic characteristics. METHODS: A cross-sectional survey based on a representative sample of the Moroccan population was conducted in 2005-2006. The survey questionnaire gathered socio-demographic information, educational level and smoking status. chi(2) analyses were performed to determine whether the smoking outcome variables differed significantly between different educational levels in relation to demographic variables. Multiple logistic regression analysis was used to calculate the adjusted odds ratio for smoking status according to educational level. RESULTS: A total of 9195 subjects were included in the study; 52% were men and 17.9% illiterate. The overall prevalence of current smoking was 18.0% (95%CI 17.2-18.8): 31.5% (95%CI 30.2-32.9) in males and 3.3% (95%CI 2.8-3.8) in females. The prevalence of current smoking was inversely associated with level of education in men and increased with educational level in women. Illiterate males tended to have a higher probability of being current smokers than males with university-level education (OR 1.93, 95%CI 1.51-2.46). CONCLUSION: These results indicate a need for tobacco control to reach all sectors of society, and especially the illiterate population.

[Prevalence and risk factors for nosocomial infections in Hassan II University Hospital, Fes, Morocco]. / Prévalence et facteurs de risque des infections nosocomiales au CHU Hassan II de Fès (Maroc).

We determined the prevalence and risk factors for nosocomial infection at Hassan II University Hospital and the causative microorganisms among 282 inpatients. The mean duration of hospitalization was 16.4 (SD = 15) days. The prevalence of nosocomial infection was 6.7%. Infections at the site of the operation were the commonest. No catheter-related infection was noted. The main organisms isolated were Escherichia coli, Klebsiella pneumoniae and Candida albicans. The occurrence of a nosocomial infection was significantly associated with surgical operation (P = 0.005), presence of urinary catheter (P = 0.002) and length of hospital stay greater than 3 weeks (P = 0.04).

Validation of the St. George's Respiratory Questionnaire in patients with COPD or asthma in Morocco.

SETTING: Chronic obstructive pulmonary disease (COPD) and asthma are a public health problem in Morocco. Their evaluation should be supplemented by quality of life measurement, but there is no specific instrument available in local Moroccan Arabic. OBJECTIVE: To validate a Moroccan Arabic version of the St George's Respiratory Questionnaire (SGRQ) in patients with COPD or asthma in Morocco. DESIGN: After a rigorous translation process of the SGRQ into local Moroccan Arabic (SGRQm), the SGRQm, spirometry, Fletcher scale and a visual analogical scale (VAS) were administered to each patient at recruitment. Data were used to examine the construct validity and reliability of the SGRQm. To examine the test-retest reliability, patients completed the SGRQm a second time 10 days later. RESULTS: A total of 131 patients with a mean age of 52 years were recruited into the study. Patients had a mean forced expiratory volume in one second (FEV1) of 1.70 1 and a mean VAS of 51.5 mm. Internal consistency of symptoms, activity and impact components was assessed using Cronbach's alpha (a) reliability coefficient; they were 0.94, 0.91 and 0.90, respectively. The test-retest reliability of components scores ranged from 0.70 to 0.87. The Fletcher scale correlated with all SGRQm scores, while the VAS had a similar correlation except with symptoms (P > 0.05). FEV1 values were negatively correlated with all SGRQm scores. CONCLUSION: The SGRQm yielded satisfactory psychometric properties.

Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study.

OBJECTIVE: To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age ⩾40 years), living in the city of Fez, Morocco. DESIGN: Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. RESULTS: Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for <10 pack-years). The prevalence of physician-diagnosed COPD was 3.2%; this was associated with an increase in smoking pack-years. CONCLUSION: These results emphasise the urgent need to take necessary measures to reduce the prevalence of tobacco smoking.

Acute abscess with fistula: long-term results justify drainage and fistulotomy.

Conventional treatment of anal abscess by a simple drainage continues to be routine in many centers despite retrospective and randomized data showing that primary fistulotomy at the time of abscess drainage is safe and efficient. The purpose of this study is to report the long-term results of fistulotomy in the treatment of anal abscesses. This is a prospective nonrandomized study of 165 consecutive patients treated for anal abscess in University Hospital Hassan II, Fez, Morocco, between January 2005 and December 2010. Altogether 102 patients were eligible to be included in the study. Among them, 52 were treated by a simple drainage and 50 by drainage with fistulotomy. The results were analyzed in terms of recurrence and incontinence after a median follow-up of 3.2 years (range 2-6 years). The groups were comparable in terms of age, gender distribution, type and size of abscess. The recurrence rate after surgery was significantly higher in the group treated by drainage alone (88 %) compared to other group treated by drainage and fistulotomy (4, 8 %) (p < 0.0001). However, there was a tendency to a higher risk of fecal incontinence in the fistulotomy group (5 % vs 1 %), although this difference was not significant (p = 0.27). In the group treated by drainage and fistulotomy, high fistula tract patients are more prone to develop incontinence and recurrence, mainly within the first year. A long-term follow-up seems not to influence the results of fistulotomy group. These findings confirm that fistulotomy is an efficient and safe treatment of anal abscess with good long-term results. An exception is a high fistula, where fistulotomy may be associated with a risk of recurrence and incontinence.

Dyspnea: a strong independent factor for long-term mortality in the elderly.

OBJECTIVE: To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors. DESIGN: Longitudinal study. SETTING: In Dordogne and Gironde, South Western France. SUBJECTS: A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. MAIN OUTCOME MEASURES: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes. RESULTS: The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects , 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10⁻4). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10⁻³). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01-1.26]); this risk increases to HR=1.42 (CI95%=[1.25-1.63]) for level-2 and to HR=1.90 (CI95%=[1.61-2.25]) for level-3 and 4. CONCLUSION: These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.

Association between smoking status, other factors and tuberculosis treatment failure in Morocco.

BACKGROUND: The association between smoking and tuberculosis (TB) treatment failure has not yet been assessed in Morocco. OBJECTIVE: To evaluate the impact of smoking on the failure rate of patients with TB. METHODS: A cohort of 727 new TB cases was followed between 2004 and 2009. Socio-demographic measurements and smoking status were collected by questionnaire. Treatment failure was defined according to international guidelines. Univariate analyses were used to assess associations of treatment failure with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. RESULTS: The patients' mean age was 35.0 ± 13.2 years. The monthly household income was <€180 for 71.4% of the patients. The rate of treatment failure was 6.9%. Failure was significantly higher among smokers (9.1% vs. 4.5%; P < 0.01), alcohol drinkers (18.5% vs. 4.9%; P < 0.01), and those with a monthly income of <€180 (8.4% vs. 3.3%; P < 0.01). After adjusting for confounding variables, smoking and low income remained significantly associated with treatment failure (adjusted OR 2.25, 95%CI 1.06-4.76, and 3.23, 95%CI 1.12-9.32). CONCLUSION: Smoking is associated with TB treatment failure in Morocco. Anti-smoking interventions should be incorporated into current TB case management.

[Frequency, types and determinants of degenerative complications of type 2 diabetes in Morocco:“EpiDiaM” cohort inclusion data]

إن مضاعفات التشيخ الناجمة عن السكري تفرض عبئاً مرضياً ثقيلاً وزيادة في معدل الوفيات. وتقدم هذه الدراسة لمحات وبائية وسريرية عن مرضى السكري في دراسة الأتراب EpiDiaM والتي تشمل 1196 حالة سكري تم اختيارهم من قبل شبكة الرعاية الصحية الأساسية في مدينة فاس. لقد كان متوسط عمر المشاركين 57.5 [SD 10.4]سنة، 47.1% منهم تتراوح أعمارهم بين 50 و 60 عاماً. وكانت الغالبية [77.7%]من النساء. وكان متوسط مدة السكري 8 [SD 6.6]سنوات. وكان ارتفاع ضغط الدم موجوداً لدى 49.3% من الأتراب، وكان 77.9% منهم لديهم وزن زائد أو سمنة، كما عانى 63.8% منهم من واحدة أو أكثر من المضاعفات. ومن بين الذين لديهم مضاعفات كان اعتلال الشبكية هو الأكثر شيوعاً [69.4%]، تليه أمراض القلب [50.8%]واعتلال الأعصاب [45.6%]ومرض الكلى [4.8%]. إن ارتفاع معدل انتشار المضاعفات يؤكد على ضرورة معالجة عوامل الخطورة التي يمكن تفاديها والحيلولة دون حدوث المضاعفات

Le diabète est une maladie à lourde charge de morbidité et de mortalité liées aux complicationsdégénératives. La présente étude présente le profil épidémiologique et clinique des patients diabétiques inclus dans l’étude de cohorte « EpiDiaM », qui portait sur 1196 cas recrutés au niveau du réseau de soins de santé de base de la ville de Fès. L’âge moyen des participants était de 57,5 (ET 10,4) ans. Dans 47,1 % des cas, les patients étaient âgés entre 50 et 60 ans. La majorité (77,7 %) était des femmes. L’ancienneté moyenne du diabète était de 8 (ET 6,6) ans. L’hypertension était présente chez 49,3 % des patients alors que 77,9 % étaient en surpoids ouobèses ; 63,8 % des patients souffraient de complications. Chez ces derniers, la rétinopathie était la complication la plus fréquente (69,4 %), suivie par la cardiopathie (50,8 %), la neuropathie (45,6 %) et la néphropathie (4,8 %).La forte prévalence des complications souligne la nécessité d’agir sur les facteurs de risque évitables et de prévenir les complications.

Degenerative complications as a result of diabetes impose a heavy disease burden and increase mortality. This study presents epidemiological and clinical profiles of diabetic patients in the EpiDiaM cohort study, which include 1196 diabetic cases recruited from the basic health care network in the city of Fez. Themean age of the participants was 57.5 (SD 10.4) years with 47.1% aged between 50 and 60 years. The majority (77.7%) were women. The mean duration of diabetes was 8 (SD 6.6) years. Hypertension was found in 49.3% of the cohort, 77.9% were overweight or obese and 63.8% had one or more complications. Among those withcomplications, retinopathy was the most common (69.4%), followed by heart conditions (50.8%), neuropathy (45.6%) and renal disease (4.8 %). The high prevalence of complications emphasizes the need to address the avoidable risk factors and prevent complications.

Knowledge and attitude about antismoking legislation in Morocco according to smoking status

Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess knowledge and attitudes about tobacco legislation among Moroccans, according to their smoking status. A cross-sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 323% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation