Epidemiology of metabolic syndrome in Tunisia. HSHS 5 study.

OBJECTIVE: To measure the prevalence of metabolic syndrome and its components in the HSHS cohort (Hammam Sousse, Tunisia), in 2009, and to identify its determining factors. METHODS: This was a descriptive epidemiological study of the "community based" type having focused on a random sample of people aged 20 and over. The metabolic syndrome was defined according to the criteria of the "International Diabetes Federation" (IDF 2005) and those of the "National Cholesterol Education Program-Adult Treatment Panel III" (NCEP-ATP III, 2001). RESULTS: The study involved 1441 people including 960 women (66.6%). The age- and sex-adjusted prevalences of increased waist circumference, blood pressure, blood sugar and triglycerides, and decreased HDL-cholesterol were respectively 63.2%, 95%CI[62.5-63.8]; 47.7%, 95%CI[47.4-48.6]; 25.7%, 95%CI[25.1-26.2]; 11.9%, 95%CI[11.4-12.3] and 65,6%, 95%CI[65.0-66.2], according to IDF thresholds and 37.4%, 95%CI[36.3-37.6]; 45.7%, 95%CI[45.4-46.6]; 13.8%, 95%CI[13.4-14.2]; 8.4%, 95%CI[8.0-8.7] and 61.9%, 95%CI[61.2-62.5], according to those of the NCEP-ATP III. The prevalence of metabolic syndrome adjusted for age and sex was 36.5% 95%CI[33.0%-38.9%] according to the IDF definition and 23.0% 95%CI[20.4%-25.6%] according to that of NCEP-ATP III. The multivariate study by logistic regression made it possible to retain three significant independent determining factors of the metabolic syndrome: age ≥40 years, low level of physical activity and family history of diabetes mellitus with respectively adjusted ORs of 3.77 95%CI[2.70-5.27], 1.39 95%CI[1.01-1.89], 1.62 95%CI[1.21-2.15], according to IDF and 5.87 95%CI[3.88 -8.88], 1.47 95%CI[1.07-2.01] and 1.45 95%CI[1.07-1.96], according to NCEP-ATP III . CONCLUSION: With this high prevalence rate of the metabolic syndrome, the establishment of an action plan would be essential. This plan should be based on the combination of the promotion of physical activity and screening for the components of the metabolic syndrome, particularly in subjects aged 40 or over, with a family history of diabetes mellitus.

[Epidemiology of smoking in the male population in Tunisia. HSHS Study 6].

OBJECTIVES: To determine the prevalence of smoking in the male population of Hammam Sousse (Tunisia), to describe its modalities and to analyse its determining factors. METHODS: This was a "community-based" study, carried out on a random sample of households, including a population of males aged 20 or over. The data were collected, at home, using a specific support consisting of a lifestyle questionnaire, a physical examination, and a biological assessment, oriented towards cardiovascular risk factors. Smoking behaviour covered both forms of cigarettes and Narghile. "Current smokers" included all men declaring that they smoked at the time of the survey, including "regular smokers", who smoked daily at the time of the survey, and "occasional smokers", less than once a day. The group of "non-smokers" at the time of the survey was the sum of "ex-smokers" and those "who had never smoked". The prevalences were calculated after their weighting according to age and the adjusted odds ratios were measured following a multivariate study by logistic regression. RESULTS: The study population was composed of 481 men with an average age of 49.6±16.35 years and a median of 49 years. Mean body mass index and systolic blood pressure were 26.9 kg/m2 ±4.20 and 151.9 mmHg±24.36, respectively. After adjusting for age, the proportions of current users, former users and subjects who had never used tobacco (all forms combined) were respectively 50.4% (95% CI [49.49-51.3]), 17.4% (95% CI [16.71-18.08]) and 30.9% (95% CI [30.06-31.73]). Daily cigarette consumption was characterized by an average onset at age 20.1±6.91 years, an average duration of 27.0±15.22 years and an average amount of 17.6±9.8 cigarettes smoked per day. After adjusting for age, level of education, and socioeconomic level, smoking behaviour was attributed to a single independent risk factor: the presence of a smoker in the family, with an adjusted OR of 45.17 (p (p<10-3) for regular cigarette smokers, and 29.66 for regular tobacco users of all forms. CONCLUSION: Smoking would be a real endemic in Tunisia, threatening the cardiovascular health of the country. The national health system is called upon to strengthen its action plan for the prevention and control of smoking, in all living environments: family, school, work, health centre, etc.

Bibliometric profile of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia).

OBJECTIVE: Describe the bibliometric profile of medical dissertations in Sousse Faculty of Medicine (SOFM) in Tunisia. METHODS: This is a cross-sectional bibliometric study of all dissertations defended from 2001 to 2005. The data were collected through a reading grid applied to the cover page, conclusion, and summary of the thesis. The specialty of the dissertation has been attributed to its first director. Themes were defined by the "essential descriptor", chosen from the descriptors used for the indexing. RESULTS: The 670 theses collected, all written in French except one in Arabic, were original, pedagogic or bibliographical works in respectively 93.3%, 6.4%, and 0.3% respectively. "Community and Preventive Medicine" was the discipline that generated the most theses with a proportion of 8.9%. About half (48%) of the dissertations were supervised by two directors. The first director was a University Hospital Professor or an Associate Professor of Conferences, respectively in 34% and 42% of cases. The chairman of the thesis jury belonged to the same specialty as the first director and was from the same department in respectively 54% and 41% of cases. Four "essential descriptors" were frequently cited as indexation of the dissertation: "tumor", "CD-Rom", "trauma", and "diabetes". These dissertations were "clinical" type in 68% of cases, of which around 80% were "case studies". CONCLUSION: The doctoral dissertation in SOFM was characterized by the orientation towards clinical and epidemiological research and the preference for general medicine and community health themes. It's often recourse to a basic research estimate and its writing in French would be two factors limiting its scientific promotion and its social influence.

Counter-COVID- 19 pandemic strategy in the Maghreb Central. Qualitative study of the perceptions of health professionals.

CONTEXT: The Maghreb Central, like all the countries of the world, was strongly mobilized (governments, ministries of health, population, civil society) in the response against COVID-19, immediately after the registration of the first cases on its territory (end of February, beginning of March) and according to pre-established control strategies. OBJECTIVES: Describe the perceptions of health professionals in the Central Maghreb (Tunisia, Algeria and Morocco) as to the Strengths/Opportunities and Weaknesses/Threats of the national response plans against COVID-19, during the first weeks of their execution, and report their proposals for optimizing the performance of control strategies. METHODS: This is a qualitative study of the perceptions of health professionals in the Maghreb Central regarding their experience of the first six weeks of fighting the COVID-19 pandemic. The data was collected using the "Delphi" technique in one turn, based on an electronic form such as "Google Form", developed according to SWOT analysis. The respondents' verbatim was grouped into homogeneous groups of items, the occurrence of which was subsequently measured. RESULTS: A total of 382 health professionals from the Maghreb Central participated in this study, with a median age of 37 years and a median professional tenure of 10 years. The major force of the Maghreb response strategies, the most shared by the respondents, was the performance of the human resources mobilized (doctors, biologists, nurses, etc.) who succeeded in quickly learning from the international epidemiological expertise accumulated in Asia and in Europe. The fight against COVID-19 in the Central Maghreb was confronted with the general and chronic fragility of the national health systems and the low support of the general population for the recommendations of the steering committees of response, threatening the capacity of the Maghreb to confront new epidemics. CONCLUSION: The success of the national response plans against COVID-19 and of possible epidemics or pandemics in the Central Maghreb, is strongly attributed to the commitment of health professionals and to community participation, necessitating the launch of assistant motivation programs. and development of health personnel and mobilization and loyalty of civil society.

The satisfaction of patients hospitalized in the surgical departments of a general hospital. Case study of Sahloul hospital in Sousse (Tunisia).

OBJECTIVE: Measure the overall and specific satisfaction rates of patients hospitalized in surgical services in Sahloul University Hospital in Sousse during the year 2018. METHODS: The study population was recruited by a quota sample of hospitalized patients in the surgical departments of Sahloul University Hospital in Sousse. Data collection was done via a patient satisfaction questionnaire, administered to outgoing patients. The questionnaire was composed of 33 items exploring technical, administrative, logistical and relational dimensions. Overall patient satisfaction, called "reactivity", was defined by a concomitant positive response to the three questions exploring satisfaction, recommendation and loyalty. RESULTS: A total of 735 patients hospitalized in six surgical departments were included (general surgery, orthopedics, maxillofacial surgery, urology, neurosurgery and cardiovascular surgery). The rates of "satisfaction", "recommendation" and "loyalty" of the patients were 71%, 70% and 69% respectively, equivalent to an "overall positive reactivity" of 62%, 95% CI [58,5%-65.5%], particularly low in the orthopedic department (43%). The logistics dimension was the least appreciated by patients, including room's condition, with almost 23% overall and 17% in the orthopedic department. CONCLUSION: The responsiveness of patients hospitalized in the surgical services of Sahloul University Hospital was low, particularly for items related to the hotel services in the hospital. Furthermore, plans to improve the quality of care and support the performance of public hospitals should pay close attention to the logistical dimension of patients' hospital stays.

Bibliometrics of Tunisian publications in "General Surgery" (Medline, 2009-2018).

OBJECTIVE: To describe the bibliometric characteristics of Tunisian publications in "General Surgery", indexed in "Medline" database from 2009 to 2018. METHODS: This is a bibliometric study conducted through a comprehensive documentary query applied to the "Pubmed" portal and using the "Medline" database. The essential themes of a publication have been defined by referring to its major keywords. RESULTS: A total of 173 publications were included in this study, representing a productivity rate of 14 articles / 100 surgeons' teachers-year. These publications were co-authored by 65 authors in first position and published by 55 journals in 15 countries, including mainly the national journal "Tunis Med" during the first five-year period 2009-2013 (27%) and the Ugandan magazine "Pan Afr Med J" during the second five-year period 2014-2018 (33%). Case reports were the most widespread type of publication in Tunisian "General Surgery", during the two periods of the study, respectively in 63% and 51% of cases. English was the major language with 57% of publications. Among the 259 major descriptors used to index the "General Surgery" articles, the occurrence of "Pancreatic Neoplasms" and "Echinococcosis, Hepatic" was respectively 3% and 2%. CONCLUSION: During the decade 2009-2018, the Tunisian research in "General Surgery" was not very prolific and was mainly "case reports" but it was directed toward population health problems; Hence the interest of a thorough training of surgeons in research methodology and scientific medical writing.

Cancers in the Central Maghreb: epidemiology from 1990 to 2017 and trends in 2040.

OBJECTIVE: To describe the epidemiology of cancers in terms of global burden of disease, incidence, prevalence and typology in the three Central Maghreb countries from 1990 to 2017, as well as their trends from 2017 to 2040. METHODS: This is a descriptive and predictive study of the epidemiology of cancers in the Central Maghreb (Tunisia, Algeria and Morocco) from 1990 to 2040. The epidemiological data: incidence, prevalence, specific mortality rate and Disability Adjusted Life Years were collected via the Global Burden of Disease Database created by the Institute of Heath Metrics and Evaluation. These parameters were expressed in terms per 100,000 inhabitants. RESULTS: In 2017 and for the three Central Maghreb countries, cancers represented the second leading cause of death, with an overall specific mortality rate of 69/100,000 and an overall incidence rate of 116/100,000 inhabitants. The Disability Adjusted Life Years rate varied from 1516/100,000 in Algeria to 1992/100,000 in Morocco. In the three Central Maghreb countries and during the year 2017, lung cancer was the first cancer in terms of mortality, regardless of age and sex, followed by colorectal cancer in Tunisia and breast cancer in Algeria and Morocco. These three cancers will remain in 2040 the most important in terms of mortality rate with lung cancer topping the list in Tunisia and Morocco with respective mortality rates of 30 and 16/100,000. CONCLUSION: Cancers are currently, and in the next two decades, an important component of the GlobalBurden of Disease in Central Maghreb countries. The typology is dominated by lung, breast and colorectal cancers. The establishment of a Maghreb cancer registry would be a fundamental component of the Maghreb cancer plan.

Thirty years of Tunisian publication of «case reports¼ in General Surgery (1989-2018).

OBJECTIVE: To describe the bibliometric profile of Tunisian "case report" publications in general surgery over the last thirty years (1989-2018). METHODS: This is a descriptive bibliometric study on "case reports", general surgery, Tunisian affiliation, indexed in the Medline database, between January 1, 1989 and December 31, 2018. The themes of Search articles were defined by referring to their major keywords used for their indexing. RESULTS: During 30 years of study, Medline indexed 188 papers in "General Surgery" type "case reports", signed by 80 authors in first position and 71 authors in last position, belonging to ten academic specialties and 19 professional affiliations. These papers were published by 60 journals, including the Ugandan magazine "Pan African Medical Journal", which published 23% of these "case reports" alone. The number of major indexing keywords was 299 words, mainly "Echinococcosis", "Pancreatic Cancers" and "Echinococcosis of the liver", together accounting for 18.1% of articles. CONCLUSION: The plethora of "case reports" in Tunisian general surgery publications over the last three decades was accompanied by a preferential edition in the journal "Pan Afr Med J" and a thematic focus on hydatid cysts and cancers pancreatic. Hence the importance of strengthening the capacity of Tunisian surgeons in research methodology and scientific medical writing.

Bibliometrics of Tunisian publications on respiratory tract diseases from 2010 to 2014.

AIM: To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014. METHODS: This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords. RESULTS: A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms¼ (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease¼ (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary¼ (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively. CONCLUSION: Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.

Tunisian documentation of «Public Health¼ in post revolution, with a taste of freedom. For a fair, participatory and efficient National Health System.

CONTEXT: Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach. OBJECTIVE: To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition. METHODS: During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. These documents were: the "2011 Health Map" of the Department of Studies and Planning of the Ministry of Health, the "Societal Dialogue Report on Health Policies, Strategies and Plans" (2014), and the "Report on the right to health in Tunisia" (2016). RESULTS: The reading of this sample of the Tunisian Public Health literature of the post-revolution brought out three consensual ideas: 1. The constitutional principle of the "right to health" (article 38 of the constitution) with its corollary the State's obligation to ensure access to comprehensive, quality and secure care; 2. The challenge of social "inequalities" of access to care, reinforced by a regional disparity in the distribution of resources, particularly high-tech (specialist doctors, university structures); 3. Advocacy for a National Health System, based on a universal health coverage for its funding and citizen participation in its governance. CONCLUSION: The new Tunisian Public Health literature, in post-revolution, calls on all stakeholders in Preventive and Community Medicine to replace their segmental, technical and hospital practices with a new approach, centered on the implementation of a National Health System that is based on a socialized financing of care and citizen participation in its management.

Smoking behavior among students of health sciences at the university of Monastir (Tunisia).

OBJECTIVE: Measure the prevalence of smoking among students of health sciences Faculties in Monastir (Tunisia) and identify factors associated with smoking behavior. METHODS: A cross-sectional study based on a self-administered questionnaire conducted among students registered in their second, fourth and sixth year at the Faculties of Medicine and Pharmacy in Monastir, in 2013. Smoker was the subject who, at the time of the survey, smoked at least one cigarette per day. Academic difficulties were used to denote any of the following incidents that a student may experience: passing exams at the retake session, revalidating an internship or repeating a school year. A logistic regression analysis was used to identify factors associated with smoking. RESULTS: The number of participants was 634 (285 Medical students and 349 Pharmacy students); they were 170 males and 464 females. The prevalence of smoking was 15%; 95% IC [12.1-17.7]. It was nearly five times higher among male compared to female students (35.3%; 95% IC [28.1-42.5]) vs 7.5%; 95% IC [5.1-9.9]); It was also higher among Pharmacy students than among Medical students (18.9%; 95% IC [14.8-23.0]) vs 10.2%; 95% IC [6.7-13.7]). In the multivariate analysis, the Faculty of Pharmacy (ORa=3.081; 95% IC=[1.7-5.7]), the male sex (ORa=6.929; 95% IC [3.9-12.0]) and the academic difficulties (ORa=1.854; 95% IC [1.02-3.38]) were found to be significantly associated with smoking. CONCLUSION: The level of tobacco use found among Medical and Pharmacy students is alarming. This serious problem has a negative impact on their behavior and can hinder their role model as future health professionals. Greater efforts are needed to develop anti-smoking programs, to educate students and to offer psychological support to deal with school difficulties.

Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity.

BACKGROUND: The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities. OBJECTIVES: To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability. METHODS: This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Data covering the period from 1990 to 2016, examined the three major categories of health problems "communicable, maternal, neonatal and nutritional diseases", "noncommunicable diseases" and "injuries", as well as the three types of risk: metabolic, environmental / professional and behavioral. RESULTS: Since 1990, cardiovascular diseases have consistently been the leading cause of death in the three Maghreb countries. During the period 1990-2016, and at varying speeds, the positions of communicable and neonatal diseases declined, while noncommunicable diseases (particularly cardiovascular diseases, cancers, mental disorders, diabetes and neurological disorders) increased significantly, to be at the top of the list of components of the global burden of disease.In 2016, road accidents have been ranked eighth in the ranking of the main components of the overall burden of morbidity in Tunisia and Morocco and ninth in Algeria. During the same period, the environmental and behavioral risk factors registered an overall decrease in the three Maghreb countries, in contrast to the metabolic risk factors that experienced a gradual and homogeneous increase in the Greater Maghreb. CONCLUSION: This GBD analysis confirmed the rather old and fairly advanced epidemiological transition in Maghreb countries, leading to a real "triple burden" threatening the stability and sustainability of national health systems. Hence the urgency of supporting the following five projects: the curriculum reform of the faculties of health sciences, the development of the second line of care, the participative management of health services, universal health coverage and the implementation of a comprehensive and integrated strategy for prevention and health promotion.