Transcutaneous canine breast cancer detection in Tunisia: a pilot study.

BACKGROUND: Breast cancer in Tunisia is often diagnosed at a late stage with long delay in time to consultation and to diagnosis.The aim of this study is to estimate the sensitivity and specificity of the transcutaneous breast cancer detection by canine olfactionin Tunisian women and to identify the potential confounding factors. METHODS: This is a diagnostic case control study that took place from October 2021 to November 2022 in the Department of Medical Oncology at the University Hospital Farhat Hached of Sousse and in the security and training dog center located in Sousse (K9 Dog Center Security & Training). A two-year-old male Belgian Malinois was trained to detect breast cancer on skin secretion samples in compresses that had been worn overnight by women on their breast and then a double-blind testing was performed. There was no contact between women and the dog. From the mentioned responses of the dog, four parameters were calculated: sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). RESULTS: Two hundred women were included in this trial: 100 breast cancer (BC) patients recruited from Farhat Hached University Hospital of Sousse and 100 healthy volunteers (HV).The calculated sensitivity was 84% (95% CI 78-89%) and the calculated specificity was 81% (95% CI 75-86%). The calculated predictive values were: PPV = 83,51% (95% CI 78,37-88,65%) and NPV = 81,55% (95% CI 76.17-86.93%). In the multivariate study, only four confounding factors of test's sensitivity were retained: age (OR = 1.210 [95% CI = 1.085-1.349]; p = 0.001), history of diabetes(OR = 0.017 [95% CI = 0.001-0.228]; p = 0.002), sampling at hospital (OR = 0.010 [95% CI = 0.003-0.464]; p = 0.010) and testing during chemotherapy courses (OR = 0.034 [95% CI = 0.003-0.404]; p = 0.007).For test's specificity, we retained the three following confounding factors: age (OR = 1,104 [95% CI = 1.021-1.195]; p = 0.014), history of benign mastopathy (OR = 0.243 [95% CI = 0.074-0.805]; p = 0.021)and history of arterial hypertension (OR = 0.194 [95% CI = 0.053-0.707]; p = 0.013). CONCLUSION: This is a pilot study that opens new avenues in developing a reliable cancer diagnostic tool that integrates the dog's olfactory ability to detect breast cancer using a transcutaneous sampling method. It could be a pre-test to select patients who are eligible to a screening mammogram, especially in low-income countries where there is no national mammography screening program. PACTR. ORG IDENTIFIER: PACTR202201864472288, registration date 11/01/2022.

Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study.

BACKGROUND: The drive to vaccinate large populations is nowadays the main instrument for combating the pandemic and preventing serious disease and death. However, breakthrough infection (post-vaccination infection) still happens after vaccination among fully vaccinated people. We aimed to assess the severity outcomes and to determine its associated factors among vaccinated COVID-19 cases in the governorate of Sousse, Tunisia. METHODS: We carried out a five-month observational longitudinal study including all the population of Sousse. Confirmed infections of SARS-CoV-2 and the vaccination status are recorded in the daily COVID- 19 database of the Regional Office of the Tunisian Ministry of Health. We included all post-vaccination COVID-19 cases for the analysis of the COVID-19 serious outcomes. Data were collected via 15-min telephonic call interviews conducted by trained interviewers. Descriptive analysis with calculating incidence rates of confirmed COVID-19 cases per 100,000 inhabitants was conducted. In binary logistic regression, adjusted odds ratios along with 95% intervals confidence were performed to determine factors related to severe or critical COVID-19. RESULTS: As of 31 July 2021, 107,545 persons over 19 years old have received at least one dose of COVID-19 vaccination. Among the vaccinated population, we traced and included 765 breakthrough infection cases, and the incidence rate was 711.3 per week. The majority were female (sex-ratio = 0.8), and the average age of the overall cases was 55.7 years. The prevalence of severe or critical cases in vaccinated COVID-19 patients occurs in 10.8% of cases. Patients with a medical history of cardiovascular diseases had more than two times increased odds to have a severe or critical disease. We also found the highest self-estimation of adherence to preventive measures was inversely correlated to serious cases and having an incomplete vaccination schema was strongly associated with complications. CONCLUSIONS: We tried to provide evidence about the breakthrough infections to improve measures of prevention and control of COVID-19. Boosting immunity for vulnerable patients added to maintaining and promoting preventive measures are not only essential to prevent severe cases of breakthrough infections of COVID-19, but also other influenza-like diseases.

Effective public health measures to mitigate the spread of COVID-19: a systematic review.

BACKGROUND: In December 2019, a novel coronavirus (2019-nCoV) was recognized in Wuhan, China. It was characterised by rapid spread causing a pandemic. Multiple public health interventions have been implemented worldwide to decrease the transmission of the 2019 novel coronavirus disease (COVID-19). The objective of this systematic review is to evaluate the implemented public health interventions to control the spread of the outbreak of COVID-19. METHODS: We systematically searched PubMed, Science Direct and MedRxiv for relevant articles published in English up to March 16, 2021. We included quasi experimental studies, clinical trials, cohort studies, longitudinal studies, case-control studies and interrupted time series. We included the studies that investigated the effect of the implemented public health measures to prevent and control the outbreak of 2019 novel coronavirus disease (COVID-19). RESULTS: The database search using the predefined combinations of Mesh terms found 13,497 studies of which 3595 in PubMed, 7393 in Science Direct 2509 preprints in MedRxiv. After removal of the duplicates and the critical reading only 18 articles were included in this systematic review and processed for data extraction. CONCLUSIONS: Public health interventions and non-pharmaceutical measurements were effective in decreasing the transmission of COVID-19. The included studies showed that travel restrictions, borders measures, quarantine of travellers arriving from affected countries, city lockdown, restrictions of mass gathering, isolation and quarantine of confirmed cases and close contacts, social distancing measures, compulsory mask wearing, contact tracing and testing, school closures and personal protective equipment use among health workers were effective in mitigating the spread of COVID-19.

Clustering of risk factors in the smoking habits of schoolchildren in Sousse, Tunisia.

BACKGROUND: In Tunisia, little is known about the association between tobacco use and other chronic disease risk factors. This is the case for both adults and children. It is important to know the characteristics of young smokers to facilitate the creation and implementation of future programs for tobacco prevention. AIM: The aim of this study was to determine the association between tobacco use and other lifestyle factors among schoolchildren in Tunisia. METHODS: We conducted a 2009/2010 cross-sectional questionnaire survey of 4003 randomly selected school children aged 13 years old (7th and 9th grades) to evaluate their knowledge, attitudes towards, and beliefs about the three risk factors for chronic disease (unhealthy diet, physical inactivity, and tobacco use). Written informed consent was obtained from each child's parents who allowed their child to participate. RESULTS: The mean age of our sample was 13.36 ± 1.28 years. The proportions of daily smokers were 2.2% and 0.1% among boys and girls, respectively. The proportions of irregular smokers were 9.1% and 1.5% among boys and girls, respectively. In our population, 19.1% (n=767) had ever experimented to smoke, with 29.8% among boys and 9% among girls (p<0.001). The proportions of schoolchildren who reported daily participation in physical activity were different between smokers and nonsmokers with 17.7% and 11.5%, respectively (p=0.03). Concerning eating habits, there was no significant difference in the consumption of fruits and vegetables; however, smokers frequently ate more high fat foods and in fast food restaurants. Similar results were found while comparing regular smoking children with those who experimented but who never became hooked on smoking. CONCLUSION: This study and previous research suggest the importance of early intervention in adolescents on smoking and combing these efforts with interventions focusing on physical activity and dietary habits.

Co-occurrence of problematic facebook and video game use: prevalence and association with mental health disorders among adolescents.

INTRODUCTION: The rapid proliferation of technology and its impact on adolescents' lives have raised concerns about addictive behaviors and its potential consequences, including behavioral and mental health problems. This study investigates the prevalence and risk factors associated with the co-occurrence of Problematic Facebook Use and Problematic Video game Use among Tunisian adolescents. METHODOLOGY: We conducted a cross-sectional study in the urban area of Sousse governorate in Tunisia during the 2018/2019 school year. We selected a representative sample of high school students enrolled in public educational institutions in Sousse. Data collection was performed through a self-administered structured questionnaire, which gathered information on sociodemographic characteristics, lifestyle behaviors, and mental health disorders. Problematic Facebook Use was assessed using the validated Arabic version of the Bergen Scale, while Problematic Video Game Use was measured using the 21-point Lemmens Scale, which was translated into Arabic. Statistical analysis was carried out using the SPSS program (version 20). RESULTS: We enrolled a total of 1342 high school students in our study, of whom, 63.2% were female with a mean age of 17.5 ± 1.44 years. The prevalence of Problematic Facebook Use and Problematic Video Game Use was  28.3% and  13% respectively. Regarding the co-occurrence of the two problematic behaviors, 31.3% of participants faced a singular addictive behavior, either related to problematic Facebook or video game use, while 5% had both addictive behaviors simultaneously. In a multivariate analysis, risk factors for the co-occurrence of Problematic Facebook and Video Game Use, in decreasing order of significance, included severe depression (AOR = 4.527; p = 0.003), anxiety (AOR = 4.216; p = 0.001), male gender (AOR = 4.130; p < 0.001), problematic internet use (AOR = 3.477; p = 0.006), as well as moderate depression (AOR = 3.048; p = 0.007). CONCLUSION: Our study found that Problematic Facebook and Video Game Use were prevalent among Tunisian adolescents. The co-occurrence of these disorders is strongly linked to male gender, problematic internet use, depression, and anxiety disorders. These findings underscore the urgency of implementing tailored and effective awareness and prevention programs to address these emerging challenges.

Weight excess among high-school students: Relation with mental health and sociodemographic factors.

INTRODUCTION: The escalating prevalence of adolescent obesity represents a complex public health challenge, influenced by interactions of environmental, socio-economic, and behavioral factors. Recent studies reveal a surge in addictive substance use among adolescents, with non-substance addictions. Overweight adolescents are particularly susceptible to risky behaviors. Tunisia is not exempt from this issue, facing a rapidly increasing prevalence. AIM: Our work aimed to assess the prevalence of obesity among adolescents and to explore the connections between sociodemographic factors, mental health, and overweight in this demographic group. METHODS: A cross-sectional study was led among sample of Tunisian high school adolescents from Sousse. We enrolled study participants through proportional stratified sampling. RESULTS: Our study included 1399students, predominantly female, with an average age of 17±1.5 years. The average BMI (Body Mass Index) was 22.7±4.1 kg/m². According to the International Obesity Task Force (IOTF), 20.4% were overweight, and 7% were obese, resulting in an overall weight excess prevalence of 27.4%. Girls exhibited a higher weight excess prevalence compared to boys. Multivariate analysis identified factors associated with overweight and obesity, including maternal self-employment(aOR=2.13,[1.35-3.35];p<0.001), regular physical activity (aOR=0.61,[0.47-0.8];p<0.001), internet usage ≥2 hours (aOR=0.70,[0.50-0.99];p=0.045), daily fruit-vegetable consumption (aOR=1.51,[1.15-1.97]; p=0.003), possible alexithymia (aOR=1.55,[1.07-2.22];p=0.018), probable anxiety (aOR=1.28,[0.87-1.89]; p=0.007), very probable anxiety (aOR=1.61,[1.14-2.2]; p=0.037), and problematic Facebook-use (aOR=0.67,[0.50-0.89]; p=0.006). CONCLUSION: Understanding factors tied to excess weight in our social and cultural context is crucial in shaping effective public health strategies. Interventions should adopt a multisectoral approach specifically targeting working mothers within the adolescent's socio-familial environment. It is fundamental also to address mental health concerns, with a particular focus on alexithymia and anxiety.

The incubation period during the pandemic of COVID-19: a systematic review and meta-analysis.

BACKGROUND: The aim of our study was to determine through a systematic review and meta-analysis the incubation period of COVID-19. It was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Criteria for eligibility were all published population-based primary literature in PubMed interface and the Science Direct, dealing with incubation period of COVID-19, written in English, since December 2019 to December 2020. We estimated the mean of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. RESULTS: This review included 42 studies done predominantly in China. The mean and median incubation period were of maximum 8 days and 12 days respectively. In various parametric models, the 95th percentiles were in the range 10.3-16 days. The highest 99th percentile would be as long as 20.4 days. Out of the 10 included studies in the meta-analysis, 8 were conducted in China, 1 in Singapore, and 1 in Argentina. The pooled mean incubation period was 6.2 (95% CI 5.4, 7.0) days. The heterogeneity (I2 77.1%; p < 0.001) was decreased when we included the study quality and the method of calculation used as moderator variables (I2 0%). The mean incubation period ranged from 5.2 (95% CI 4.4 to 5.9) to 6.65 days (95% CI 6.0 to 7.2). CONCLUSIONS: This work provides additional evidence of incubation period for COVID-19 and showed that it is prudent not to dismiss the possibility of incubation periods up to 14 days at this stage of the epidemic.

Impairment of left and right ventricular longitudinal strain in asymptomatic children with type 1 diabetes.

AIM: The relationship between type 1 diabetes (T1DM) and cardiac function in children is not well established. The purpose of this study was to investigate whether children and adolescents with T1DM present early asymptomatic abnormalities of left ventricular (LV) and right ventricular (RV) function. In addition, we evaluated the relationship of any such abnormalities with glycemic control and diabetes duration. METHODS: This was a prospective study. Standard echocardiography, tissue Doppler imaging, and two-dimensional strain analysis were performed prospectively in 52 children with T1DM. The results were compared with those from 52 healthy children matched for age and sex. RESULTS: There were no significant differences between the two groups in LV ejection fraction or RV systolic function. There was a difference between the two study groups in transtricuspid flow: the E-wave and A-wave velocities were significantly higher in the diabetic group. Left ventricular global longitudinal strain (LV GLS) was significantly lower in children with T1DM (-20.01 ± 1.86% vs. -22.99 ± 0.98%, respectively; P < .001), as was RV free-wall longitudinal strain (RV FWLS) (-29.13 ± 1.85% vs. -30.22 ± 1.53%, respectively; P = .002). LV GLS was correlated with diabetes duration (r = 0.444, P < .001) and glycated hemoglobin (HbA1c) (r = 0.683, P < .001); however, no correlation was found between RV FWLS and HbA1c or diabetes duration. CONCLUSIONS: Our findings suggest that LV GLS and RV FWLS are impaired in children with T1DM and that the decrease in LV GLS is correlated with diabetes duration and HbA1c levels.

Tobacco use: the main predictor of illicit substances use among young adolescents in Sousse, Tunisia.

Introduction Early adolescence is a critical period usually associated with experimentation with illicit substances. In Tunisia few studies explored these risk behaviors among young adolescents. Aims To evaluate the prevalence and the predictors of the use of illicit substances among the young adolescents of Sousse. Methods A cross-sectional study was conducted in the region of Sousse, Tunisia during the 2013/2014 school year among 4272 schoolchildren in 16 public middle schools. Data about psychosocial characteristics and risk behaviors among the schoolchildren, their parents, their siblings and their friends were collected anonymously using a self-administrated questionnaire. Results Females represented 50.5% of participants. The mean age of schoolchildren was 13.3 (±1.2) years. Lifetime illicit substances use prevalence was 2.9% [confidence interval (CI) 95%: (2.4%-3.4%)] and lifetime use of tobacco prevalence was 12.9% [CI 95%: (11.9%-13.9%)]. The age of tobacco onset was significantly younger to the age of experimentation with illicit substances. Insomnia, sadness and illicit substances use among peers were associated with illicit substances use among participants. While the most influential risk factor on illicit substances use was current cigarette smoking with an adjusted odds ratio (OR) of 7.2 [CI 95%: (4.5-11.2)]. Conclusion A national substances use prevention program should be implemented in the schools of Tunisia with an emphasis on tobacco use prevention.

Clustering of chronic diseases risk factors among adolescents: a quasi-experimental study in Sousse, Tunisia.

Background The objective of the study was to evaluate the effectiveness of a school-based physical activity and nutritional behavior intervention, on the reduction of clustering of chronic diseases risk factors among school children. Materials and methods A quasi-experimental school-based intervention was conducted with an intervention group and a control group in the region of Sousse in Tunisia. The intervention was implemented between 2010 and 2013, with data collected at pre and at post intervention. Studied risk factors were: smoking, sedentary behavior, low fruit and vegetable intake and obesity. Odds ratios (ORs) were used to calculate the clustering of two risk factors. We calculated ORs in each group before and after the intervention. Results In the intervention group, the prevalence of adolescents that had no risk factors has significantly increased (p = 0.004). In the control group the prevalence of adolescents carrying two or more risk factors has increased (p = 0.06). The results showed that all risk factors tended to cluster together in both groups. In the intervention group, the calculated OR for smoking and sedentary behavior decreased after assessment (OR = 5.93) as well as the OR for smoking and low fruit and vegetable intake (OR = 3.26). In the control group, all ORs increased, showing an enhancement of the association. Conclusion This study showed the effectiveness of a school-based intervention in reducing the clustering of chronic diseases risk factors.

Long term effect of a school based intervention to prevent chronic diseases in Tunisia, 2009-2015.

BACKGROUND & OBJECTIVES: We aimed to evaluate the long term effect of school based intervention to prevent non- communicable disease risk factors. METHODS: It was a quasi experimental study conducted during the period of 2009-2015. We involved school children aged from 11 to 16 years old. For the assessment of the program's effectiveness, subjects in both groups were examined at baseline, at the end of the 3-year intervention period and at the follow-up, one year after program's cessation. RESULTS: In the intervention group, the prevalence of school children who reported to be eating 5 fruits and vegetable sdaily increased significantly from 30.0% at pre-assessment to 33.2% at post-assessment, one year after (p=0.02, p=0.41 respectively). For the control group, this prevalence had significantly decreased from 40.2% at baseline to 35.0% at post-intervention, at the follow up, this proportion increased to 44.5%(p=0.001, p<10-3 respectively). Concerning smoking habits, we observed a decreasing trend in the intervention group from 5.7% at pre-assessment, to 4.8% at post-assessment and to 3.4% at the follow-up (p=0.19 and p=0.25 respectively). There was also a significant decrease in school children who did recommended physical activity in the same group. CONCLUSION: The present work showed that interventions promoting healthy lifestyles should be maintained. Developing countries should be encouraged and supported to design, conduct, and evaluate robust preventive interventions.

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014.

BACKGROUND: Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. OBJECTIVE: To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. METHODS: We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. RESULTS: The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. CONCLUSION: This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia.

No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in North African countries. We aimed to estimate the prevalence of the metabolic syndrome in Tunisian adolescents. A representative sample of 1569 adolescents was enrolled. The prevalence of the metabolic syndrome was 0.4% with no statistical difference according to sex (p > 0.05). Overweight/obesity was the most common component of the metabolic syndrome (13.7%). This information will be used to develop prevention programs by promoting healthy lifestyles in schools.