Radon as a natural tracer for gas transport within uranium waste rock piles.

Acid mine drainage (AMD) has been identified as the main cause for outflow of acid water and radioactive/non-radioactive contaminants. AMD encompasses pyrites oxidation when water and oxygen are available. AMD was identified in uranium waste rock piles (WRPs) of Indústrias Nucleares do Brasil-Caldas facility (Brazilian uranium mine), resulting in high costs for water treatment. AMD reduction is the main challenge, and scientific investigation has been conducted to understand oxygen and water transportation within WRPs, where 222Rn is used as natural tracer for oxygen transportation. The study consists of soil radon gas mapping in the top layer of WRP4 using active soil gas pumping, radon adsorption in active charcoal and 222Rn determination using high-resolution gamma-ray spectrometry. A sampling network of 71 points was built where samples were collected at a depth of 40 cm. Soil radon gas concentration ranged from 33.7 to 1484.2 kBq m(-3) with mean concentration of 320.7±263.3 kBq m(-3).

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

AIMS: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. METHODS: We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. RESULTS: ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. CONCLUSIONS: Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).

The global diabetes pandemic: the Tunisian experience.

OBJECTIVE: The prevalence of diabetes mellitus is known to be increasing rapidly worldwide, but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in Tunisia, to compare the prevalence to previous studies and to analyse the relationship between diabetes and age, sex, area of residency and body mass index (BMI). SUBJECTS AND SETTING: We have used data from the Tunisian National Nutrition Survey, a cross-sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults. We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus and IFG. RESULTS: The overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women) giving age-adjusted prevalence of diabetes of 8.5% (7.3% in men and 9.6% in women). Step-wise logistic regression showed age of more than 40 years, urban residency and high BMI to each be significantly and independently related to diabetes prevalence. The prevalence of diabetes mellitus has more than doubled in Tunisia over a 15-year period. CONCLUSIONS: Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas with an increased prevalence compared to previous studies. The results underline the need to increase public awareness and to emphasize the benefit of lifestyle modification in order to prevent type II diabetes.

Prevalence of metabolic abnormalities in the Tunisian adults: a population based study.

AIMS: To estimate the prevalence of individual metabolic abnormalities and the cluster of metabolic abnormalities in a representative sample of the Tunisian adult population and to identify their relationship with gender, age and residency. The definition used is an adaptation of the NCEP ATP III definition, using total cholesterol>or=5.2 mmol/l instead of HDL-cholesterol. MATERIALS AND METHODS: We used a sample of the Tunisian National Nutrition Survey (TNNS), a cross-sectional health survey conducted in 1996, to estimate the nutritional status of the population. The TNNS included 2 927 adults aged 20 years or older who had measurements of height, body weight, waist circumference, blood pressure, fasting plasma glucose, total cholesterol and triglycerides. The cluster of metabolic abnormalities was defined as the presence of three or more metabolic abnormalities. RESULTS: The prevalence of abdominal obesity, hypertriglyceridemia, high total cholesterol, high blood pressure and high fasting plasma glucose was, respectively, 9%, 23%, 24%, 45% and 15% in men and 33%, 19%, 29%, 44% and 15% in women. The prevalence of the cluster was more frequent in women than in men (18% versus 13%, P<0.001) and in those living in urban communities (21% in women, 16% in men) rather than rural communities (11% in women, 8% in men) (P<0.001). The prevalence also increased significantly with age (P<0.001). CONCLUSION: The cluster of metabolic abnormalities and its components are common in the Tunisian adult population and prevalence increases significantly with female sex, urban residency and age.

The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria.

AIMS: To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. METHODS: The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. RESULTS: The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. CONCLUSION: The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.

Disease-specific medical records improve the recording of processes of care in the management of type 2 diabetes mellitus.

A retrospective review of the medical records of 961 patients with type 2 diabetes managed in primary care in Tunisia was undertaken. Recording of process of care measurements improved from 65 to 84% for blood pressure, from 60 to 71% for fasting glucose, and from 11 to 53% for weight measurement (P<0.001 for all). The introduction of disease-specific medical records significantly improves the recording of care of patients with type 2 diabetes mellitus.

Clinical and metabolic characteristics of newly diagnosed diabetes patients: experience of a university hospital in Tunis.

PURPOSE: The aim of our retrospective study was to explore the clinical and metabolic characteristics of newly diagnosed diabetes patients over the age of 30 years. METHODS: Study participants were consecutive, newly diagnosed patients with diabetes, over the age of 30 years, presenting to our university hospital department between January 1999 and June 2003. Clinical and metabolic data were collected retrospectively by medical record review. RESULTS: Three hundred seventy patients were included; mean age was 54.1+/-14.0 years; 49% were women and a family history of diabetes was reported in 52% of patients. Patients presented with acute complications in 40% of cases. Symptoms of polyuria-polydipsia and weight loss were present at diagnosis in 87% and 76% of cases respectively. 58% of our patients were obese or overweight (BMI> or =25 kg/m(2)), hypertension was present in 22%, hypertriglyceridemia in 27% and high LDL cholesterol in 27%. Neuropathy was diagnosed in 24%, nephropathy in 13%, coronary heart disease in 9%, retinopathy in 8% of cases, stroke in 3% and peripheral arterial disease in 2%. Insulin was prescribed initially in 47% of cases. CONCLUSIONS: Our results demonstrate that clinical symptoms and acute ketosis are the most common presenting features of diabetes mellitus in adults at the hospital level. Associated chronic complications are frequent.

Variations in care of diabetes in primary care centres in Tunis.

The aim of this study was to investigate the care of diabetes in primary care in the public sector in Greater Tunis and in particular, to assess variations in care across centres with the intention of seeking explanations for any differences identified. We undertook a retrospective medical review of patients with diabetes from four primary care health centres. Data were collected concerning patient characteristics, process of care criteria, outcome of care criteria, attendance rates, treatment and health centre characteristics. The total sample size was 235 patients. Outcome of care criteria were found to be similar across each of the centres. Process of care criteria were found to be significantly varied between the centres for all measurements used. Variations were also found in treatment and attendance rates across the health centres. In conclusion, there is a significant variation in the management of diabetes in primary care across centres within Greater Tunis, despite the use of standardised, national guidelines. A number of factors related to the centres may have given rise to these variations.

Quality of care of patients with type 2 diabetes in a Tunisian university hospital.

OBJECTIVES: The aim of this retrospective study was to explore the quality of ambulatory management provided to patients with type 2 diabetes. METHODS: Five hundred ninety-three patients with type 2 diabetes attended our outpatient department in 2002. Clinical and biological data were collected from the medical records of these patients. RESULTS: The mean age was 61.7 +/- 10.5 years; 60.5% were women and known duration of diabetes was 11.8 +/- 7.5 years. Eighty-five percent of patients had 2 or more visits and 58% were on insulin. Glycaemic control was assessed using fasting blood glucose in 97.3%, post-prandial blood glucose in 28.3% and glycated haemoglobin in 50.6% of cases. HbA1c was over 8% in 60.7% of patients. Weight was measured at least once in 86.5% of cases, blood pressure in 91.2% and lipids levels estimated in 58%. BMI was less than 25 kg/m2 in 16.2% of patients and blood pressure less than 140/90 mmHg in 40.1% of cases. Foot examination was recorded only in 5% of patients, ECG was performed in 23.8% of cases and fundoscopy in 19.2% of patients. Proteinuria was documented in 19.1% of cases and renal function assessed in 54.4% of patients. CONCLUSIONS: These findings suggest that the management of type 2 diabetes is still inadequately performed in our centre and more progress is needed to prevent micro and macrovascular complications.