Economic burden of lung cancer in Morocco: A cost of illness study.

INTRODUCTION: Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco MATERIALS AND METHODS: A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months. RESULTS: The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations. The average direct medical cost was 4455.3 USD (95 % CI: 4037.4-4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %. The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001). CONCLUSION: These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.

Cross-cultural adaptation and validation of the Moroccan version of the Glaucoma Quality of Life-15 (GQL-15) questionnaire in patients with glaucoma.

BACKGROUND: Glaucoma is the second leading cause of blindness in the world. In addition, visual impairment and psychological strain have been shown to have a significant impact on quality of life (QoL) in glaucoma patients. Maintaining the quality of life of glaucoma patients has become an important component of treatment. The goal of this study is to develop a Moroccan Arabic dialect version of the Glaucoma Quality of Life-15 questionnaire and to examine its psychometric properties. METHODS: The Glaucoma Quality of Life-15 questionnaire was translated and cross-culturally adapted into Moroccan Arabic dialect and administered to glaucoma patients recruited from the ophthalmology department of the Omar Drissi Hospital, Hassan II University Hospital, Fez. Sociodemographic and other clinical data were collected. Psychometric properties were performed, including internal consistency, which was tested using Cronbach's alpha (α), test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining the convergent and divergent validity of items. RESULTS: The questionnaire was administered to 148 patients with a mean age of 60.91 ± 15.10 years. Over half of the patients were female (58.1%), patients were married (77.7%), illiterate (62.2%) and unemployed (82.3%). The majority of patients had primary open angle glaucoma (68.9%). The mean time to complete the GQL-15 was 3.26±0.51min. The mean summary score for the GQL-15 was 39.50±16.76. Cronbach's alpha for the entire scale was 0.95 (central and near vision 0.58; peripheral vision 0.94; glare and dark adaptation 0.87). CONCLUSION: The Moroccan Arabic dialect version of the GQL-15 demonstrates adequate reliability and validity. Therefore, this version could be used as a reliable and valid tool for quality-of-life assessment in Moroccan glaucoma patients.

Cultural Adaptation and Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in Moroccan Arabic dialect.

BACKGROUND: The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. OBJECTIVE: The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. STUDY DESIGN: Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. RESULT: The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. CONCLUSION: Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

[The perception of liaison psychiatry by the medico-chirurgical services]. / La perception de la psychiatrie de liaison par les services médico-chirurgicaux, Fès, Maroc.

INTRODUCTION: Research addressing the perception of liaison psychiatry by caregivers is still limited in Morocco. Collaboration between practitioners in liaison psychiatry is necessary, and the perception of physicians influences their implications in liaison psychiatry. OBJECTIVES: To evaluate the perception of this activity among the various medical and surgical units, determine the involvement, level of collaboration and expectations of practitioners, as well as the difficulties and constraints encountered. METHODOLOGY: A survey was carried out among medical personnel at the Hassan II University Hospital Centre in Fez in 2016, through a self-questionnaire determining the perception and position of carers with regard to liaison psychiatry. The data are collected using an anonymous self-administered questionnaire, consisting of 27 items. We included in this study a targeted population: interns, residents and professors. RESULTS: The total population of caregivers participating in this survey was 615 physicians, including 111 professors, 436 residents, and 68 interns. The participation rate was 80.32%. The average age was 30.25 years, with 47.6% (236) women and 52.4% (258) men. The percentage of doctors who obtained their doctorates in medicine in Morocco was 89.3% (85.9% at the Faculty of Medicine in Fez) and 92.3% had received a unique internship in the psychiatry department during their university studies, while 98.7% never received any continuing training in the field of psychiatry. Half of responding physicians reported difficulties in managing psychiatric disorders diagnostically, and 59.5% (292) reported difficulties in treating patients with psychiatric disorders, while 90% (444) reported that they are unable to provide therapeutic follow-up. Only 35.6% of the doctors surveyed were informed about the establishment of liaison psychiatry, but only 10% of these doctors were informed about the procedure for requesting a psychiatric opinion. Faced with a psychiatric disorder, 98% of doctors managed the situation by seeking psychiatric advice, 87.1% considered this request urgent. The reasons for not soliciting q psychiatrist were divided between difficulties in identifying a psychiatric disorder (51%) and difficulties in requesting an opinion (49%). CONCLUSION: Our study showed several difficulties perceived by practitioners, whether in the diagnosis, treatment or follow-up of patients with psychiatric manifestations. Collaboration between different practitioners is an indispensable element of patient management. Improving knowledge through awareness-raising and the organization of scientific days bringing together the different specialties will help to improve doctors' perceptions.

Frequency, types and determinants of degenerative complications of type 2 diabetes in Morocco: "EpiDiaM" cohort inclusion data.

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. The mean 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 with complications, 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.

[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.

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.

[Epidemiological and pathological features of cancer in Fez Boulemane region, Morocco]. / Aspects épidémiologiques et anatomopathologiques des cancers dans la région de Fès-Boulemane (Maroc).

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fes from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast (62%) and uterine cervix (22.6%) predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended.

Epidemiological and pathological features of cancer in Fez Boulemane region, Morocco

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fez from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast [62%] and uterine cervix [22.6%] predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended

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.

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.

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

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.

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

[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.

Association of the ENPP1 K121Q polymorphism with type 2 diabetes and obesity in the Moroccan population.

AIM: The ectonucleotide pyrophosphatase/phosphodiesterase 1 enzyme (ENPP1), which downregulates insulin signaling by inhibiting insulin-receptor tyrosine kinase activity, is encoded by the ENPP1 gene. A common functional ENPP1 K121Q polymorphism has been suggested to contribute to insulin resistance, obesity and type 2 diabetes (T2D) in various ethnic groups. For this reason, we assessed the association between the ENPP1 K121Q polymorphism in T2D and obesity phenotypes in the Moroccan population. METHODS: Using LightCycler((R)) technology, we genotyped the ENPP1 K121Q polymorphism in 503 subjects with T2D and 412 normoglycaemic individuals. RESULTS: There was no evidence of an association between ENPP1 K121Q and T2D in either an additive (P=0.99) or recessive mode of inheritance (P=0.47). However, the Q121 variant was significantly more frequent in obese than in non-obese subjects after adjusting for age, gender and T2D status. We observed genetic heterogeneity between obese and non-obese T2D patients (P=0.02). The K121Q polymorphism was associated with T2D in the presence of obesity in both additive (1.55 [95% CI 1.16-2.07]; P=0.003) and recessive (2.31 [95% CI 1.34-3.97]; P=0.002) modes of inheritance. CONCLUSION: Although there was no evidence of an association between the ENPP1 K121Q variant and the general phenotype of T2D, we did find an association with adult obesity and T2D. The Q121 allele frequency in Morocco is 37.3%, placing it between European Caucasians (15%) and Black Africans (79%). This study is the first to report an association between K121Q and metabolic diseases in the Moroccan population.

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.

[Diabetes and erectile dysfunction in Morocco: epidemiological study among outpatients]. / Diabète et dysfonction erectile au Maroc : etude epidémiologique auprès d'une population de consultants.

We studied the relationship between erectile dysfunction (ED) and diabetes among 189 men (> 40 years) attending primary health care centres in Morocco. Of the 89 diabetic men, 82% had ED while only 17% of the 100 non-diabetic men had ED. The frequency of ED among diabetic men increased with age, from 60% in those aged 40-49 years to 94.95% in those aged > or = 60 years (from 6.3% to 35.4% in men without diabetes for similar ages). ED was reported by 93.3% of diabetic men who had had diabetes for > 15 years. The frequency of ED did not differ with type of diabetes but it was significantly commoner in diabetic men with a low level of education and with hypertension.

[Diabetes and erectile dysfunction in Morocco: epidemiological study among outpatients]

We studied the relationship between erectile dysfunction [ED] and diabetes among 189 men [> 40 years] attending primary health care centres in Morocco. Of the 89 diabetic men, 82% had ED while only 17% of the 100 non-diabetic men had ED. The frequency of ED among diabetic men increased with age, from 60% in those aged 40-49 years to 94.95% in those aged >/= 60 years [from 6.3% to 35.4% in men without diabetes for similar ages]. ED was reported by 93.3% of diabetic men who had had diabetes for > 15 years. The frequency of ED did not differ with type of diabetes but it was significantly commoner in diabetic men with a low level of education and with hypertension