Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey.

Background: Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults. Methodology: This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)]. Results: Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS. Conclusion: The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.

Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia.

INTRODUCTION: The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. METHODS: This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). RESULTS: In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). CONCLUSIONS: Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.

Effectiveness of a training program on health-care professionals' knowledge and practices regarding thermo-sensitive reusable medical devices disinfection: A quasi-experimental study.

INTRODUCTION: Appropriate knowledge of healthcare professionals (HCPs) on the various aspects of disinfection and reuse of medical devices is a basic requirement to ensure proper disinfection and to minimize the risk of healthcare associated infections. In this regard this study aimed to assess the effectiveness of a training intervention on knowledge and practices regarding thermosensitive reusable medical devices (TRMD) disinfection among HCPs. METHODS: This was a quasi-experimental study including a pre-test, an intervention (workshops, demonstrations, posters), and a post-test evaluation of the HCPs' knowledge and practices regarding the disinfection of TRMD. It was conducted between February and July 2022 at Hedi Chaker University hospital, Sfax, Southern Tunisia. RESULTS: Overall, 31 participants were females (54.4%). The global Knowledge Score (KS) had significantly risen from pre-to post-training test (61.0 ± 9 vs 74.0 ± 12.5; p < 0.001). According to the disinfection type, the KS of non-critical and critical TRMD disinfection had significantly increased between pre and post-intervention (60 (IQR = [40.0-80.0]) vs 80 (IQR = [40.0-80.0]), p < 0.001) and (66.6 (IQR = [50.0-66.6]) vs 83.3 (IQR = [66.6-100.0]); p < 0.001) respectively. The mean change in global KS of TRMD disinfection was statistically higher among females (17.5 ± 11.2 vs 8.5 ± 3.2; p = 0.006) and medical staff (18.9 ± 11.9 vs 7.1 ± 3.9; p = 0.019). Conformity scores did not significantly change after the training program (58.1 ± 22.7 vs 63.7 ± 19.6; p = 0.678). CONCLUSION: This study highlighted the effectiveness of the training intervention on HCP knowledge. However, practices were not improved. Conducting ongoing audits with on-the-job training is extremely needed.

Low back-pain among school-teachers in Southern Tunisia: prevalence and predictors.

OBJECTIVES: In the professional environment, low back pain (LBP) is a multifactorial symptomatology, despite scientific and technological advances in the design and the arrangement of increasingly ergonomic workstations. Teachers are not exempt from this risk, due to prolonged sitting or standing. In light of this, this study aimed to estimate LBP prevalence among teachers in Southern Tunisia and to identify their determinants. METHODS: It was a cross-sectional study including a representative sample of teachers from secondary, middle, and primary schools in Sfax, Tunisia, conducted during the period March-April 2021. LBP intensity was assessed using a visual analog scale from 1 to 10. A severe LBP was defined as VAS≥7. RESULTS: Among the participants, 292 teachers were females (55.6 %). The median age was 48 years (Interquartile Range (IQR)=[41-53] years). Overall, 377 teachers had a severe LBP, with a global prevalence of 71.8 %. Multivariate analysis showed that independent determinants of LBP among teachers were female gender (Adjusted Odds Ratio (AOR)=2.81;p<0.001), age ≥30 (AOR=5.68;p=0.009), chronic diseases (AOR=2.52;p<0.001), working at primary schools (AOR=1.75;p=0.033), working for ≥4 h per day (AOR=2.41;p=0.005), inadequate ergonomic conditions at work (AOR=1.78;p=0.008) and distance home-school ≥10 km (AOR=2.27;p=0.003). CONCLUSIONS: This study demonstrated that LBP among teachers was alarmingly high. Different individual, ergonomic, and occupational factors were predictors of this symptom. Thus, development of rational strategies for LBP prevention among teachers and the improvement of working conditions are urgently needed.

COVID-19-Related Fear and Mental Distress Among Tunisian Primary, Middle and High School Teachers: Prevalence and Predictive Factors.

This study aimed to determine the prevalence and predictive factors of fear of COVID-19 and serious mental distress among teachers in public schools of Southern Tunisia. This was a cross sectional study among a representative sample of 525 teachers. The level of Fear was assessed using the Fear of COVID-19 Scale (FCV-19S). A high level was defined as an FCV-19S ≥ 22. Kessler 6 (K6) was performed to predict serious mental distress. Serious mental distress was defined as a K6 score ≥ 13. The prevalence rates of high level of fear of COVID-19 and serious mental distress were 32.8% and 63.8%, respectively. Independent factors associated with a high level of fear of COVID-19 were female gender (Adjusted odds ratio (AOR)=1.6 [1.1-2.5]), chronic disease (AOR=1.6 [1.1-2.4]), home-living children (AOR=3.3 [1.4-7.8]), and poor material working conditions (AOR=1.5 [1.2-2.1]). The high level of fear of COVID-19 (AOR=3.1 [1.8-5.1]) was independently associated with serious mental distress. Living in a rural area (AOR=0.4 [0.3-0.8]), previous COVID-19 infection (AOR=0.5 [0.4-0.8]) and going to school on foot (AOR=0.3 [0.2-0.51]) were independently associated with a lower prevalence of serious mental distress.

Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip.

OBJECTIVES/BACKGROUND: Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip. PATIENTS/METHODS: A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9. RESULTS: Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality. CONCLUSION: Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.

Effectiveness of a Training Intervention about Healthcare Waste Management on the Knowledge and Practical Skills of Healthcare Professionals in a Teaching Hospital of Southern Tunisia.

This quasi-experimental study aimed to assess the impact of a training program on knowledge and practical skills of healthcare professionals(HCPs) regarding healthcare waste(HCW) management in a Teaching Hospital in Southern Tunisia.The total mean knowledge score(KS) and practice score(PS) increased significantly on post training test as opposed to pre-training test with mean changes of 17.9 ± 10.1 and 26.9 ± 2.1, respectively.The mean PS did not significantly change from the first to the final follow-up measurement(p = 0.25).Three predictor factors were found to be independently associated with change in KS:age(ß=-0.16;p = 0.006),sanitary staff(ß = 0.116;p = 0.038) and administrative staff(ß = 0.122;p = 0.032).Training program could therefore be an effective intervention for improving knowledge and practices among HCPs.

Adverse effects of personnel protective equipment among first line COVID-19 healthcare professionals: A survey in Southern Tunisia.

BACKGROUND: Health care professionals (HCP) were obliged to wear personal protective equipment (PPE) during pandemic in order to minimize the risk of transmission of the emerging virus. The objective of the study was to estimate the prevalence of adverse effects related to the wear of PPE among HCP and to determinate their predictive factors. METHODS: This was a cross-sectional study including a representative sample of 300 randomized HCP at Hedi Chaker University Hospital Sfax, Tunisia, during the period August-September 2021. Data collection was carried out by an anonymous self-administered questionnaire. RESULTS: PPE related adverse effects were noted among 87 HCP with a prevalence of 57.2%. Multivariate analysis showed that factors independently associated with PPE adverse effects were female gender (Adjusted Odds Ratio (AOR) = 1.8; p = 0.048), chronic diseases (AOR = 0.29; p = 0.001) and previous infection with COVID-19 (AOR = 0.46; p = 0.004). Frequent use of bleach or other disinfection product without protection and use of hot water at work were independently associated with a high risk of adverse effects ((AOR = 2.22; p = 0.003) and (AOR = 2.83; p = 0.005), respectively). Similarly, a duration of use of PPE>4 h per day (AOR = 1.98; p = 0.039), as well as use of visors and/or glasses (AOR = 1.84; p = 0.045) were independently associated with PPE related adverse effects. CONCLUSION: The prevalence of adverse effects related to the wear of PPE was alarmingly high among HCP. Multiple risk factors were highlighted, notably professional aspects. Adequate and repetitive training for caregivers on the correct use of PPE remain essential to manage this problem.

Prevalence and Factors Affecting Willingness to Accept or Refuse Vaccination against COVID-19 among Healthcare Professionals in Southern Tunisia.

BACKGROUND: The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. Health care professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. This study aimed to estimate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors. Methods: This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of HCP in Southern Tunisia, on March-April 2021. Results: Among 300 participants, the COVID-19 vaccine acceptability rate was 65.3%. Factors independently associated with vaccine acceptability were age groups <30 years [Adjusted Odds Ratio (AOR)=4.36; p = 0.002)], urbanity of residence (AOR = 3.44; p = 0.027), medical professional category (AOR = 2.69; p = 0.023) and caring for coronavirus infected patients (AOR = 2.32; p = 0.047). Belief that COVID-19 vaccination is important to work safely as a health care provider (AOR = 3.26; p = 0.013), should be available for all HCP (AOR = 17.98; p = 0.004) and has been quickly developed before it has been thoroughly vetted and tested for efficacy and safety (AOR = 5.88; p < 0.01) were independently associated with willingness to accept vaccine. Planning to get a COVID-19 vaccine for the next years and recommending it to the family were independent predictive factors of accepting COVID-19 vaccine ((AOR = 6.88; p < 0.001) and (AOR = 25.03; p < 0.001), respectively).Conclusion: The acceptance rate of vaccination against COVID-19 among Tunisian HCP is still low in South Tunisian hospitals. Socio-demographic, cultural and professional factors predisposing to the vaccination willingness were highlighted. Combating the vaccine hesitancy of HCP through enhancing sensibilization campaigns is essential to promote vaccination in general population.

Epidemiological profile and performance of triage decision-making process of COVID-19 suspected cases in southern Tunisia.

INTRODUCTION: During an epidemic, screening processes can play a crucial role in limiting the spread of the infection. The aim of this study was to describe the epidemiological profile of COVID-19 suspected cases and to evaluate the performance of the triage process in predicting COVID-19 in Southern Tunisia. METHODS: It was a prospective study including all patients consulting to the Hedi Chaker University Hospital departments from March to June 2020. A clinical triage score (CTS) was used to assess the risk of the infection and to refer patients to the appropriate part of the facility accordingly. RESULTS: Overall, 862 patients were enrolled, among whom 505 patients (58.6%) were classified as suspected cases (CTS ≥4). Of these, 46.9% (n = 237) were of mild form. Samples were collected from 215 patients (24.9%), among whom five were COVID-19 positive, representing a positive rate of 2.3%. The in-hospital cumulative incidence rate of COVID-19 was 580/100000 patients. The total daily incidence decreased significantly during the study period (p < 0.001, chi-square for linear trend = 25.6). At a cut-off of four, the CTS had a sensitivity of 40%, a specificity of 32.4%, and negative and positive predictive values of 95.8% and 1.4%, respectively. DISCUSSION: Although the triage process based on the CTS was not as performant as the RT-PCR, it was crucial to interrupt virus spread among hospitalized patients in "COVID-19-free departments".

Point prevalence survey of health-care associated infections and their risk factors in the tertiary-care referral hospitals of Southern Tunisia.

BACKGROUND: Health-care associated infections (HAI) are considered a public health problem and have substantial effect on mortality and morbidity. This study aimed to determine the prevalence of HAI in South Tunisian University Hospitals (UH) and to identify their risk factors. METHODS: We performed a point prevalence study, in the UH of Southern Tunisia in February 2019, including all hospitalized patients for at least 48 hours. RESULTS: Overall, 898 patients were included in this survey, among whom 480 participants (53.5%) were males. There were 81 HAIs, accounting for a prevalence of HAI of 9.02%. Urinary tract infections (28.4%) were the most common HAI, followed by respiratory tract infections (22.2%). The main identified microorganisms among HAI patients were Klebsiella pneumonia (22.7%) and Escherichia coli (20.7%). Independent intrinsic risk factors of high prevalence of HAI were diabetes (Adjusted Odds Ratio (AOR)=3.5;p=0.016) having a rapidly fatal disease (AOR=4;p=0.024) and an ASA scores ≥2 (AOR=2.8;p=0.045). As for extrinsic risk factors, admission in ICU (AOR=11.1;p= 0.04), a length of hospital stay ≥ 7 days (AOR=4.1;p=0.04), previous hospitalization within 90 days prior to the admission (AOR=4.2;p=0.01) and having a peripheral vascular catheter (AOR=6.7; p=0.039) were independently associated with higher prevalence of HAI. Lower prevalence of HAI was independently associated with prescription of antimicrobial preoperative prophylaxis (AOR= 0.1; p=0.02). CONCLUSION: Our findings illustrated high prevalence of HAI in South Tunisian Hospitals, affecting principally fragilized patients who may require special needs. Therefore, promoting hygiene programs for health professionals to establish patient safety's culture is urgently needed.