Insights on the effect of process conditions on the optical properties of silver ion exchanged soda-lime silicate glass.

The effects of ion exchange time and temperature on the optical properties and plasmonic response of silver ion exchanged soda-lime silicate glass were investigated using scanning electron microscopy (SEM) in energy dispersive spectrometry (EDS) configuration, m-lines spectroscopy, photoluminescence (PL) spectroscopy, and UV-visible absorption spectroscopy. SEM analyses in EDS mode provided profiles of silver oxide molar concentration. These profiles were directly correlated to the silver diffusion coefficient using an adjustment procedure. The effective indices of ion exchanged glasses measured by the standard prism coupling technique (m-lines) allowed access to refractive index distributions in ion exchange regions. These ion-exchanged glasses underwent evaluation to determine their potential suitability for use in multimode planar systems. The PL results acquired after ion exchange demonstrated that the creation of Ag0atoms from Ag+ions was responsible for the decline and quenching of PL intensity at ion exchange times and temperatures increase. Silver nanoparticles were generated in the samples subjected to ion exchange at 480 °C without the need for post-exchange treatments. The emergence of the surface plasmon resonance band around 427 nm in the optical absorption spectra confirmed the formation of Ag nanoparticles in annealed glasses. Estimates of the UV-visible absorption spectra indicated an average size of silver nanoparticles ranging from 1.8 to 2.4 nm.

Evaluation of the immune response of dogs after a mass vaccination campaign against rabies in Tunisia.

BACKGROUND: Rabies (RABV) is an enzootic disease in Tunisia, with dogs being the primary reservoir. Vaccinating dogs is the key to eradicate rabies. Regional Veterinary Services conduct nationwide immunisation campaigns on an annual basis. Evaluation of the immune response is still important to make sure that the vaccination is effective in the conditions of the Tunisian field. In this paper, the FAVN technique was used to test rabies antibody dynamics in dogs from three distinct Tunisian areas observed for one year following a mass vaccination campaign. RESULTS: On day 30 after vaccination, 75% of all dogs vaccinated during the campaign were sero-positive (titres greater than or equal to 0.5 transformed IU/ml). On day 180, 48% of all dogs were sero-positive. Only 25.6% of primary-vaccinated dogs remained sero-positive on day 180 and 7% on day 365, whereas 91% of previously sero-positive dogs remained sero-positive on day 365. CONCLUSIONS: Although a single rabies vaccine is successful at stimulating an immunological response, it is recommended that primary-vaccinated dogs have a second booster between one and three months after the initial vaccination to maintain seropositivity. To achieve the rabies eradication objective, all dogs should receive an annual booster to maintain effective immunological protection.

Synthesis and luminescence spectroscopy study of a novel orange-red colour emissions phosphor based on Tb3+ ion-doped Na2 ZnP2 O7.

Here, we report the synthesis and study of new orange-red (OR) colour-emitting phosphors Na2 ZnP2 O7 :xTb3+ (x = 1, 1.25, 1.5, and 1.75 mol%) using a conventional solid-state reaction. The sample crystallographic structures and their room temperature photoluminescence properties were measured using X-ray powder diffraction, excitation and emission spectra, as well as emission decay curves. X-ray diffraction analysis showed an isostructural tetragonal structure for all the doped materials with no impurities. Several colour emissions corresponding to 5 D4 →7 F6 (blue), 5 D4 →7 F5 (green), 5 D4 →7 F4 (orange) and 5 D4 →7 F3,2,0 (red) intraconfigurational transitions were observed and investigated. These colours were dominated by the OR colours. 5 D4 energy level lifetime was independent of Tb3+ concentration. Various radiative and luminescence parameters, such as experimental branching ratio, radiative decay rate, and luminescence quantum efficiencies, were calculated and discussed. Chromaticity diagram calculations illustrated an orange emission for all the studied materials.

Family medicine in the service of internal security: morbidity and cost of prescriptions.

BACKGROUND: The study of morbidity and cost of drug prescriptions generated by the primary care physician, with specific populations directs Quality Improvement strategies of care. AIM: To identify acute pathologies in primary care medicine forces for internal security and to study the cost of drug prescription . METHODS: This is a cross-sectional survey during which, we analyzed the medical records (MR) and medical prescriptions (MP)for patients older than 5 years, presenting for acute pathologies, at the first online consultation polyclinic of the internal security forces(ISF) of Mahdia, during the year 2014. Data were collected using a standardized form. We opted for a two-stage sampling the first agreement by taking the second month of each season, the second systematic taking MR from one day to two. RESULTS: We analyzed 701 MR. The average age of the consultants was 37 years with a sex ratio de1,34. Systems, respiratory, digestive, musculoskeletal, skin and cardiovascular, were accumulating 88.3% of acute morbidity diagnosed. The most prescribed therapeutic classes were antipyretics / analgesics (61.6%), antibiotics (42.7%), local treatments oto-rhino-laryngological and throat (28.6%), cough (13.6%), the non steroidal anti inflammatory (12.2%) and mucolytics (11.7%). The median cost of the prescription was 12.070 Tunisian Dinar (TD). The contribution of the patients served at the polyclinic of the FIS of Mahdia, in drug costs, was 35.1%. CONCLUSION: we were able to highlight the specificities of morbidity in the front line at the polyclinic of the FSI of Mahdia , the nature and cost of drug prescription that was equivalent to that of the general population but with better contribution third party payers.

Hospital cost of invasive pneumococcal disease in children aged under 15 years old in Tunisia.

BACKGROUND: Pneumococcal infections are an important cause of morbidity and mortality in the world and in Tunisia. Data on the economic burden of these infections are needed to inform decision-making to include pneumococcal vaccinations in routine childhood immunization. AIMS: This study aimed to estimate the medical cost of hospitalizations due to invasive pneumococcal disease (pneumonia and meningitis) among children aged under 15 years old in Tunisia. METHODS: A prospective multicentre study was conducted in 15 paediatric departments, across different socio-economic areas of Tunisia, from June 2014 to May 2015. All children aged under 15 years old who were hospitalized for pneumococcal pneumonia or confirmed bacterial meningitis were enrolled. A case report form was completed for every eligible case. Activity Based Costing method was used to estimate the hospital cost. Data entry and statistical analysis were conducted using SPSS, version 20.0. RESULTS: During the study period, 727 children were hospitalized for pneumococcal pneumonia and 60 children were hospitalized for bacterial meningitis, among them 21(35%) had confirmed pneumococcal meningitis. The median hospital cost for pneumococcal pneumonia was 353.910 Tunisian Dinars (TND) and TND 1680.632 for pneumococcal meningitis. Using overall data extrapolation, it was estimated that nearly 1091 hospitalizations for pneumococcal pneumonia and 69 hospitalizations for pneumococcal meningitis occurred each year in Tunisian children aged under 15 years of age, incurring total costs of TND 502 079.408. CONCLUSION: The economic burden of pneumococcal infections seems to be substantial in Tunisia. The estimated costs does not reflect the real costs of this infection. Cost-effectiveness studies would be helpful to inform policy-makers to take appropriate decisions.

Hospitalizations for communicable diseases in a developing country: prevalence and trends-Monastir, Tunisia, 2002-2013.

BACKGROUND: In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013). METHODS: All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS: HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. CONCLUSION: This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.

Rheumatic heart disease in a developing country: Incidence and trend (Monastir; Tunisia: 2000-2013).

BACKGROUND: The penicillin therapy of ß hemolytic streptococcal pharyngitis has aided in the decrease of rheumatic heart disease (RHD) in developing countries. Tunisia is an endemic area, however, and incidence of RHD is weakly documented. We aimed at establishing the standardized incidence rate (SIR) of RHD in Monastir governorate and at determining RHD prevalence among hospitalized patients in two cardiology departments. METHODS: From the regional register of Monastir Hospital morbidity, we have selected newly diagnosed patients with RHD, residents of Monastir, and hospitalized to the 2 cardiology departments between 2000 and 2013 (2001 not included). FINDINGS: We studied 676 newly admitted patients. We estimate 1060 to be the number of new annual RHD cases in Tunisia. The SIR per 105 person-years was 10.97, being 9.3 in men and 19.1 in women, respectively. We have notified a negative trend of crude incidence rate/105 Inhabitants (Inh) (CIR) (r=-0.23, p<10-3), and a strong positive correlation between age and CIR/105 Inh (r=0.989, p<10-4). RHD lethality was 1%. We have registered 728 hospitalizations for RHD, representing 2.5% of all cardiology hospitalizations [95% CI: 2.3-2.7%], with a prevalence for 13.3% for women aged 15-29years. The median hospital stay was 9days (IQR: 5-15). CONCLUSION: Our results confirm the RHD incidence decrease, consistent with epidemiological transition in Tunisia. We have also emphasized on the close trend of RHD with age and the predominance of RHD among women especially at the procreation age.

Psychometric Examination of an Arabic Version of the State-Trait Anger Expression Inventory.

OBJECTIVES: This study aimed to examine the psychometric properties of an Arabic version of the trait anger and anger expression scales of the State-Trait Anger Expression Inventory (STAXI). METHODS: This study took place between April 2005 and August 2014. Adults in Yemen (n = 334) and Tunisia (n = 200) were recruited from university campuses and a smoking cessation clinic, respectively. The STAXI was translated into Arabic using back-translation methods. An explanatory principal component analysis was conducted to explore the factor structure of the anger expression scale, utilising parallel analyses to determine the number of retained factors. RESULTS: Good internal consistency of the trait anger scale was observed among the Yemeni (Cronbach's alpha = 0.76) and Tunisian (Cronbach's alpha = 0.86) samples. The parallel analysis suggested a three-factor solution for the anger expression scale (anger in, anger out and anger control), in accordance with the original STAXI. The internal consistency of anger in, anger out and anger control factors ranged between 0.51-0.79 in the Yemeni sample and 0.66-0.81 in the Tunisian sample. Overall, items loaded on the anger control factor included all items proposed by the original authors and this factor had higher reliability than the other two factors in both samples. CONCLUSION: The results of the current study provide initial support for the use of the trait anger and anger expression scales of the STAXI in Arabic-speaking countries.

Acute coronary syndrome among patients with chest pain: Prevalence, incidence and risk factors.

BACKGROUND: Urbanization and adoption of new diet and lifestyles had increased the cardiovascular risk factor (CVRF) rate and therefore, acute coronary syndrome (ACS) in developing countries such as Tunisia. We aimed at determining ACS prevalence among a sample of Tunisian patients with chest pain, at establishing the standardized incidence rate (SIR) of ACS, and at quantifying the relationship between ASC and CVRF in this population. METHODS: We studied 3158 patients admitted to a chest pain unit for non-traumatic chest pain collected in Emergency Data from January 2012 to December 2014. For all patients, the data were collected using a standardized form. We performed univariate rather than multivariate logistic regression analyses to identify age and gender-related CVRF in ACS. Linear interpolation was used for curve estimation. RESULTS: 707 (22.3%) chest pain patients were classified as ACS. The age-SIR per 10(-5)personyear (PY) was 85.7; it was 112.6 in men and 45.3 in women. Eighty one percent of patient with ACS cumulated 2 CVRF and more. The highest odds ratio were 2.00 (95% CI 1.64-2.44) for diabetes and 1.81 (95% CI 1.50-2.18) for active smoking. ACS in elderly patients was significantly associated with active smoking (OR: 2.36), diabetes (OR: 1.72) and personal ACS history (OR: 1.71). We found a significant and very high linear relation between the number of CVRF and ACS odds ratio (R(2)=0.958). CONCLUSION: Our results showed that the incidence of ACS in a Tunisian population is not very different from what is observed in developed countries; with a close relation with CVRF especially diabetes and smoking.

The risk of acute coronary syndrome in Ramadan.

BACKGROUND: Data on the effect of fasting on coronary disease are rare and controversial. The aim of our study was to investigate the influence of Ramadan on the prevalence of acute coronary syndrome among chest pain patients in the emergency department of Monastir. METHODS: It was a prospective study, performed in the emergency department of Fattouma Bourguiba University Hospital of Monastir, during the 3 months before, during and after Ramadan from 2012 to 2014. We included all patients with non-traumatic chest pain during the study period. Data were collected using a standardized form. The uniformity chi 2 test, ANOVA test, Kruskal-Wallis test were performed at the 5% level. Binary logistic regression model was used for multivariate analysis. RESULTS: The SCA prevalence was 17% a month before Ramadan, 22% during Ramadan and 28% one month after Ramadan (p = 0.007). According to the results of the multivariate analysis, the period of Ramadan is not associated with increase of risk of SCA whereas the risk doubles after Ramadan in all group (p = 0.001). In subgroups analysis, the period of R was associated with an amplification of risk in men aged more than 55 years and women older than 65 years (OR: 2.1; p = 0.020) and among subjects with hypertension (OR: 2.4, p = 0.007). Ramadan and Shawwal were not associated with an increase of risk among subjects without CVX risk factor. CONCLUSION: We have demonstrated that the risk of SCA has increased in Ramadan only among the elderly and patient with hypertension. The increased risk in Shawwal can be explained by the lifting of dietary restriction.

The risk of acute coronary syndrome in Ramadan.

BACKGROUND: Data on the effect of fasting on coronary disease are rare and controversial. The aim of our study was to investigate the influence of Ramadan on the prevalence of acute coronary syndrome among chest pain patients in the emergency department of Monastir. METHODS: It was a prospective study, performed in the emergency department of Fattouma Bourguiba University Hospital of Monastir, during the 3 months before, during and after Ramadan from 2012 to 2014. We included all patients with non-traumatic chest pain during the study period. Data were collected using a standardized form. The uniformity chi 2 test, ANOVA test, Kruskal-Wallis test were performed at the 5% level. Binary logistic regression model was used for multivariate analysis. RESULTS: The SCA prevalence was 17% a month before Ramadan, 22% during Ramadan and 28% one month after Ramadan (p = 0.007). According to the results of the multivariate analysis, the period of Ramadan is not associated with increase of risk of SCA whereas the risk doubles after Ramadan in all group (p = 0.001). In subgroups analysis, the period of R was associated with an amplification of risk in men aged more than 55 years and women older than 65 years (OR: 2.1; p = 0.020) and among subjects with hypertension (OR: 2.4, p = 0.007). Ramadan and Shawwal were not associated with an increase of risk among subjects without CVX risk factor. CONCLUSION: We have demonstrated that the risk of SCA has increased in Ramadan only among the elderly and patient with hypertension. The increased risk in Shawwal can be explained by the lifting of dietary restriction.

Patients' attitude towards bedside teaching in Tunisia.

OBJECTIVE: To assess patient' reaction towards bedside teaching at the University Hospital of Monastir (Tunisia) and to identify the factors that may influence it. METHODS: A cross-sectional study was conducted during December 2012 at the University Hospital of Monastir. Each department, except the psychiatric department and the intensive care units, was visited in one day. All inpatients present on the day of the study were interviewed by four trained female nurses using a structured questionnaire. RESULTS: Of the 401 patients approached, 356 (88.8%) agreed to participate. In general, the results demonstrate that patients were positive toward medical students' participation. The highest acceptance rates were found in situations where there is no direct contact between the patient and the student (e.g. when reading their medical file, attending ward rounds and observing doctor examining them). As the degree of students' involvement increased, the refusal rate increased. Gender, age, educational level, marital status and the extent of students' involvement in patient's care were identified as the main factors affecting patients' attitude. CONCLUSIONS: Taking advantage of this attitude, valorizing patient role as educator and using further learning methods in situations where patient's consent for student involvement was not obtained should be considered to guarantee optimal care and safety to patients and good medical education to future physicians.

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design.

BACKGROUND: Repeat abortion is a public health concern favored by many obstetric and social factors. The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion. METHODS: We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC). Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women's demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3-4 weeks following pregnancy termination. RESULTS: Of the 500 interviewed women, 211 (42.2 %; CI95% [37.88 - 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion. CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %). CONCLUSION: Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

[Determinants of risky sex practices among consultants of a Voluntary HIV counseling and testing Centre]. / Déterminants des pratiques sexuelles à risque chez les consultants d'un Centre de Conseils et de Dépistage Anonyme et Gratuit du VIH

BACKGROUND: Thirty years after the discovery of human immunodeficiency virus (HIV), knowledge and practices must be improved. AIM: Contribute to reducing the risk of virus transmission. METHODS: A study about the determinants of risky practices was conducted among the consultants of the Voluntary HIV Counseling and Testing Centre (VCTC) in Monastir University Hospital. RESULTS: We performed a cross sectional descriptive study with a total of 241 consultants who used the services of the VCTC during the period from January 1, 2008 to December 31, 2011. Data gathering was based on a self-administered questionnaire. Consultant's mean age was 27.4 ± 8 years with a male predominance. Three patients out of four were single and 65% have at least secondary-level education. Knowledge about the risk of HIV infection after an unprotected sex and drug use by injection were reported by 94.3% and 76.7% of the participants respectively. Risky sex practices were adopted by 89.3% of the subjects. At least secondary school level, knowledge of risk factors of contamination and fear of the virus transmission were identified as determinants of safe sexual practices (0,004 ≤ p ≤ 0,032). CONCLUSION: Improving knowledge of populations at risk for HIV is a privileged axis to lead to a reduction of infectious risk in our country.

Predictors of smoking relapse in a cohort of adolescents and young adults in Monastir (Tunisia).

BACKGROUND: Smoking prevalence in adolescents and young adults is substantially elevated in Tunisia. Moreover, there is a lack of knowledge regarding the effectiveness and associated factors in smoking cessation interventions among adolescents and young adults. This study aims at identifying the major factors leading to smoking relapse among adolescents and young adults in the region of Monastir, Tunisia. METHODS: We carried out a prospective cohort study at the smoking cessation center of the University hospital of Monastir, Tunisia. The population study consisted of all adolescents and young adults (15-30 years) consulted during a period of two years (2009 - 2010). A questionnaire was used to explore the patient's sociodemographic characteristics, smoking history, nicotine dependence (Fagerstrom test) and anxiety / depression (Hospital Anxiety and Depression Scale). A telephone survey was conducted in July 2011 to assess smoking cessation results. A multivariate Cox regression was used to identify predictors of smoking relapses. RESULTS: A total of 221 adolescents and young adults were included in this study with a mean age of 25.5 ± 3.9 years. At follow up, 59 study participants (26.7%) were abstinent and the overall median abstinence was 2 months. In the multivariate analysis smoking relapse was associated with being an adolescent patient (HR 2.16; 95% CI: 1.54-3.05), medium or higher nicotine dependence at baseline (HR 2.66, 95% CI: 1.06-7.05 and HR 3.12, 95% CI: 1.20-8.12 respectively), not receiving treatment (HR 1.70, 95% CI: 1.25-2.33) and have friend who is a smoker (HR 1.63; 95% CI: 0.96-2.79). CONCLUSION: The results of this study provide important information about beneficial effect of smoking cessation support for adolescent and young adults. More efforts must be deployed to deal with contributing factors to smoking relapse.

[The clinical breast examination. An experience in general medicine]. / L'examen clinique des seins. Une expérience en médecine générale.

BACKGROUND: A Tunisian woman from 27 will be affected by breast cancer between 0 and 74 years of her life. Evolution of this cancer is relatively short. Its mortality is 10% when not detected. The regular practice of clinical breast examination is one of the tools of awareness and adherence to screening women for breast cancer. AIM: To describe the results and the obstacles to the realization of the early diagnosis of the breast cancer for the clinical examination by the general practitioner. METHODS: A forward-looking study realized over 9 months which concerned 105 women of more than 24 years old, consulting for the other motive, in a basic health center. The appropriate statistical tests had been used at the risk of 5 %. RESULTS: The rate of participation was 12 %. The age mean was 46.4 ± 10 years old. An abnormal clinical examination, was identified at 36.2% of the women. The multi parity decreases the risk of developing a breast clinical abnormality, with OR= 0.14 (IC 95 % [0.035-0.580]) while histories favoring the breast cancer increase this risk with an OR=2.79; (IC 95 % [1.09-7.13]). The general practice had asked for a radiological examination for 67.5 % of the women. His request was influenced by the result of the clinical examination (OR= 20.42 (IC 95 % [7.01-59.49])). Four cases of malignant tumors had been diagnosed. CONCLUSION: We recommend giving the general practitioners responsibilities for the women gynecological health and for the coordination between the different actors, via a weekly day of prevention.

Women's knowledge, attitudes and practice about breast cancer screening in the region of Monastir (Tunisia).

Breast cancer remains a worldwide public health problem. In Tunisia, it is considered to be the primary women's cancer and causes high morbidity and mortality. This study aimed to investigate female knowledge, attitudes and practice of breast cancer screening in the region of Monastir (Tunisia). We conducted a descriptive cross-sectional design exploring knowledge, attitudes and practices of women in the region of Monastir on breast cancer screening. The study was conducted in health centres of this region from 1 March 2009 to 30 June 2009. Data were collected via a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods and attitudes towards the relevance and effectiveness of breast cancer screening. A scoring scheme was used to score women's responses. A total of 900 women agreed to take part in the study. Their mean age was 41.6±12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 92% of participants had poor knowledge of the specific risk factors for breast cancer and 63.2% had poor knowledge of the screening methods. Proper practice of breast cancer screening was observed in 14.3% of cases. Multiple logistic regression analysis showed that good knowledge of risk factors and screening methods, higher level of education and positive family history of breast cancer were independently correlated with breast cancer screening practice. This study revealed poor knowledge of breast cancer and the screening methods as well as low levels of practice of breast cancer screening among women in the region of Monastir. Results justify educational programs to raise women's adherence to breast cancer screening programs in Tunisia.

Trends in hospital morbidity among adults in the region of Monastir (Tunisia) between 1996 and 2007.

AIM: To study trends of hospital morbidity among adults in the region of Monastir during a period of 12 years (1996 - 2007). METHODS: We analyzed data from the morbidity database of the university hospital of Monastir (Tunisia) between 01/01/1996 and 31/12/2007. Data were drawn from the register of hospital morbidity implemented in the Department of Preventive Medicine and Epidemiology since 1995. The International Classification of Diseases (tenth revision) was used to identify and classify morbid conditions. RESULTS: During the study period, we collected 150749 admissions with male tendency (sex-ratio = 1.27). Among these admissions 24.4% were over than 64 years. Morbid conditions were dominated by Ischemic Heart diseases (4.24%) followed by cancers and diabetes mellitus (3.3% and 2.52% respectively). Chronological trends, using Spearman correlation rank test, showed that overall rate of chronic conditions increased significantly from 4.4% in 1996 to 9.1% in 2007 (r'= |0.88|, p-value < 0.001). In contrast, the rate of infectious and parasitic diseases decreased from 4.3% to 2.9% (r'= |0.98|, p-value < 0.001). CONCLUSION: Morbidity trends reflect the epidemiological transition of our country and call to a backing of the ambulatory system and the development of specific services able to decrease the needs of hospitalizations.

[Chronological observation of the epidemiological characteristics of perinatal indicators in the Monastir health region (Tunisia) between 1994 and 2008]. / Caractéristiques épidémiologiques chronologiques des indicateurs de périnatalité dans la région sanitaire de Monastir (Tunisie) entre 1994-2008.

In the Tunisian healthcare system, the mother-child pair is a key target of the national perinatal program established in 1990. The purpose of this study is to define the epidemiological profile and to study the chronological tendencies of the main perinatal care indicators in the region of Monastir. The paper is based on a population study involving all parturients who gave birth in Monastir public maternities over a period of 15 years (1 January 1994 to 31 December 2008). Data were drawn from the register of births of all public maternities located in the region. The study examined 121,046 parturients. The mean age of parturients was 28.8 ± 5.5 years. 17.2% of parturients were aged 35 and over. Two thirds of deliveries were performed in the 2nd and 3rd level care maternities. Over the course of the fifteen years, absent prenatal care decreased significantly, from 11% in 1994 to 1% in 2008 (p<0.001). The percentage of parturients aged 35 and over increased significantly, from 14% in 1994 to 18% in 2008 (p< 0.001). Prematurity also increased significantly, from 4.2% in 1994 to 7% in 2008. These results are a reflection of the demographic and social transition of the country. The Tunisian healthcare system will need to show greater vigilance and to promote a greater focus on prenatal care quality.

[Epidemiological and chronological profile of the parturientes in the extreme ages in the monastir region between 1994 and 2003]. / Caracteristiques epidemiologiques et chronologiques des parturientes aux ages extremes dans la région de monastir entre 1994-2003.

BACKGROUND: Pregnancy outside 19 - 34 years interval is risk factors of the maternal and fetal morbidity and mortality. Tunisia, witch known an epidemiological transition, implanted the national program of perinatality since 1990 and one of its objectives is the surveillance of the high risk pregnancies. AIM: The aim of this study is to draw up the epidemiological profile of the parturient in extreme ages in the region of Monastir and to study the chronological tendencies of the associated factors during a decade (1994 - 2003). METHOD: In all, the study interest 13225 extreme ages parturient, representing 22.5% of all women admitted for delivery in the public maternities of the district. RESULTS: The means age was 18.6 ± 0.6 years for the parturient less than 20 years and 37 ± 2 years for the older than 35 years and more, among them 40% were older primipara. The prenatal care was inadequate for 35.4% of younger women and 47.6% of aged women. During the decade, we notice a significant decrease of the frequency of pregnancy for teenager parturient (from 3 in 1994 to 1.99% in 2003), and increase for the aged parturient (from 14.7 in 1994 to 17.7% in 2003) (p < 0.001). Adequate prenatal care increased and the frequency of parturient without any follow-up decreased (from 17.2 to 2%) (p < 0.001). CONCLUSION: Given to this demographic and social transition, our healthcare system is called for greater vigilance and a more rigorous application of the recommendations of the national program of perinatality.