An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.

INTRODUCTION: Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. AIM: To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. METHODS: Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. RESULTS: The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. CONCLUSION: This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

Major mistakes in scientific medical writing based on manuscripts' reviews.

INTRODUCTION: Peer review is a crucial process in ensuring the quality and accuracy of scientific research. It allows experts in the field to assess manuscripts submitted for publication and provide feedback to authors to improve their work. AIM: To describe mistakes encountered while peer reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. METHOD: This was a bibliometric study of research manuscripts submitted to "La Tunisie Médicale" and reviewed during 2022. The data collected included the type of the manuscripts and the number of reviews conducted per manuscript. The study also identified variables related to writing mistakes encountered during the peer review process. RESULTS: A total of 155 manuscripts (68% original articles) were peer reviewed and 245 reviews were delivered, by two reviewers. Out of 62 mistakes detected, 21% concerned the results section. In 60% of the manuscripts, the keywords used were not MeSH (Medical Subject Headings) terms. The introduction lacked in-text citations in 30% of the reviewed manuscripts, while the method section did not have a clear study framework (27%). The two major mistakes detected in the results section were the misuse of abbreviations in tables/figures, and the non-respect of the scientific nomenclature of tables/figures with respectively 39% and 19% of manuscripts. CONCLUSION: This study identified 62 mistakes while reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. Scholars can benefit from participation in scientific writing seminars and the use of a safety checklist for scientific medical writing to avoid basic mistakes.

Epidemiology of metabolic syndrome in Tunisia. HSHS 5 study.

OBJECTIVE: To measure the prevalence of metabolic syndrome and its components in the HSHS cohort (Hammam Sousse, Tunisia), in 2009, and to identify its determining factors. METHODS: This was a descriptive epidemiological study of the "community based" type having focused on a random sample of people aged 20 and over. The metabolic syndrome was defined according to the criteria of the "International Diabetes Federation" (IDF 2005) and those of the "National Cholesterol Education Program-Adult Treatment Panel III" (NCEP-ATP III, 2001). RESULTS: The study involved 1441 people including 960 women (66.6%). The age- and sex-adjusted prevalences of increased waist circumference, blood pressure, blood sugar and triglycerides, and decreased HDL-cholesterol were respectively 63.2%, 95%CI[62.5-63.8]; 47.7%, 95%CI[47.4-48.6]; 25.7%, 95%CI[25.1-26.2]; 11.9%, 95%CI[11.4-12.3] and 65,6%, 95%CI[65.0-66.2], according to IDF thresholds and 37.4%, 95%CI[36.3-37.6]; 45.7%, 95%CI[45.4-46.6]; 13.8%, 95%CI[13.4-14.2]; 8.4%, 95%CI[8.0-8.7] and 61.9%, 95%CI[61.2-62.5], according to those of the NCEP-ATP III. The prevalence of metabolic syndrome adjusted for age and sex was 36.5% 95%CI[33.0%-38.9%] according to the IDF definition and 23.0% 95%CI[20.4%-25.6%] according to that of NCEP-ATP III. The multivariate study by logistic regression made it possible to retain three significant independent determining factors of the metabolic syndrome: age ≥40 years, low level of physical activity and family history of diabetes mellitus with respectively adjusted ORs of 3.77 95%CI[2.70-5.27], 1.39 95%CI[1.01-1.89], 1.62 95%CI[1.21-2.15], according to IDF and 5.87 95%CI[3.88 -8.88], 1.47 95%CI[1.07-2.01] and 1.45 95%CI[1.07-1.96], according to NCEP-ATP III . CONCLUSION: With this high prevalence rate of the metabolic syndrome, the establishment of an action plan would be essential. This plan should be based on the combination of the promotion of physical activity and screening for the components of the metabolic syndrome, particularly in subjects aged 40 or over, with a family history of diabetes mellitus.

Place of distancing measures in containing epidemics: a scoping review.

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing ('social isolation', 'social distancing', 'quarantine') combining with 'epidemics'. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words: Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.

Epidemiology of dyslipidemia in Tunisia, HSHS 3 study (Hammam Sousse Sahloul Heart Study).

INTRODUCTION: Dyslipidemia is a major cause of morbidity and mortality worldwide because it increases the risk of cardiovascular diseases. AIM: To determine the prevalence of dyslipidemia and its components in the general population of Hammam Sousse (Tunisia) and to identify its risk factors. METHODS: This was an analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based¼ cross-sectional study on cardiovascular risk factors including dyslipidemia, with a random sample in two-stages, proportional-probability clusters. All subjects above 20 years underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. Dyslipidemia was defined by: total cholesterol ≥5.2 mmol/l, hyper LDL (Low Density Lipoprotein) cholesterolemia ≥4.1 mmol/l, hypo HDL (High Density Lipoprotein) cholesterolemia <1.03 mmol/l for men and <1.29 mmol/l for women and hyper-triglyceridaemia: ≥2.26 mmol/l. Multivariate logistic regression analysis was conducted to determine factors independently associated with dyslipidemia. RESULTS: The study population was composed of 481 males (M) and 960 females (F), with a sex ratio of 0.5. Mean cholesterol was higher in women (5 mmol/l±1.01) than in men (4.8 mmol/l±0.92). Only 24.9% of men and 29.1% of women had normal HDL cholesterol levels. Women had higher levels of hypercholesterolemia and LDL cholesterolemia than men (p<10-6). Multivariate analysis showed that dyslipidemia was independently and statistically significantly associated with age ≥40 years (p<10-3), physical inactivity (p<10-3) and obesity (p=0.025). CONCLUSION: As a result of the epidemiological situation of dyslipidemia, the promotion of an active lifestyle seems essential. In addition, nutritional education improves the lipid profile by promoting weight loss and balancing lipid consumption.

Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic.

CONTEXT: Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic. OBJECTIVE: To describe public health experts' perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia. METHODS: This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts. RESULTS: A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics. CONCLUSION: The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.

Epidemiology of diabetes mellitus in Tunisia. HSHS 2 study (Hammam Sousse Sahloul Heart Study).

BACKGROUND: National epidemiological studies on diabetes mellitus are rare, ancient and often carried out schools or clinics settings. OBJECTIVES: To determine the prevalence of diabetes mellitus and identify its risk factors in the adult population of the city of Hammam Sousse (Tunisia) during the year 2009. METHODS: This study is a part of analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based¼ cross-sectional study on cardiovascular risk factors including diabetes mellitus, with a two-stage proportional probability cluster random sample. All subjects aged 20 years and more underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. The diagnosis of diabetes mellitus was defined by a fasting blood glucose level ≥7 mmol/l. Overweight was defined by a Body Mass Index (BMI) ≥ 25 kg/m². A multivariate logistic regression analysis was conducted to determine independent risk factors associated with diabetes mellitus. RESULTS: The population was composed of 481 males (M) and 960 females (F), a sex ratio of 0.5 with mean ages respectively of 49.6±16.35 years and 46.6±16.18 years. The prevalence of diabetes mellitus adjusted by age and sex was 12.1% (95%CI[11.7-12.5]); M: 12.7% (95%CI[12.1-13.3]), F: 11.5% (95%CI[10.9-12.1]). The prevalence rate of patients newly detected with diabetes mellitus was 1.9% (95%CI[1.7-2.1]): M: 1.8% (95%CI[1.6-2.0]), F: 2.1% (95%CI[1.8-2.4]). The multivariate study revealed five independent factors significantly associated with diabetes mellitus. In addition to non-modifiable factors (male gender, age ≥40 years old, low schooling level and family history of diabetes), diabetes mellitus was 2 (95%CI[1.3-3.2]) times more prevalent in overweight cases. CONCLUSION: In deep trouble of this epidemiological situation of diabetes mellitus, it is urgent to launch a universal intervention strategy based on the promotion of a healthy lifestyle motivating regular physical activity and a low-calorie diet.

Epidemiology of arterial hypertension in Tunisia: Hammam Sousse Sahloul Heart Study (HSHS).

INTRODUCTION: Tunisia is experiencing a double burden of morbidity, characterized by the explosion of cardiovascular diseases and their risk factors including arterial Hypertension. The objective of this study, based on the HSHS cohort (Hammam Sousse Sahloul Heart Study), was to determine the prevalence of hypertension in the general population and to identify its predisposing factors. METHODS: HSHS is a cardiovascular health promotion initiative in the city of Hammam Sousse (Tunisia). The study was conducted via a random sample of households, using the WHO PEV technique, made up of 33 clusters, of 33 households each. All people aged 20 and over, included, benefited from a questionnaire, a physical examination and a biological assessment. The Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) were measured from the average of the last two measurements, by an OMRON type tensiometer, of suitable width. These prevalences were adjusted according to sex and age group, by their weighting coefficients in the general population, and they were accompanied by their 95% CIs. Binary logistic regression was conducted to identify independent factors associated with hypertension. RESULTS: The study population was composed of 481 men (33.4%) and 960 women (66.6%), with an average age of 49.6±16.35 years in males (M) and 46.6±16.18 in females (F). In addition to the family history of hypertension, the sufficient weekly consumption of vegetables and fruits was low (M: 32.4%, F: 24.9%). The adjusted rate of hypertension in the adult study population was 32.5%, 95%CI[31.9-33.1] (M: 36.4%, 95%CI[35, 5-37.3]; F: 28.4%; 95% CI[27.6-29.2]), reaching in the age group of 60 years and above: M: 74.6% (95%CI[66.9-82.3], F: 82.7% (95%CI[73.8-83.6]) Multivariate analysis identified five independent factors significantly associated with hypertension: male sex (ORa=1.55 [1.18-2.03]), age over 40 years (ORa=6.54[4.70-9.11]), low level of schooling (ORa=1.80 [1.36-2.38]), low physical activity (ORa=1.42[1.07-1.88]) and high socio-economic level (ORa=1 .84 [1.30-2.63]). CONCLUSION: The HSHS study confirmed the high prevalence of hypertension, and the extent of its low detection and control. Hence the need for a universal approach to health promotion, oriented towards the general population, piloted by its local organizations, based on the adoption of a healthy lifestyle, and centered on physical activity.

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000-2019).

Describe the epidemiology of tuberculosis in the last two decades (2000-2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years' old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

Forty-year Tunisian bibliometrics of general surgery theses in the four national faculties of medicine (1980-2019).

The objective of this work was to establish the bibliometric profile of Tunisian theses in 'general surgery' and to describe their themes, their study designs, and their writing quality. This is a retrospective descriptive bibliometric study, covering all the theses in medicine in the specialty of 'general surgery', defended in the four medical faculties of Tunisia, during the forty last years from 1980 to 2019. During the study period, 739 theses in 'general surgery' were discussed in Tunisia, with an average of 19 theses per year. The most studied research topic was emergencies (41%), followed by common surgical pathologies (26%) and digestive oncology (21.5%). Descriptive studies and case studies represented the majority of study designs with respective proportions of 56.9% and 40.6%. Only 20.7% of these theses had a scientific writing quality deemed satisfactory. The least respected elements in writing their summaries were statistical (confidence intervals and standard deviations) and documentary (keywords). Despite the plethora of themes of Tunisian theses in 'general surgery', their basic methodology and their editorial non conformity require the educational reform of the dissertations, both doctoral students and supervisors, by strengthening their skills in research methodology and scientific communication written.

Global university performance. Bibliometric analysis of the ARWU platform (2003-2020).

OBJECTIVES: Describe the 2020 report of the ARWU "Academic Ranking World Universities" classification and identify, accordingly, the roadmap of academic excellence, particularly in the countries of the Greater Maghreb. METHODS: This is an in-depth reading of the 2020 results of the ARWU bibliometric platform (launched in 2003) from top 1000 world-class universities. Six criteria were used in this ranking: 1. Alumni (10%): students who received Nobel / Fields prizes; 2. Award (15%): professors who have won the Nobel / Fields prizes; 3. HiCi (20%): Most cited scientists; 4. PUB (20%): number of publications 5. TOP (20%): proportion of publications in the most influential periodicals; 6. PCP (10%): Per Capita Performance. RESULTS: The 2020 ARWU ranking was characterized by the domination of the "Top 10" ranking by the United States, particularly the "Harvard University", the Asian boom of 55% of the "Top 1000" ranking (Chinese universities evolved from 16 in 2004 to 81 in 2020 in the "Top 500" list) and finally an African incubation of academic excellence, manifested by the selection of nine South African institutions (including the "University of Cape Town ", world rank between 201-300), and the re-entry for the first time of a Maghreb university in the" Top 1000 "list, Tunis El Manar (rank between 901-1000), with the following scores: N&S: 1 , 4; Pub: 26.1 and PCP: 10.3, for a total score of 37.8 points. CONCLUSION: This report proves once again, the promising academic perspectives of Asia and Africa in the inclusion of the "Top 1000" list of the ARWU ranking. The roadmap for academic excellence would thus be based on the triad of centering scientific publications, in prestigious journals and by national author networks.

Bibliometric profile of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia).

OBJECTIVE: Describe the bibliometric profile of medical dissertations in Sousse Faculty of Medicine (SOFM) in Tunisia. METHODS: This is a cross-sectional bibliometric study of all dissertations defended from 2001 to 2005. The data were collected through a reading grid applied to the cover page, conclusion, and summary of the thesis. The specialty of the dissertation has been attributed to its first director. Themes were defined by the "essential descriptor", chosen from the descriptors used for the indexing. RESULTS: The 670 theses collected, all written in French except one in Arabic, were original, pedagogic or bibliographical works in respectively 93.3%, 6.4%, and 0.3% respectively. "Community and Preventive Medicine" was the discipline that generated the most theses with a proportion of 8.9%. About half (48%) of the dissertations were supervised by two directors. The first director was a University Hospital Professor or an Associate Professor of Conferences, respectively in 34% and 42% of cases. The chairman of the thesis jury belonged to the same specialty as the first director and was from the same department in respectively 54% and 41% of cases. Four "essential descriptors" were frequently cited as indexation of the dissertation: "tumor", "CD-Rom", "trauma", and "diabetes". These dissertations were "clinical" type in 68% of cases, of which around 80% were "case studies". CONCLUSION: The doctoral dissertation in SOFM was characterized by the orientation towards clinical and epidemiological research and the preference for general medicine and community health themes. It's often recourse to a basic research estimate and its writing in French would be two factors limiting its scientific promotion and its social influence.

Under 5 Child Mortality in the Maghreb countries.

INTRODUCTION: Mortality, particularly at younger ages, is a key measure of population health. AIM: To describe under 5 children mortality trends and its related factors in the Great Maghreb countries over the last three decades 1994-2019. METHODS: We conducted an observational descriptive study to clarify the situation in the Maghreb countries with regard to the under-five death rates and the various causes related to them during the last three decades (1990-2019). The data was collected from the Global Burden of Diseases, Injuries, and Risk Factors (GBD). RESULTS: he overall trend for the five Maghreb countries was towards the decrease in the mortality rates for all age groups and for both sexes. Mauritania remains at the top of the list in term of the number of deaths followed directly by Morocco. The number of deaths of under-5 children is higher among boys in all Maghreb countries and the most affected age group is under 1 year old. Regarding the causes of under-5 mortality in Maghreb countries, the top-5 causes were similar; except in Mauritania where infectious diseases remain the leading under-5 mortality cause, like in other sub-Saharan countries. CONCLUSION: Despite the big drop in under 5 child Mortality rates, a lot remains to be done in Maghreb countries to improve children health.