[Premature birth: a risk factor for maternal depression?] / L'accouchement prématuré : un facteur de risque de dépression maternelle ?

Premature birth constitutes a major ordeal not only for the child but also the mother. It reveals the psychological capacities of mothers with depressive affects as signs. Hedi Chaker university hospital in Sfax in Tunisia carried out a study on mothers of premature babies. These mothers were significantly more depressed. Certain factors appear to favour the occurrence of postnatal maternal depression and must therefore benefit from specific support.

[Psychological distress in medical and paramedical personnel in anesthesia and intensive care]. / La détresse psychologique du personnel médical et paramédical d'anesthésie-réanimation.

Anesthesia and intensive care medicine is considered one of the specialties involving more professional stress (PS). On this basis, our study aimed to assess the level of anxiety and PS in the personnel in anesthesia and intensive care and to identify the associated factors. We conducted a cross-sectional, descriptive and analytical study including 54 participants (38 technicians and 16 residents) working in the Departments of Anesthesia and Intensive Care at Habib Bourguiba and Hedi Chaker University Hospitals, Sfax, Tunisia. PS assessment was performed using the Karasek questionnaire. The Hamilton Anxiety Rating Scale (HARS) was used to measure the severity of anxiety symptoms. According to the Karasek questionnaire, the average decision latitude score was 69, the average psychological demand score was 23.9 and the average social support score was 19.6. According to this questionnaire, 40.7% of personnel was stressed and 38.9% was in isostrain condition. Average HARS score was 17.8, average psychic anxiety score was 8.7 and average somatic anxiety score was 9, with a significant difference between the medical and paramedical personnel. Severe to very severe anxiety was recorded in 25.9% of cases. HARS score was correlated to female gender (p=0.017) and to psychiatric histories (p=0.003). This study highlights that medical and paramedical personnel in anesthesia and intensive care is exposed to a significant risk of PS. Changes in working environment as well as learning professional stress management techniques should be proposed.

[Sexual disorder in hemodialysis patients]. / Troubles sexuels chez le patient Hémodialysé.

OBJECTIVES: To identify the sexual problems, to assess their prevalence and to determine the various factors involved in their occurrence in patients on hemodialysis for at least 6 months. PATIENTS AND METHODS: Fifty hemodialysis patients consulting in the dialysis unit of the nephrology department of the University Hospital Hedi Chaker of Sfax (Tunisia), during the period from 1 June to 30 August 2012, were included in this study, The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression. The patients' quality of life was assessed by Kidney Disease Quality of Life ¼ (KDQoL). RESULTS: Patients' mean age was 51.2 years. The average of hemodialysis period was 6,73 years. After the beginning of hemodialysis, 26% of patients were sexually inactive and 62% reported a decrease of their sexual activity. The prevalence of sexual dysfunction was 86.48%. Mean age of 55 years or greater was significantly correlated with risk of sexual disorders. These disorders were also positively correlated with personal medical history, some nephropathy data, a hemodialysis period greater than or equal to 1 year, depression, anxiety and impaired quality of life. CONCLUSION: The prevalence of sexual dysfunction in hemodialysis patients is high and many factors were involved in their occurrence. A collaborative effort between nephrologists, psychiatrists and sexologists before dialysis, seems to be essential.

[Schizophrenia and education: about 32 Tunisian students suffering from schizophrenia]. / Schizophrénie et scolarité : etude tunisienne à propos de 32 lycéens et étudiants atteints de schizophrénie.

AIM: To study the schooling among school and university students suffering from schizophrenia. METHODS: A retrospective, descriptive and analytic study based on information from medical records of patients treated in Psychopedagogy Unit in psychiatry department «B" of the Hedi Chaker Hospital University of Sfax, during the period from 1995 to 2009. Inclusion criteria were: diagnosis of schizophrenia (DSM-IV-TR) and follow-up duration of at least one year. RESULTS: Thirty-two patients were included. The sex ratio (M/F) was 2.2. The average age was 20.7 years at the first consultation and 19.17 years at the disease onset which was insidious in 75% of cases. Undifferentiated (46.8%) and paranoid (31.2%) were the most frequent types of schizophrenia. The education level at the disease onset was secondary (62.5%) and high (37.5%). The school results were low in 62.5%. Patients who received at least one blank year were 56.3% and those who were reoriented 12.5%. They dropped out in 75% of cases. Grade repetition after the onset of schizophrenia (53.1%) was correlated with two factors: low socioeconomic status (p= 0.008) and conventional antipsychotic treatment (p= 0.021). CONCLUSION: Our results confirm the negative impact of schizophrenia on the normal course of schooling. Collaboration between psychiatrist, school doctor and teacher becomes a necessity to guarantee early schizophrenia diagnosis and adequate medical and educational care.

[Attempted suicide in high school and university students: a Tunisian case study of 61 cases]. / Tentative de suicide du lycéen et de l'étudiant: Étude Tunisienne à propos de 61 cas.

AIM: To determine the global profile of pupils and university students who made suicide attempts. METHODS: We have retrospectively examined 1623 files of pupils and university students who have consulted the psycho-pedagogical unit of psychiatry department « B ¼ of Hedi Chaker Hospital, Sfax -Tunisia, during this time span from January 1997 to December 2009. We have taken a census 61 of files of those consulting for suicide attempts. RESULTS: The prevalence of suicide attempts in Tunisian pupils and university students is low (3.75 %) and is probably due to sociocultural considerations. It is often a young girl (70.5%) having school difficulties (50.8%) and adaptation problems (60.6 %), impulsively accomplishing her suicide attempt (91.8%), at home (83.6 %), by drug ingestion (70.6%). CONCLUSION: This profile shows the major need for communication within the family, and for the generalization of listening units at schools and universities.

[Burn out in health care providers: a Tunisian study about 142 nurses]. / L'épuisement professionnel du soignant: Etude tunisienne à propos de 142 infirmiers.

BACKGROUND: Burnout is a syndrome which affects preferentially help professions, having a strong emotional interpersonal implication. AIM: To assess the prevalence of burn out in a sample of Tunisian nurses, and to determine its causes and perceived repercussions. METHODS: In a first step, we assessed the work conditions, the perceived burn out and its possible consequences in 142 nurses from 12 different wards. In a second step, we used the Malasch Burn Inventory to assess the burn out symptoms in ours ample. RESULTS: More than two thirds (69%) of our sample had a burn out. Forty five point eight percent of the affected professionals had a high level of emotional distress, 36.6% had a high level of depersonalization and 22.5% had a low level of professional fulfillment. The high caseload was the first cause of burn out (72.5% of professionals) and was associated to a moderate level of burn out (OR=3.80; 95%IC: 1.079-13.420 ; p = 0.038). Role ambiguity and undefined responsibilities were associated to a high level of emotional distress (p=0.04) and depersonalization (p=0.03), and a low level of professional fulfillment (p=0.0001). High scores of emotional distress were associated to a high number of work hours (p=0.006) and less than 10 years in carrier duration (p=0.008). In our study, feelings of uselessness were associated to high levels of emotional distress (p=0.05) and depersonalization (p=0.002) on the one hand, and to a lower level of personal fulfillment on the other hand (p=0.04). Moreover, we found that cases with suicide ideations had a higher level of burn out (p=0.04). Concerning physical symptoms, emotional distress was associated to multiples somatic complains. CONCLUSION: Our results corroborate partially with those of the literature and illustrate some parameters that can be the cause of burnout, such as working conditions, role ambiguity, and lack of experience among the young nurse. Therefore, it is important to take into consideration this various factors had their impact on quality of life of caregivers.

[Female sexuality during pregnancy and postpartum: a study of 80 Tunisian women]. / Sexualité féminine au cours de la grossesse et en post-partum: a propos de 80 femmes Tunisiennes.

AIMS: To investigate the impact of pregnancy and the post partum period on the female sexuality and the coupledom, and to evaluate the quality of information and dialogue about this subject. METHODS: A prospective descriptive and analytical study included patients from the department of obstetrics and gynecology in the university hospital Hédi Chaker during July and August 2010. We choose randomly 80 Tunisian women, whatever the reasons for consultation. Data were obtained via questionnaires containing 45 questions about sexual behavior during the last pregnancy and the postpartum period, the influence on coupledom, and the quality of information and dialogue about this subject. Statistical analysis was conducted using SPSS for Windows version 17. Statistical significance was defined as a p value 5% using the X2 test. RESULTS: The average age was 31.64 (± 6) years. Before pregnancy,sexuality was qualified as "satisfactory" by nearly the half of the sample (48, 5%) against 78.8% by their partners. 18% of women thought it was not possible to have intercourse during pregnancy. This idea doesn't correlate with the education (p=0.151) neither the geographic origin (p=0.064). 54.5% of women mentioned a decrease on their sexual interest and activity during pregnancy. The three main causes of this decline were: the physical symptoms (83%), the fear to harm the fetus (66.7%) and the women hypoactive sexual desire (33.4%). After delivery, sexual interest and activity tends to be reduced in 64% of women. The resumption of normal sexual activity was about 4 months around the delivery (with variations between 1 month and 2 years). Sexuality was considered as taboo by 81, 8% of women. The information on sexuality by health professionals was deemed insufficient by 78.8% of women. CONCLUSION: Sexuality remains a taboo for the most of woman. Their belief in the impossibility of intercourse during pregnancy doesn't correlate with education neither with origin. The period of pregnancy and the postpartum changes the sexual behavior, interferes with the quality of life and disturbs the coupledom. However information and the support of women in this period are still insufficient.

[Evaluation of depression in elderly people living in nursing homes: a study involving 35 people]. / De la dépression chez la personne âgée en maison de retraite: Etude auprès de 35 résidents.

BACKGROUND: Depression in the elderly is often inadequately diagnosed and insufficiently treated. Regardless of the nature of the depression, the influence and the impact of the biological, situational, social and psychological factors would be more important in old subjects than in young ones when the disorder occurs. The nursing home, as an institution, is another factor facilitating the appearance of depression. AIM: The aim of our survey is to determine the prevalence of depression in old people living in a nursing home and to evaluate the degree of their autonomy. METHODS: Our study is a transverse, descriptive and analytical survey carried out on 35 old people at a nursing home in Sfax. Forty residents were excluded from this survey for reasons of dementia (25 cases), debility (5 cases), disabling psychiatric pathologies (4 cases), deafness (5 cases) and one resident who refused the interview. The evaluation has been achieved using two scales specific to the geriatric practice: • The scale of depression: GDS (geriatric depression Scale) applied to 30 items. • The scale of autonomy: IADL (Instrumental Activities of Daily Living) applied to 6 items. RESULTS: • The examined population was composed of 35 people aged from 65 to 93 with a sex ratio of 1.05. • 51.4% of the residents were in a state of depression. • Depression was more frequent in: • Female subjects (58.8% of women compared to 44.4% of men) • Subjects aged less than 70 (66% of subjects aged less than 70 versus 40% of older subjects) • 17.1% of the residents were independent, 42.9% were dependent and 40% were heavily dependent. CONCLUSION: Depression in the elderly is related to several depressice factors particularly for patients living in institution. This situation needs very important adaptive capacities.