Alarming trends in Tobacco use in high school Tunisian adolescents: MedSPAD2013-2021

Background

Tobacco use is a global health concern, with smoking initiation often beginning in adolescence. In Tunisia, published data assessing trends of tobacco consumption at the national level only concerns middle school students aged 13 to 15 years. No data related to high school students are however published yet. We aimed to determine tobacco smoking prevalence in Tunisian adolescents and assess trends from 2013 to 2021.

Methods

Pooled data from three Mediterranean school surveyson alcohol and other drugs (MedSPAD surveys: 2013, 2017, and 2021) were used. Based on three-stage stratification sampling method, teenagers aged between 15 and 17 years, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire assessing socio-demographic characteristics and risky behaviours. We studied weighted prevalence estimates of cigarettes and water pipe (WP) smoking. All statistical analysis, including trend analysis, were performed with STATA software.

Results

A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.6 and mean age of 16.2±0.8 years. The prevalence of cigarette smoking increased from 17.8%, to 20.2% then to 24.7% for 2013, 2017 and 2021, respectively. As for WP smoking, its prevalence increased from 14.8%, to 16.7% then to 19.9% for 2013, 2017 and 2021, respectively. Trends analysis concluded to significant increase over study period for cigarettes and WP smoking (p < 10-3). The increase was most alarming for girls regarding WP smoking (consistent increase over the study period).

Conclusions

Our findings underscore the alarming increasing trend for different forms of tobacco smoking among Tunisian youth. It is therefore crucial to strengthen tobacco control measures among young adolescents in order to counteract the tobacco industry’s expanding marketing of new products primarily targeting this population.

Key messages

• The prevalence of cigarette and water pipe smoking increased significantly among high school Tunisian adolescents from 2013 to 2021.

• A better commitment to the implementation of MPOWER measures for tobacco control is therefore urgent.

Leading causes of death in Tunisia, 2020

Background

Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19’s effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020.

Methods

Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization cause-of-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software.

Results

A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system.

Conclusions

The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD’s coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization.

Key messages

• Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths.

• The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.

Cannabis use in Tunisian adolescents: Alarming trends from 2013 to 2021

Background

Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021.

Methods

Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis.

Results

A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cannabis use increased from 1.4%, to 3.8% then to 7.9% for 2013, 2017 and 2021 respectively. Trend assessement concludes to significant increase in overall cannabis use (p &lt; 10-3). Besides, there was a significant increase in both public and private schools, and among both boys and girls. However, the greatest increase was among male students (3.5% in 2013, 9.2% in 2017 and 16.1% in 2021) (p &lt; 10-3).

Conclusions

Despite the reinforcement of restrictive legislative measures, the prevalence of cannabis use among Tunisian high school adolescents is significantly increasing. Moreover, it’s important to further investigate problematic cannabis use and its effects on adolescents’ physical and mental health.

Key messages

• Trend assessement confirmed the significant increase in lifetime cannabis use in high school adolescents in Tunisia, for both sexes and for both private and public sector.

• This alarming public health issue requires urgent legislation review and close multisectoral collaboration to control supply and demand.

Nonmedical use of anxiolytics among Tunisian students: Connecting the dots from 2013 to 2021

Background

Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021.

Methods

Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021) were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of

prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software.

Results

A total of 14.723 students were enrolled with sex ratio (Male/Female) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of nonmedical anxiolytics’ use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p &lt; 10-3). However, a non-significant increase was revealed from 2013 to 2017.

Conclusions

Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors.

Key messages

• Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents.

• The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.

Percutaneous edge-to-edge repair for systemic tricuspid valve regurgitation in patients with congenital heart disease: the first descriptive cohort

 

In patients with congenital heart diseases (CHD) systemic tricuspid regurgitation (STR) is frequent.

Here, we report our experience with percutaneous edge-to-edge repair (PETER) in a series of 12 CHD patients with STR using the MitraClip system.

Twelve patients (median age = 35 years, 83% males) with severe STR (ccTGA (n=5), asTGA (n=3), SV (n=4)), at high-risk for surgical treatment, gave informed consent for treatment using PETER. The XTR MitraClip device (Abbott, Santa Clara, CA) was used. At baseline, 7/12 patients were in NYHA functional class ≥ III. Standard femoral venous access was successfully used in 10/12 patients. In SV patients, the systemic valve was accessed directly through the right atrium (n=2), after a Fontan conduit puncture (n=1), or after direct atrial surgical access (n=1). In TGA patients, either transseptal (ccTGA patients, n=4) or transbaffle (asTGA patients, n=3) puncture was performed (4).

Mitraclip devices were successfully implanted in 11/12 patients (Figure 1). One procedural complication was reported for a patient with SV in whom a septal leaflet rupture occurred following clip release, leading to severe STR; the patient died from refractory cardiac failure one week later. Peri-procedural complications included one case of left femoral vein injury and one case of atrial flutter treated by catheter ablation. After a median follow-up of 12-months (range 1–25) following device implantation, no death had occurred. The patients had significant reduction in STR (from severe to moderate in 10/11 patients) and clinically improved (10/11 patients were in NYHA class I or II).

To conclude, percutaneous edge-to-edge therapy of STR in CHD patients is feasible, safe and effective to reduce STR and SRV dilatation. This reduction is associated with a significant clinical improvement.

Funding Acknowledgement

Type of funding sources: None.

Isolation and characterization of plant growth promoting traits of a rhizobacteria: Pantoea agglomerans lma2

The use of microbial technology in agriculture is expanding quickly with the identification of new bacterial strains which are more effective in promoting the growth of plants. The rhizobacteria that promote the growth of plants can have a positive effect on the productivity of crops especially when subjected to salt stress. A nitrogen-fixing bacterium was isolated from the wheat rhizosphere of an arid region. The strain was identified on the basis of tests API20E and 16S rRNA sequencing, as Pantoea agglomerans lma2. This strain degraded several carbon sources: sugars (fructose, ribose, dextrin, salicin...), lipids (lecithin, tributyrin and tween 80), proteins (gelatin, casein), grew on KCN and could grow from pH 4 to 8 and had an optimum at pH 7. The growth temperature showed a maximum at 30 degrees C and the bacteria could tolerate from 4 to 41 degrees C and the growth rate was higher when the NaCl concentration was between 100 and 300 mM. The performance of activities enhancing the growth of plants of P. agglomerans lma2 was significantly better in the presence of salt. Rates of Indole Acetic Acid (IAA), siderophores production and solubilization of phosphate increased between 100 and 400 mM NaCl compared to the control without salt. The maximum values were saved to 300 mM for the production of siderophores (18.32%) and solubilization of phosphate (1061.49 microg mL(-1)) and 100 mM for the production of IAA (161 microg mL(-1)). A significant correlation existed between these three activities. These results showed that P. agglomerans lma2 with its Plant Growth Promoting Rhizobacteria (PGPR) and halophilic properties could constitute a good fertilizer in arid and saline zone.

Effect of Azotobacter vinelandii and compatible solutes on germination wheat seeds and root concentrations of sodium and potassium under salt stress

The effect of plant growth-promoting Rhizobacteria (PGPR) and exogenous application of compatible solutes on seed germination and root concentrations of sodium and potassium of two wheat varieties (Triticum durum L.) were evaluated under saline stress. In this experiment, Azotobacter vinelandii strain DSM85, glycine betaine and proline were used. Inoculated seeds for each variety were placed on Whatman paper in 9 cm Petri dishes containing 15 mL of distilled water or NaCl solutions at various concentrations (control, 100, 200, 300 mM) supplemented with or without glycine betaine (GB) or proline at 5 mM. The results indicated that addition of proline (5 mM) stimulated the production of indol acetic acid and the growth of A. vinelandii at 200 and 300 mM NaCl, respectively. The germination rate index and the germination final percentage decreased significantly (p < 0.05) with increasing salinity level. The germination was significantly diminished at 300 mM with significant variation among varieties and Waha variety had higher germination percentage than Bousselam variety. Inoculation of seeds by A. vinelandii and exogenous application of proline had significantly positive effect on the germination at this concentration of NaCl. The rate of accumulation of Na+ in roots was important at 100 mM and increased at 200 mM. The concentration of K+ decreased when salinity increased. The effect of inoculation or inoculation with proline decreased the accumulation of Na' and reduced the loss of K+ under salt stress. From the present study we can conclude that the use of A. vinelandii strain DSM85 and external application of low concentrations of proline on seeds might be considered as a strategy for the protection of plants under saline stress.