Gender differences in adverse childhood experiences, resilience and internet addiction among Tunisian students: Exploring the mediation effect

Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified.

Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis

OBJECTIVE

In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA).

METHODS

We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique.

RESULTS

Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01).

CONCLUSION

Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.

Hand hygiene and biomedical waste management among medical students: a quasi-experimental study evaluating two training methods

BACKGROUND

Several studies revealed that medical students have low performance levels of hand hygiene (HH) and biomedical waste management (BMWM). However, there have been limited interventions directed at young students targeting HH and BMWM enhancement. Given these data, we aimed at assessing HH and BMWM among medical students after two training methods.

METHODS

We performed a quasi-experimental study from September 2021 to May 2022, which included fifth-year medical students enrolled in the faculty of Medicine of Monastir (Tunisia). We relied on a conventional training based on presentations and simulations guided by the teacher and a student-centred training method based on courses and simulated exercises prepared by students. We used the WHO HH Knowledge Questionnaire and the "BMWM audit" validated by The Nosocomial Infection Control Committee in France.

RESULTS

A total of 203 medical students were included (105 in the control group and 98 in the experimental group) with a mean age of 23 ± 0.7 years. Regarding HH, we found a statistically significant increase in post-test scores for both training methods. A higher post-test mean score was noted for student-centred method (14.1 ± 1.9 vs. 13.9 ± 2.3). The overall improvement in good HH knowledge rates was greater after student-centred method compared to conventional training (40.5% vs. 25%). Concerning infectious waste, mean scores were higher after student-centred learning in all hazardous waste management steps (25 ± 3.3 vs. 23.6 ± 5.5).

RESULTS

Coupling student-centred teaching and continuous supervision could improve HH and BMWM knowledge and practices among medical students.

Adverse childhood experiences and sleep disorders among Tunisian adolescents: The mediating role of internet addiction

BACKGROUND

Adverse childhood experiences (ACEs) are a prevalent health problem worldwide. Different side effects have been linked to this issue such as sleep disorders. This matter is well known. However, its influencing mechanisms are not well investigated in literature.

OBJECTIVE

To investigate the mediating role of internet addiction in the relation between adverse childhood experiences (ACEs) and sleep disorders among a population of high-school students in the region of Gafsa (Tunisia).

PARTICIPANTS AND SETTING

We performed a cross-sectional study, in February 2020, including adolescents registered in all secondary schools of Gafsa city.

METHODS

Sleep disorders were evaluated via the Pittsburgh Sleep Quality Index, internet addiction via the Internet Addiction Test and adverse childhood experiences via the Adverse Childhood Experiences-International Questionnaire.

RESULTS

A total of 414 students were enrolled in our study with a mean age of 17.18 ± 1.5 years. Exposure to intra-familial violence was more reported than social adversities with 99.1 % and 84 % respectively. Males showed higher rates of internet addiction (82.9 % vs 78.3 %, p < 0.001). Sleep disorders were reported in 94 % of students, predominantly among females (95.4 % vs 91 %, p < 0.001). Our results revealed that ACEs predict sleep disturbances through internet addiction (% mediation =18.3 %, p = 0.005). More particularly, an important mediation effect of internet addiction on the relationship between ACEs and sleep disorders was found among females (% mediation =30 %).

CONCLUSION

Internet addiction was found to be a mediating factor in the relation between ACEs and sleep disturbances among Gafsa high school students.

Validity and reliability of a modified short version of a stigma scale for use among Tunisian COVID ‐19 patients after quarantine: A cross‐sectional study

Background and Aim

The COVID‐19 is a stigmatizing infectious disease even after healing. Until now, no COVID‐19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID‐19 stigma and reduce it effectively. Indeed, stigmatization of COVID‐19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12‐item HIV stigma scale among Tunisian COVID‐19 patients.

Methods

A cross‐sectional study was conducted between November and December 2020 among a representative sample of COVID‐19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12‐item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self‐image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA).

Results

The responses of 346 COVID‐19 patients were obtained. Their median age was 40 years (interquartile range: 30‐54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14‐item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self‐image, and disclosure concerns, respectively.

Conclusion

This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID‐19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

Change of life habits and applying barrier measures after exposure to COVID-19, Mahdia (Tunisia)

Introduction

The COVID-19 pandemic is causing considerable lifestyle changes through barriers measures, lockdown and social distancing. These changes include: Preoccupation with Covid-19 pandemic news, sleep disturbances and eating habits changes.

Aim

To assess the lifestyle changes after exposure to a risk of coronavirus contamination.

Methods

We conducted a cross sectional study during November and December 2020 among adults tested for COVID-19 in Mahdia (Tunisia).To assess the life habits changes (sleep, physical exercises and diet), the compliance with barrier measures and preoccupation with COVID-19 pandemic news, a reliable tool was developed and pretested by experts at the department of Preventive and Community Medicine

Results

A total of 277 participants were enrolled, the average age was 34.32 years ± 13.7. Among them 60.8% were women (sex-ratio = 0.51).Almost two thirds 62.2% were tested positive for Covid-19. Doctors presented 29.2% of the respondents. Among the study sample, 38.6% lived with elderly people. Approximately three quarters 77.8% reported an improvement in compliance with barrier measures. The majority 92.1% respected more the social distancing. As for hand washing and for mask wearing, 87.7% said to wash their hands more, and 95.3% were more concerned about wearing masks. A life habits change was observed among 16.7% of the respondents. Almost half of the participants 45.5% increased their physical activity, while 76.2% tried to get a healthy diet. Sleep disorders were registered among 48.7% of respondents. Preoccupation with the COVID news was observed in approximately half of the participants (57.8%).

Conclusions

The COVID19 pandemic affected different aspects of our lives. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.

Key messages

A life habits change was observed among 16.7% of the respondent, sleep disorder were registered among 48.7%, and 77.8% reported and improvement in applying barrier measures.

Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.

The fear of Covid-19 and its predictive factors among health care workers in Mahdia Tunisia

Background

The massive spread of the corona virus being relatively deadly, leads to psychological pressures dominated by an atmosphere of panic and worries mainly among Health Care workers (HCWs). Only few studies have evaluated this impact on HCWs mental health in Tunisia.

Aim

we aimed at determining the prevalence of corona virus fear and its associated factors among HCWs in the University Hospital Tahar Sfar Mahdia (Tunisia).

Methods

We conducted a cross sectional study among HCWs staff in the University Hospital Tahar Sfar Mahdia which is located in the Central-East part of Tunisia in December 2020. The fear of corona virus disease was assessed using the valid French version of the Fear of Covid-19 Scale (FCV-7).

Results

A total of 173 professionals were recruited with a mean age of 35.35 ± 9.31 years. Among them, 66% were women. One third of participants (33.3%) were medical professionals. Almost, 68% have experienced a high level of fear. Our survey showed a significantly higher level of fear among females 70.1% and elderly people 60.8%. It was positively associated (p &lt; 0.05) with anxiety and depression, high risk perception and the responsibility degree of being a virus vector for their loved ones. Anxiety and depression disorders (standardized β = 3.118, CI = 0.545-5.832,p=0.018), high risk perception (β = 3.321,CI = 0.097-6.545, p = 0.044), knowledge about Covid-19 transmission (β = 2.586, CI = 0.439-4.734, p = 0.019), degree of responsibility (β = 3.130, CI = 0.373-5.887, p = 0.026), being a doctor (β = -6.475, CI = -8.785- -4.165, p = 0.001) and Perceived Vulnerability to Disease (β = 0.26,CI = 0.157-0.363, p &lt; 001) were found to be predictive factors of corona virus fear in the linear regression model (Adjusted R2 = 0.374).

Conclusions

Authorities should introduce a preventive strategy based on psychological intervention for HCWs to overcome their fear and worries.

Key messages

The high prevalence of the fear of Covid-19 among health care workers is alarming. Its impact on mental health cannot be ignored. The health authorities worldwide should not have as objective only the reduction of the transmission, but also the work on individual fears to ensure a society totally free of covid-19.

Perceived Stress related to COVID-19 among Tunisian adults during the lockdown period

Background

Public health emergencies such as the Covid-19 pandemic can affect the health, safety and well-being of individuals and communities. This pandemic may lead to emotional reactions such as stress, anxiety and depression in the general population.

Aim

To evaluate the perceived stress among Tunisian adults during the period of lockdown.

Methods

A cross-sectional study was conducted during the lockdown period targeting adults using online social networks. The data was collected through a “Google Form” questionnaire published on Face book. Perceived stress was measured using the ‘Perceived Stress scale'.

Results

A total of 164 adults participated in our study with a majority of women (77.4%) and a mean age of 34.57 ± 12.1 years. Almost half of our participants (48.1%) were from the Governorate of Sousse. Among the respondents, 58.5% felt in perpetual threat and only 15.4% knew how to manage their stress. Univariate analyses showed that perpetual threat was significantly associated with age (p = 0.015), being single (p = 0.03) jobless (p = 0.02), and spending more than one hour documenting on COVID-19 (p = 0.02). After adjusting to sex and age; the multivariate analysis showed a statistically significant association between stress level and anxiety p &lt; 10-3; OR: 8.62; IC [3.1-23.8]); fear of catching the virus (p = 0.031; OR: 3.10; IC [1.1-6.7]) and insomnia (p = 0.001; OR: 7.46; IC [2.4-24.7]).

Conclusions

Our results showed that there is a high prevalence of stress in the general population during confinement. A national program of population mental health management should be implemented along with the pandemic management.

Key messages

The COVID 19 may lead to emotional reactions such as stress, anxiety and depression in the general population. A national program of population mental health management should be implemented along with the pandemic management.

Adverse childhood experiences and health risk behaviours by gender among Tunisian adolescents

Background

Adverse Childhood Experiences (ACEs) have become an alarming phenomenon exposing individuals at a great risk of developing mental health issues. To date, there remains a lack of adequate researches on ACEs especially among adolescents. This survey aimed to describe the prevalence of childhood adversities and to determine their role in developing risky behaviours amongst Tunisian youth.

Methods

We conducted a cross sectional study among schooled adolescents in the governorate of Mahdia (Tunisia) from January to February 2020. Exposure to violence was assessed using the validated Arabic version of the WHO ACE questionnaire. The Internet Addiction Test (IAT) and the Hospital Anxiety and Depression scale (HAD) were used as a screening tool for internet addiction, anxiety and depression.

Results

A total of 1940 adolescents were recruited. The majority of them (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported ACE categories. According to gender, males had higher rates of exposure to physical abuse and social violence than females. The most common risky behaviour was internet addiction (50%) followed by substance use (16.6%). After adjustment for anxiety and depression, the dose-response association between ACE and risky behaviours was well established.

Conclusions

These results among youth have both public health and societal implications.

Key messages

The prevalence of exposure to adverse childhood experiences as well as risky behaviors are alarming among Tunisian adolescents. Screening addictive behaviors among youth with a history of childhood adversities is needed.

The impact of childhood adversity on addictive behaviours through impulsivity among adolescents

Background

Little is known about the mechanism by which Adverse childhood experience (ACE) affects adolescent's engagement in addictive behaviours in the African context. We investigated the role of impulsivity in the link between ACE and behavioural addiction among schooled youth in Tunisia.

Methods

We performed a cross sectional study among 1940 schooled adolescents in the region of Mahdia (Tunisia) from January to February 2020. We used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale as well as the Internet Addiction Test were used as screening tools for impulsivity and internet addiction.

Results

A total of 1940 adolescents returned the questionnaires. About 97.5% reported experiencing at least one ACE. We found that ACEs score predict addictive behaviours through impulsiveness (p &lt; 0.001; % mediated = 16.7%). Particularly, intra-familial ACEs (p &lt; 0.001; % mediation = 27.8%) demonstrated the most mediation by impulsivity followed by exposure to extra-familial ACEs (p &lt; 0.001; % mediation = 10.5%). There were interactions between ACE and impulsivity in terms of their impact on internet addiction (p &lt; 0.001; % mediation = 37.5%).

Conclusions

The mediation part of impulsivity in the association between ACE and cyberaddiction is alarming.

Key messages

Impulsive behaviors mediates the effect of childhood adversity on addictive behaviors. Great mediation part of impulsivity (37.5%) for internet addiction among Tunisian youth.

Social stigma among COVID-19 patients after quarantine in Sousse, Tunisia

Background

Assessing stigma related to COVID-19 is crucial to better understand the pandemic's impacts and establish effective stigma-reducing interventions. The aim of this study was to screen for stigma and evaluate its associated factors among adults with COVID-19 living in the governorate of Sousse (Tunisia).

Methods

A cross sectional study was conducted among a representative sample of patients with COVID-19 between the 6th of November and the 12th of December 2020 in the governorate of Sousse. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context.Three pre-trained medical doctors administrated the pre-tested Arabic questionnaire to each participant by phone calls. Higher scores reflect a higher level of perceived Covid-19-related stigma.

Results

Responses of 346 participants with COVID-19 infection were obtained. The majority of participants were females (60.4%) with a median age of 40 years (interquartile range, 30 to 54.5 years). Among them, 12.7% were health professionals and 12.5% had at least secondary educational level. Because of COVID-19 illness, 17.1% reported financial deterioration. We found mean scores of 14.6 ±4.07, 6.8±2.39 and 6.2±1.95 for social stigma, disclosure concerns and negative self-image dimensions respectively. Social stigma score was significantly higher among adults (14.9±3.9 versus 13.05±4.4 among elderly; p = 0.01) and people with low socioeconomic level (15.8±4.8 versus 14.3±3.8; p = 0.02). Lower scores of social stigma were found among health caregivers (13.3±2.6 versus 14.8±4.2; p = 0.002). Those factors remained as predictors of social stigma after linear regression analysis.

Conclusions

Screening for stigma is required in order to identify the most vulnerable patients and could prevent among them social repercussions. Psychological assistance of patients with social stigma would help them to overcome this crisis.

Key messages

Being adult with low socioeconomic level and not being health worker were determinants of social stigma.

Psychological assistance for COVID-19 patients is crucial to prevent social stigma repercussion during this outbreak.

Perceived vulnerability to Covid-19 among health care workers in a Tunisian University Hospital

Background

Health Care workers (HCWs) are constantly on the front line during the current pandemic, facing a permanent influx of patients with a significant risk of viral contamination. Our study aimed at estimating the corona virus disease high risk perception and evaluating determinant factors of the perceived vulnerability to Covid-19 among HCWs in the region of Mahdia (Tunisia).

Methods

We conducted a cross sectional study among HCWs in the University Hospital Tahar Sfar Mahdia in Tunisia in December 2020. The perceived vulnerability to disease was assessed using the validated perceived vulnerability to disease scale (PVDS).

Results

A total of 173 professionals were recruited with a mean age of 35.35 ± 9.4 years. Among them, 66% were women. One third of participants (33.3%) were doctors. The majority of them (86%) have experienced a high level of risk perception. The older HCWs (p = 0.04), the nursing personnel (p = 0.02), as well as, those with pre-existing chronic diseases (p = 0.04) perceived greater vulnerability to Covid-19. It was also significantly associated (p = 0.01) with undressing faults. Being older (standardized β = 0.193, CI = 0.601-7.707, p = 0.003), having pre-existing chronic diseases (β = 0.184, CI = 0.478-8.888, p = 0.05), high risk perception (β = 0.162, CI= -0.087-10.47, p = 0.02) and undressing faults (β = 0.224, CI = 0.582-1.306, p = 0.008), were found to be the determinant factors of the perceived vulnerability to disease PVD in a multivariate linear logistic regression model (adjusted R2=0.129).

Conclusions

Perceived vulnerability to Covid-19 is mainly manifested by an atmosphere of fear of getting infected, but also by compliance with barrier measures. This fact is aligned with health authorities's strategies to ensure a society totally free of Covid-19.

Key messages

During the current Covid-19 pandemic the majority of health care workers worldwide have experienced a high level of risk perception which negatively impacts their mental health.

Health care workers must be provided with the personal protective equipment PPE essential to protect themselves against the Covid-19 transmission.

Validation of the 12-item HIV-stigma scale adapted for use among Tunisian COVID-19 patients

Background

Although, there is a rapidly accumulating body of studies on the various aspects of COVID-19, little interest was given to develop valid specific scales measuring COVID-19-related stigma. The current study aims to testvalidity and reliability ofa modified version of the 12-item HIV Stigma Scale, adapted for adults with COVID-19 infection living in the region of Sousse (Tunisia).

Methods

A cross sectional study was conducted among patients with COVID-19 infection between November and December 2020. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context. A preliminary version with twenty items covering the four dimensions of COVID-19 stigma was tested (Personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The psychometric evaluation included internal consistency as well as principal component analysis (PCA).

Results

Responses of 346 COVID-19 patients were obtained.Among participants, 60.4% were women with a median age of 40 years (interquartile range, 30 to 54.5 years). Evidence for internal validity was supported by a PCA, suggesting a three factor solution with fourteen items. The 14-item scale demonstrated good internal consistency. The global Cronbach'sα was 0.91, with values of 0.94, 0.93 and 0.98 for social stigma, negative self-image and disclosure concerns respectively.

Conclusions

The results suggest construct validity and reliability of the 14-item stigma scale measuring three aspects related to COVID-19 infection in Tunisia.

Key messages

The 14-item stigma scale is a good psychometric tool to be used in assessing COVID-19 related stigma in Tunisia.

Monitoring COVID-19 stigma with a valid and reliable would guide its prevention actions.

Assessment of cardiovascular risk factors in the health care centers among a Tunisian adults

Background

Almost one third of deaths worldwide are attributable to cardiovascular diseases (CVD). In Tunisia, although a national strategy for the management of high blood pressure and diabetes has been implemented since 1999, CVD still represent a common cause of death. Purpose: To evaluate the assessment of cardiovascular risk factors in the health care centers among the adults of the governorate of Sousse, Tunisia.

Methods

Cross-sectional study was conducted in 2014 among 1977 adults living in 16 districts randomly selected from the delegations of the governorate of Sousse. Data collection was performed by trained doctors using a pre-tested questionnaire administered by interview to participants in their homes. Blood pressure and anthropometric measures were taken after each interview.

Results

The mean age of the participants was 39.8 (± 13.8) years. The sex ratio F/M was 1.54. Among patients with hypertension, 72% of were unbalanced; while 26.2% of participants without a history of hypertension had high blood pressure. Assessment of physical activity, dietary behaviors and weight in the health centers during the previous year, were reported by 28.3%, 32.6% and 36.5% of participants respectively. Assessment of smoking status and waist circumference were rarer with frequencies of 13.5% and 5.6% respectively.

Conclusions

The current national Tunisian program for diabetes and hypertension management should be reformed. Healthy life style promotion should integrate this national program.

Key messages

Dispite thenational strategy for the management of high blood pressure and diabetes in Tunisia; Cardio vascular disease still represent a common cause of death. The current national Tunisian program for diabetes and hypertension management should be reformed.

Video Game addiction among a Tunisian cohort of adolescents: Incidence and associated factors

Background

The concept of Video Game addiction is not yet recognized in the scientific literature. However, several authors suggest relating excessive video game attachment to addiction behavior, especially among adolescents. The aim of the study is to determine the incidence of video game addiction and its associated risk factors among high school students during the 2018/2019 school year in the governorate of Sousse.

Methods

A prospective longitudinal study with a one-year follow-up was conducted among 404 high school students enrolled in four high schools randomly selected from the governorate of Sousse. The same questionnaire was self-administered to participants in their classrooms in 2017/2018 and then in 2018/2019. The Arabic version of the ‘Game Addiction Scale for Adolescents' was used to detect possible video game addiction.

Results

The mean age of participants was 16.4 ± 1.1 years. Girls represented 66.8% of the sample. During the 2018/2019 school year, 25 adolescent became addicted to video games, with an incidence rate of 6.2%. This incidence was of 10.4% among boys and 4.1% among girls (p = 0.012). Smoking, experimenting cannabis and inhalants were significantly associated with the transition to video game addiction with odds ratio of 3.3 [1.1-9.5], 8.0 [1.9-34.3] and 12.1 [2.5-57.6] respectively.

Conclusions

The current study highlights the extent of video game addiction among adolescents in the governorate of Sousse. A comprehensive approach to prevent and manage cross addictions must be implemented in the schools of Tunisia.

Key messages

Incidence of video game addiction is high in high-school adolescents of Sousse. Comprehensive prevention program targeting behavioral addictions and substances use is required in Tunisia.

Discriminatory attitudes against people tested for corona virus in the region of Mahdia (Tunisia)

Background

Several incidents of stigmatization of healthcare workers, COVID-19 patients and their families have come up during the current pandemic across the world.

Aim

To evaluate discriminative behaviors against people tested for Covid-19 in the governorate of Mahdia in Tunisia.

Methods

We performed a cross sectional study among people tested for Covid-19 from November to December 2020 in the region of Mahdia. Discrimination was assessed using a pretested brief questionnaire inspired from the reliable French version of HIV stigma scale. Trained members of the study team explained the study's purpose and collected data from each participant via phone calls.

Results

A total of 277 participants were recruited with a mean age of 34.32 ±13.7 years. Among them, 60.8% were women and 62.2% were tested positive for Covid-19. Fourty three percent of participants were health professionals with 25.3% of them were directly involved in the care of COVID-19 patients. More than half of respondents (61%) have experienced discrimination. Thus, 40% were subjected to verbal and physical assaults. Concerning stigma among health care workers, 60% were doctors and 67.2% have worked in a covid-19 care service. Our survey shows a higher level of Covid-19 related stigma among married respondents and those living with elderly people (46.8% and 43.8% respectively). Discrimination was associated with being a health care professional (p = 0.05), mainly a doctor (p = 0.03) and having COVID-19 infection (p = 0.02).

Conclusions

The continued discriminatory and stigmatising attitudes towards people tested for Covid-19 negatively impacts their access to health care services. We recognise a pressing need to improve the knowledge of Covid-19 transmission, and implement universal precautions across all health facilities.

Key messages

The high prevalence of discriminatory attitudes against people tested for Covid-19 is alarming. It’s an unpleasant experience causing numerous psychological distresses among those who undergo it. Establishing a positive safety culture and providing appropriate education to reduce the stigma towards infected people offers an effective way to improve the quality of care.

Adverse childhood experiences and risky behaviours in two Tunisian University Hospitals

Introduction

According to the Health Word Organization (WHO), adverse childhood experiences (ACEs) have several harmful outcomes on mental health in adolescence and later life. We aimed at investigating the relationship between ACEs and risky behaviors among Tunisian health professionals.

Methods

A cross sectional study was conducted between November 2018 and March 2019 among health care workers in two University Hospitals in Tunisia. We assessed exposure to violence in the hospital, behavioral (cyberaddiction) and chemical addiction (tobacco and alcohol use). ACEs were screened using the Arabic validated version of the Adverse childhood experiences-International Questionnaire (ACE-IQ) developed by the WHO.

Results

A total of 546 health professionals were enrolled with a mean age of 34.5 ± 9.6 years and a majority being female (70%). Almost 34.8% were doctors. The majority of them (67.3%) reported exposure to physical violence at work by patient or their families. The most common hazardous practice was internet addiction (18.5%) followed by tobacco use (13.2%). All health risk behaviors were significantly more prevalent among males and youth (&lt;35 years) (p &lt; 0.01). After adjustment for violence at work and socidemographic characteristics, logistic regression revealed that ACEs especially physical violence (OR = 1.8; IC [1.1-2.9]), emotional abuse (OR = 4.5 [1.2-16.6]) and bullying (OR = 2.6 [1.6-4.2]) increase the risk of the adoption of addictive behaviors among health caregivers.

Conclusions

Policy makers might implement collaborative interventions with psychiatrics targeting the prevention of early life adversities, this could be helpful to delay the onset of risky behaviors.

Key messages

Exposure to early life adversities increase the risk of addictive behaviors among health caregivers. Collaborative interventions with psychiatrics targeting screening childhood adversities could be helpful to delay the onset of risky behaviours.

Knowledge,attitudes and practices of protective equipment use during the outbreak, Mahdia (Tunisia)

Introduction

Health workers, as the first line of defence during infectious pandemic, are also one of the main vectors of coronavirus transmission. Preventing the spread of infection to and from caregivers relies on the effectiveness of personal protective equipment (PPE). This study aimed at assessing knowledge, attitudes and practices related to PPE use in a healthcare setting in the region of Mahdia (Tunisia).

Methods

A cross-sectional study was carried out on December 2020 among health care professionals (HCP) in the University Hospital Tahar Sfar Mahdia. The measurement tool was developed by specialists at the Department of Preventive Medicine after reviewing literature then pretested.

Results

A total of 173 HCP were enrolled with an average age of 35 ±9.3 years. More than half of participants were females (64.7%), 32.9% were doctors and 34.7% were nurses. Among them, 35.8% have worked during a pandemic before. The level of good knowledge was 52%. The main sources of information for HCP were the Ministry of Health (63.6%), social network and media (58.4%). About 25.4% of HCP was satisfied by the preventive measures training received in the hospital. Half of HCP (54.3%) admitted that their knowledge related to the pandemic was not sufficient. While third of the HCP (31.8%) thought that it is necessary to wear the full PPE, 16.8% knew how to put on their PPE and 27.2% knew how to take it off.

Conclusions

Taking into account knowledge, attitudes and practices related to PPE use allows the implementation of a strategy aimed at mastering the management of this equipment by health care workers.

Key messages

Assessing the Knowledge, attitudes and practices related to the personal equipment among health care givers: 52%. Implementation of a strategy aimed at mastering the management of this equipment by health care workers.

Impulsivity mediates the impact of early life adversity on high risk behaviors among Tunisian adolescents

Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI = [47.9-52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated = 16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated = 37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors.

Lessons learned from the fight against COVID-19 in the Great Maghreb. Five lessons for a better response

OBJECTIVE

Identify the lessons learned in the Greater Maghreb, during the first semester of the fight against the COVID-19 pandemic, in the field of response.

METHODS

During the first week of May 2020, a consultation of experts was conducted, using the "Delphi" technique, through an email asking each of them, the drafting of a good practice recommendation for "Public health". The Group coordinator finalized the text of the lessons, later validated by the signatories of the manuscript.

RESULTS

Five lessons of good «response» against epidemics have been deduced and approved by Maghreb experts, linked to the following aspects: 1. Total reservation of hospital beds for patients; 2. Clinical management of the response; 3. Discreet conflict of interest; 4. Community participation in the response; 5. Contextualization of the global fight strategy.

CONCLUSION

Based on the finding of low relevance of the Maghreb response against COVID-19, this list of lessons would help support the performance of Maghreb health systems in the management of epidemics.

Lessons learned from the fight against COVID-19 in the Great Maghreb.Five lessons for better resilience

OBJECTIVE

To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience.

METHODS

An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript.

RESULTS

A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary.

CONCLUSION

Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.

Lessons learned from the fight against COVID-19 in the Greater Maghreb. Five lessons for better preparation

OBJECTIVE

To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of preparation of health systems.

METHODS

An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent to them requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript.

RESULTS

A list of five lessons for the preparation of the national health systems of the Greater Maghreb for the fight against epidemics, was deduced and approved: 1. Liberal health systems are incapable of managing epidemics; 2. The specialties of "Public Health" are often marginalized; 3. Health personnel in the Maghreb are doubly devalued; 4. Flagrant regional disparities in the field of health care are still observed; 5. A general shortage of preventive equipment and medical devices has been noted.

CONCLUSION

Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by the vulnerability of the preparation of health systems, this list of lessons could constitute a roadmap for the reform of health systems. Maghrebian health, towards more performance in managing possible waves of COVID-19 or new emerging diseases with epidemic tendency.

Attitudes of health professionals towards the response to the COVID-19 pandemic in Maghreb

OBJECTIVE

Measuring the attitudes of health professionals in two Maghreb countries (Tunisia and Algeria) with regard to the response to COVID-19 during the first quarter of 2020.

METHODS

This scoping study was based on a "Google Form" covering three constituents of the response plan against COVID-19: responders, activities and crisis communication. The attitudes of health professionals who are working in Tunisia and Algeria were measured through the Likert scale with four propositions, grouped in pairs, during the analysis.

RESULTS

The study population consisted of 280 health professionals, 170 of whom are Tunisians along with 110 Algerians. The medians of age and that of professional seniority are, respectively, 37 and 10 years. The role of "health workers", "Mass Media" and "civil society associations" was found to be satisfactory according, respectively, to 92%, 71%, and 55% of the respondents. As far as 72% of health professionals are concerned, the "barrier measures" were respected by the population. Approximately, seven in ten respondents were satisfied with the quality of communication occuring between the Ministries of Health and its epidemiological structures.

CONCLUSION

Health professionals of the Maghreb working in Tunisia and Algeria had a generally positive perception of the role of population responders, community engagement, and the quality of official communication in regards to the response plan against COVID- 19. This perception would be a prerequisite for the success of community participation and multisectoral action as well as essential in the strategy of prevention and control of this pandemic and of possible other health emergencies.

Counter-COVID- 19 pandemic strategy in the Maghreb Central. Qualitative study of the perceptions of health professionals

CONTEXT

The Maghreb Central, like all the countries of the world, was strongly mobilized (governments, ministries of health, population, civil society) in the response against COVID-19, immediately after the registration of the first cases on its territory (end of February, beginning of March) and according to pre-established control strategies.

OBJECTIVES

Describe the perceptions of health professionals in the Central Maghreb (Tunisia, Algeria and Morocco) as to the Strengths/Opportunities and Weaknesses/Threats of the national response plans against COVID-19, during the first weeks of their execution, and report their proposals for optimizing the performance of control strategies.

METHODS

This is a qualitative study of the perceptions of health professionals in the Maghreb Central regarding their experience of the first six weeks of fighting the COVID-19 pandemic. The data was collected using the "Delphi" technique in one turn, based on an electronic form such as "Google Form", developed according to SWOT analysis. The respondents' verbatim was grouped into homogeneous groups of items, the occurrence of which was subsequently measured.

RESULTS

A total of 382 health professionals from the Maghreb Central participated in this study, with a median age of 37 years and a median professional tenure of 10 years. The major force of the Maghreb response strategies, the most shared by the respondents, was the performance of the human resources mobilized (doctors, biologists, nurses, etc.) who succeeded in quickly learning from the international epidemiological expertise accumulated in Asia and in Europe. The fight against COVID-19 in the Central Maghreb was confronted with the general and chronic fragility of the national health systems and the low support of the general population for the recommendations of the steering committees of response, threatening the capacity of the Maghreb to confront new epidemics.

CONCLUSION

The success of the national response plans against COVID-19 and of possible epidemics or pandemics in the Central Maghreb, is strongly attributed to the commitment of health professionals and to community participation, necessitating the launch of assistant motivation programs. and development of health personnel and mobilization and loyalty of civil society.

Impact of social violence and childhood adversities on pregnancy outcomes: a longitudinal study in Tunisia

Background

Accumulating research suggests that exposure to intra-familial adversities are significant risk factors for adverse pregnancy outcomes. However, the relationship between social violence (peer violence, witnessing community violence and exposure to collective violence) and pregnancy outcomes has not been extensively investigated. Our study aims to examine the association between social Adverse Childhood Experiences (ACEs) and pregnancy outcomes and to explore the role of depression during pregnancy as a mediator of this association.

Methods

We performed a prospective follow-up study of pregnant women in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from September 2015 to August 2016. Enrolled women were followed during the second trimester, third trimester of pregnancy and during the postnatal period. Exposure to violence was assessed retrospectively using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. The Self Reporting Questionnaire 20-Item (SRQ-20) was used as a screening tool for depression during pregnancy.

Results

We recruited and followed a total of 593 women during the study period. Witnessing community violence was the most frequently reported social ACE among pregnant women (237; 40%), followed by peer violence (233; 39.3%). After adjustment for high risk pregnancies, environmental tobacco smoke, and intra-familial ACEs, the risk of premature birth was significantly associated with exposure to collective violence (P < 0.001) and witnessing community violence (P < 0.05). The risk of low birth weight was significantly associated with witnessing community violence (P < 0.001). In the mediation analysis, depression mediated significant proportions of the relationship between the cumulative number of ACEs and pregnancy outcomes.

Conclusions

Social ACEs may have a long-term effect on maternal reproductive health, as manifested by offspring that were of reduced birth weight and shorter gestational age. A public health framework based on the collaboration between pediatric, psychiatric obstetrical health professionals, education professionals and policy makers could be applied to ensure primary prevention of childhood adversities and pay attention to expected mothers with history of exposure to such adversities.