L'influence de la COVID-19 sur la santé mentale des enseignants Tunisiens

Contexte

Au fur et à mesure que le virus du SARS-COV 2 se propageait, un climat de panique et de suspicion s'installait partout notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à étudier l'association de la COVID-19 et l'atteinte mentale grave chez les enseignants Tunisiens.

Méthodes

Une étude transversale moyennant un auto-questionnaire était menée sur un échantillon représentatif des enseignants du niveau secondaire entre mars et avril 2021 à Sfax, Tunisie. La santé mentale était estimée par l’échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Au total, 525 enseignants participaient à l'étude. Parmi eux, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile=[41-53]). Quatre cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La prévalence de la COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux cents enseignants avaient peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N=314). Les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA)=1,6 ; p=0,02), un antécédent de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence d'atteinte mentale grave.

Discussion/Conclusion

Les résultats de cette étude suggèrent que la COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial demeure une obligation à planifier.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Ampleur de l'infection du SARS-COV2 chez les enseignants et son impact sur leur santé mentale

Introduction

Les épidémies engendrent un climat de panique et de suspicion qui se propage plus rapidement que l'agent pathogène lui-même. C'était le cas durant l'épidémie de COVID-19 notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à estimer la prévalence de la maladie COVID-19 chez les enseignants et à étudier son association avec la détresse psychologique.

Matériels et méthodes

Il s'agissait d'une étude transversale moyennant un auto-questionnaire, menée sur un échantillon représentatif de 525 enseignants du niveau secondaire entre Mars et Avril 2021. La santé mentale était estimée par l'échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Parmi les 525 enseignants participants à l'étude, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile= [41-53]). Quatre-cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La notion de contage pour la COVID-19 était notée chez 184 cas (35 %). La prévalence de la maladie COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux-cents enseignants avaient la peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N= 314). Dans l'analyse multi-variée par régression logistique binaire, les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA) =1,6 ; p=0,02), un antécédant de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence de maladie mentale grave.

Conclusion

L'état de santé mentale représente un problème majeur de santé publique pendant cette pandémie. Les résultats de cette étude suggèrent que la maladie COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial devrait être pensé par les acteurs communautaires et sanitaires.

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Profil épidémiologique et aspects cliniques du COVID long

Introduction

Depuis l'évolution de la pandémie COVID-19, plusieurs études documentaient la persistance de séquelles et de symptômes à distance de la phase aiguë de la maladie baptisé COVID long. Cette entité émergente cliniquement peu spécifique, restait sans définition consensuelle jusqu'à peu du temps. Notre étude visait à déterminer la prévalence du COVID long, ses caractéristiques cliniques et ses facteurs prédictifs.

Matériels et méthodes

Il s'agissait d'une étude transversale observationnelle par méthode d'entretien téléphonique durant le mois de Janvier 2021. Les patients de la liste régionale exhaustive des patients testés positifs pour SARS-Cov-2 durant le mois d'Octobre 2020 étaient inclus dans notre étude. Les mineurs et les patients décédés étaient exclus. Un délai minimal de 8 semaine définissait le COVID long. Un questionnaire était utilisé pour évaluer les caractéristiques sociodémographiques et cliniques du patient.

Résultats

Au total, 2070 patients participaient à l'étude. Il y avait 1230 femmes (59,4 %) soit un ratio hommes/femmes de 0,68. L'âge médian était de 40 ans [intervalle semi-interquartile (ISI) : 12,5 ans]. L'obésité était la maladie chronique la plus fréquente chez 402 patients (19,4 %). Il y avait 258 patients hypertendus (12,5 %), 190 patients diabétiques (9,2 %), 108 patients dyslipidémiques (5,2 %) et 247 fumeurs actifs (12 %). La prévalence du COVID long était de 41,6 % (N=861). Parmi eux, 229 patients (26,5 %) ont consulté un médecin au sujet de leur COVID long et 122 patients (14,13 %) ont complété par une exploration paraclinique. Selon les manifestations cliniques, les symptômes décrits du long COVID étaient l'agueusie (68,9 %), les problèmes de concentration et de mémoire (24,9 %), la fatigue (17,4 %), les céphalées (10,4 %), l'anosmie (6,5 %), la dyspnée résiduelle (5,9), les douleurs thoraciques (4,4 %) et les palpitations (4,2 %). Les facteurs indépendants associés au COVID long étaient l'âge inférieur à 60 ans (Odds Ratio ajusté (ORA)=1,8 ; IC=[1,5-2,66] ; p<0,001), le sexe féminin (ORA=1,6 ; IC=[1,35-1,96] ; p<0,001), l'antécédent de maladie respiratoire (ORA=1,8 ; IC= [1,2-2,8] ; p=0,002), l'antécédant de cancer (ORA=3,5 ; IC=[1,03-12,2] ; p=0,048), le traitement anticoagulant (ORA=1,45 ; IC =[1,1-1,8] ; p=0,002),le traitement par l'acide salicylique (ORA = 1,4 ; IC =[1,1-1,9] ; p = 0,026) et la forme clinique de l'épisode aigue : légère (ORA=5,5 ; IC=[3,5-8,5] ; p<0,001) et modéré (ORA=7,1 ; IC=[4,2-11,9] ; p<0,001).

Conclusion

La compréhension multidisciplinaire de tous les aspects de la pandémie de COVID-19, y compris ces manifestations à long terme, doit être repensée surtout à la phase post-vaccinale. Le COVID long pose de plus en plus un problème de santé publique vu sa fréquence et sa gravité. Par conséquent, des consensus de suivi systémique des patients COVID-19 à long court s'avèrent alors nécessaires pour une meilleure évaluation diagnostique, pronostique et thérapeutique de cette nouvelle entité.

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Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Introduction

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015.

Methods

We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

Results

We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005).

Conclusions

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients.

Key messages

Non-communicable diseases. Morbidity and mortality.

Is internet addiction related to self-esteem and insomnia among engineering students?

Introduction

With the availability and mobility of new media, Internet addiction (IA) has emerged as a potential problem in young people which refers to excessive computer use that interferes with their daily life, with harmful behavioral-psychological impact. The aim of this study was to estimate the prevalence of IA among engineering students (ES) and to evaluate its relationship with self-esteem and insomnia.

Methods

In a cross-sectional survey using an anonymous self-administered questionnaire, data was collected from a randomized sample of 305 ES in Sfax, Southern Tunisia. Previously validated and standardized scales including Insomnia Severity Index (ISI) and Rosenberg self-esteem and Internet Addiction Test (IAT) were performed.

Results

Among 305 ES, 185 (60.7%) were females, giving a male to female ratio of 0.6. Their mean age was 22.9 ± 2.6. Prevalence of internet addiction was 41.3% (N=); it was moderate in 102 ES (80.9%) and severe in 24 ES (19.1%). As for insomnia and low self-esteem, their prevalence rates were 59.6 and 28.2%, respectively. Unhealthy lifestyle behaviors including mixing cannabis with tobacco (OR = 11.2; p = 0.02), skipping meals once a day (OR = 3.6; p = 0.041), first use of smartphones at younger age (OR = 2.2; p = 0.042) and spending ≥3 hours per day on line (OR = 3.2; p = 0.032) were statistically associated with internet addiction. Academic failure during the last year (OR = 2.02; p = 0.04) was significantly more frequent among internet addicted ES. Moreover, mental health disorders, notably feeling frequently in depressive mood (OR = 1.9; p = 0.048), insomnia (OR = 1.24; p = 0.007) and low self-esteem (OR = 2.62; p = 0.003) were statistically associated with internet addiction.

Conclusions

Ranking at an alarming rate, internet addiction has been found to have a very strong relationship with insomnia and low self-esteem among ES, and at times it affected their social life and their relationship with their family.

Key messages

Internet addiction among engineering students. Insomnia and self-esteem among engineering students.

Are lifestyle behaviors correlated to mental health disorders in medical students?

Background

Recently, there has been a renew interest to medical students’ mental health, which may be influenced by several sociodemographic and cultural factors, academic overload, but also by lifestyle behaviours. This study aimed to assess the correlation between major lifestyle behaviors and mental health in medical students.

Methods

A cross-sectional questionnaire survey was conducted among 521 medical students randomized from different levels, at Southern Tunisia Medical School, 2017. The 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) were used to assess mental health and lifestyle, respectively.

Results

The mean values of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. According to SLIQ components, we noted an unhealthy lifestyle in 36.9%, 50.1% and 20.2% for diet, physical activities and stress level, respectively. The prevalence of psychological distress (GHQ-12≥4) was 50.1%. The GHQ-12 items analysis revealed that 235 cases (45.1%) were unable to concentrate, 237 cases (45.5%) felt unhappy and depressed and 195 cases (37.4%) had a loss of sleep over worry. Low family financial situation (Odds Ratio (OR)=1.5;95%CI = [1.1-2.3]), internship level, (OR = 1.8;95%CI = [1.1-3.3]) and medium/poor academic performance (OR = 2.2;95%CI = [1.5-3.2]) were significantly associated with psychological distress. Multivariate analysis showed that unhealthy lifestyle was independently associated with psychological distress (Adjusted OR = 5.8;95%CI = [2.4-14.8]).

Conclusions

Our study highlighted the magnitude of psychological distress in medical students. Unhealthy life style was a potential predictive of mental disorders. These findings are extremely useful for guiding future curricular changes upon entry into medical schools.

Key messages

Mental disorder prevalence ranked at an alarming rate among medical students. Promoting healthy life style represents a reliable tool to sustain a good quality of life for the future-doctors.

What are the determinants of body image distortion and dissatisfaction among Tunisian teenagers?

Background

Body image (BI) is considered as central to many aspects of human functioning including emotions, thoughts, behaviors and relationships. This study aimed to investigate the prevalence and the main determinants of distortion and dissatisfaction among teenagers.

Methods

This was a cross-sectional school-based study using a self-administered questionnaire, conducted among a randomized sample of 1300 school-adolescents in Southern Tunisia, 2018. BI perception was assessed by the Stunkard Figure Rating Scale.

Results

Among 1210 respondents (93%), BI distortion and dissatisfaction prevalence were 44.8% and 42.4%, respectively. Multivariate analysis showed that 16-18 years age group (Adjusted Odds Ratio (AOR)=1.28; p = 0.046), low family financial situation (AOR=1.88; p = 0.014), as well as high frequency of eating pasta (AOR=1.3;p=0.04) and fast-food consumption (AOR=1.7;p=0.042) were independently associated with under-estimated BI. Skipping breakfast (AOR=1.9; p = 0.017) and having one obese parent (AOR=1.9;p=0.01) were independently associated with higher frequency of over-estimated BI. For BI dissatisfaction, independent factors associated with desire to lose weight were female gender (AOR=1.53; p = 0.007), high family financial situation (AOR= 2.1,p=0.008) and having one parent obese (AOR=2.21,p&lt;0.001). Frequent fast-food consumption (AOR=1.9, p = 0.038) and eating between meals (AOR=1.57,p=0.01) were associated with higher desire to gain weight.

Conclusions

Our study highlighted a substantially high prevalence of BI distortion and dissatisfaction among adolescents. Their determinants included socio-demographic factors and lifestyle behaviors. Increased awareness among parents and public health planners may help adolescents improve accuracy of BI attitudes.

Key messages

BI distortion and dissatisfaction are pervasive problems that increased negative affect in adolescents. Promotion of healthy lifestyle including balanced diet and physical activity is warranted.

Is school furniture design a contributing factor to low back pain in adolescents?

Background

Recent evidence showed that low back pain (LBP) is frequent among youth. Individual etiologic factors are most often associated with musculoskeletal overuse and altered postural control. This study aimed to evaluate the association between school furniture design and LBP in school-adolescents.

Methods

A cross-sectional study was conducted using a self-reported questionnaire distributed to school-adolescents aged 12-18 years, in Southern Tunisia, 2018. We performed a stratified three-step sample to obtain a representative sample of 1400 subjects.

Results

The response rate was 87.2% (1221 students). The mean schoolbag weight was 3±1.3 kg. The schoolbag to body weight ratio was 0.05±0.03. The main method of carrying a schoolbag was on both shoulders (57.2%). During the last 3 months, LBP was reported in 391 cases (32%). Multivariate analysis using logistic regression showed that high-school grade was independently associated with LBP (Adjusted Odds Ratio (AOR)=2.7;95% CI = [1.9-3.7];p&lt;0.001). Classroom furniture and layout design independently associated with LBP included too low seat backrest (AOR=1.4;95% CI = [1.12-1.87];p=0.005), too far seat to black(board) distance (AOR=1.5;95% CI = [1.1-2.2];p=0.041), schoolbag to body weight ratio ≥10% (AOR=1.7;95% CI = [1.2-2.4]; p = 0.002) and carrying schoolbag for 30-60 minutes (AOR=1.48;95% CI = [1.1-2.1]; p = 0.029). Otherwise, carrying school bag by hand (AOR=0.25; 95% CI = [0.07-0.89]; p = 0.033) was found to be independently associated with lower prevalence of LBP complaints.

Conclusions

Current design of school furniture is not compatible with the adequate purposed dimensions in students. It increased substantially the risk of LBP, which emphasizes the need for multi-disciplinary approach involving teachers, policy makers and health care professionals.

Key messages

School related LBP may threaten the physical performance and the social life of adolescents. Revising school environments and radical ergonomic interventions are mandatory.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

INTRODUCTION

Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs).

METHODS

We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM).

RESULTS

We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001).

CONCLUSION

Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.