Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia

INTRODUCTION

The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP.

METHODS

This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022).

RESULTS

In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P  = 0.010) and (75 [70-80] vs. 80 [75-80]; P  = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P  = 0.022), HBP symptoms (OR = 9.1; P  < 0.001), and HBP complications (OR = 12.3; P  < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P  = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P  = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P  = 0.028).

CONCLUSIONS

Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.

Direct medical cost related to the management of pemphigus: A pilot Tunisian study

INTRODUCTION

Pemphigus is a therapeutically challenging disease with high morbidity and economic burden. First-line prescription of rituximab remains limited in Tunisia due to its high cost. Systemic steroids remain the standard of care but are associated with a major risk of morbidities and higher treatment costs.

AIM

To assess the direct medical costs of pemphigus in Tunisia.

METHODS

Retrospective estimation of direct medical costs during the 18 months following the diagnosis using the "bottom-up approach" in the Dermatology Department of Hedi Chaker Hospital, Sfax, Tunisia.

RESULTS

Total medical costs were estimated at 38745.7 €, with an average cost of 1 210 € per patient and per year: paraclinical investigations (46%), medical treatment (30%), hospitalization (21%) and outpatient visits (3%). The average cost was the highest in the age group of 15-24 years (1553 €). Treatment costs related to corticosteroid-induced morbidity were estimated at 1208 €.

CONCLUSIONS

The management of pemphigus in Tunisia needs to be adapted to take into account the health economic analysis in order to reduce overall disease costs and the burden of steroid-induced morbidities.

Effectiveness of a training program on health-care professionals' knowledge and practices regarding thermo-sensitive reusable medical devices disinfection: A quasi-experimental study

INTRODUCTION

Appropriate knowledge of healthcare professionals (HCPs) on the various aspects of disinfection and reuse of medical devices is a basic requirement to ensure proper disinfection and to minimize the risk of healthcare associated infections. In this regard this study aimed to assess the effectiveness of a training intervention on knowledge and practices regarding thermosensitive reusable medical devices (TRMD) disinfection among HCPs.

METHODS

This was a quasi-experimental study including a pre-test, an intervention (workshops, demonstrations, posters), and a post-test evaluation of the HCPs' knowledge and practices regarding the disinfection of TRMD. It was conducted between February and July 2022 at Hedi Chaker University hospital, Sfax, Southern Tunisia.

RESULTS

Overall, 31 participants were females (54.4%). The global Knowledge Score (KS) had significantly risen from pre-to post-training test (61.0 ± 9 vs 74.0 ± 12.5; p < 0.001). According to the disinfection type, the KS of non-critical and critical TRMD disinfection had significantly increased between pre and post-intervention (60 (IQR = [40.0-80.0]) vs 80 (IQR = [40.0-80.0]), p < 0.001) and (66.6 (IQR = [50.0-66.6]) vs 83.3 (IQR = [66.6-100.0]); p < 0.001) respectively. The mean change in global KS of TRMD disinfection was statistically higher among females (17.5 ± 11.2 vs 8.5 ± 3.2; p = 0.006) and medical staff (18.9 ± 11.9 vs 7.1 ± 3.9; p = 0.019). Conformity scores did not significantly change after the training program (58.1 ± 22.7 vs 63.7 ± 19.6; p = 0.678).

CONCLUSION

This study highlighted the effectiveness of the training intervention on HCP knowledge. However, practices were not improved. Conducting ongoing audits with on-the-job training is extremely needed.

Low back-pain among school-teachers in Southern Tunisia: prevalence and predictors

OBJECTIVES

In the professional environment, low back pain (LBP) is a multifactorial symptomatology, despite scientific and technological advances in the design and the arrangement of increasingly ergonomic workstations. Teachers are not exempt from this risk, due to prolonged sitting or standing. In light of this, this study aimed to estimate LBP prevalence among teachers in Southern Tunisia and to identify their determinants.

METHODS

It was a cross-sectional study including a representative sample of teachers from secondary, middle, and primary schools in Sfax, Tunisia, conducted during the period March-April 2021. LBP intensity was assessed using a visual analog scale from 1 to 10. A severe LBP was defined as VAS≥7.

RESULTS

Among the participants, 292 teachers were females (55.6 %). The median age was 48 years (Interquartile Range (IQR)=[41-53] years). Overall, 377 teachers had a severe LBP, with a global prevalence of 71.8 %. Multivariate analysis showed that independent determinants of LBP among teachers were female gender (Adjusted Odds Ratio (AOR)=2.81;p<0.001), age ≥30 (AOR=5.68;p=0.009), chronic diseases (AOR=2.52;p<0.001), working at primary schools (AOR=1.75;p=0.033), working for ≥4 h per day (AOR=2.41;p=0.005), inadequate ergonomic conditions at work (AOR=1.78;p=0.008) and distance home-school ≥10 km (AOR=2.27;p=0.003).

CONCLUSIONS

This study demonstrated that LBP among teachers was alarmingly high. Different individual, ergonomic, and occupational factors were predictors of this symptom. Thus, development of rational strategies for LBP prevention among teachers and the improvement of working conditions are urgently needed.

[Socio-demographic and clinical profile of a population of patients coming for consultation to the psychiatric department of a general hospital in southern Tunisia]

Introduction

mental disorders are a very common health condition and a major public health issue. The purpose of this study was to examine the epidemiological and clinical characteristics of patients coming for consultation to the psychiatric department of the Regional Hospital of Gabes, and to identify risk factors for the main mental disorders.

Methods

we conducted a retrospective study, including all patients consulting the psychiatry department of Gabes for the first time between 01/01/2010 and 31/12/2013. Diagnoses were classified according to the 10^th reversion of the WHO International Classification of Diseases (ICD10).

Results

one thousand one hundred and one consultation cases were included in this study. The sex ratio (M/F) was 0.96. The average age of patients was 34 years (IQR=24-47.5 years), the median time between symptom onset and consultation to the psychiatric department was 1 year (IQR=3months-2 years). The three most common diagnosed were depressive disorders (21%), followed by schizophrenia (10.6%) and mental retardation (9.7%). Depressive disorders were significantly more common among female patients (p<0.001), married patients (p<0.001) and middle-aged adults (40-65 years) (p<0.001). The prevalence of these disorders was not significantly associated with either educational level, professional activity or socio-economic level.

Conclusion

the knowledge of the socio-demographic and clinical profile of the most frequent mental disorders and factors associated with them would make it possible to better adapt the supply of care to the demand and to identify the needs in terms of mental health training in South-East Tunisia.

Adverse effects of personnel protective equipment among first line COVID-19 healthcare professionals: A survey in Southern Tunisia

BACKGROUND

Health care professionals (HCP) were obliged to wear personal protective equipment (PPE) during pandemic in order to minimize the risk of transmission of the emerging virus. The objective of the study was to estimate the prevalence of adverse effects related to the wear of PPE among HCP and to determinate their predictive factors.

METHODS

This was a cross-sectional study including a representative sample of 300 randomized HCP at Hedi Chaker University Hospital Sfax, Tunisia, during the period August-September 2021. Data collection was carried out by an anonymous self-administered questionnaire.

RESULTS

PPE related adverse effects were noted among 87 HCP with a prevalence of 57.2%. Multivariate analysis showed that factors independently associated with PPE adverse effects were female gender (Adjusted Odds Ratio (AOR) = 1.8; p = 0.048), chronic diseases (AOR = 0.29; p = 0.001) and previous infection with COVID-19 (AOR = 0.46; p = 0.004). Frequent use of bleach or other disinfection product without protection and use of hot water at work were independently associated with a high risk of adverse effects ((AOR = 2.22; p = 0.003) and (AOR = 2.83; p = 0.005), respectively). Similarly, a duration of use of PPE>4 h per day (AOR = 1.98; p = 0.039), as well as use of visors and/or glasses (AOR = 1.84; p = 0.045) were independently associated with PPE related adverse effects.

CONCLUSION

The prevalence of adverse effects related to the wear of PPE was alarmingly high among HCP. Multiple risk factors were highlighted, notably professional aspects. Adequate and repetitive training for caregivers on the correct use of PPE remain essential to manage this problem.

COVID-19-Related Fear and Mental Distress Among Tunisian Primary, Middle and High School Teachers: Prevalence and Predictive Factors

This study aimed to determine the prevalence and predictive factors of fear of COVID-19 and serious mental distress among teachers in public schools of Southern Tunisia. This was a cross sectional study among a representative sample of 525 teachers. The level of Fear was assessed using the Fear of COVID-19 Scale (FCV-19S). A high level was defined as an FCV-19S ≥ 22. Kessler 6 (K6) was performed to predict serious mental distress. Serious mental distress was defined as a K6 score ≥ 13. The prevalence rates of high level of fear of COVID-19 and serious mental distress were 32.8% and 63.8%, respectively. Independent factors associated with a high level of fear of COVID-19 were female gender (Adjusted odds ratio (AOR)=1.6 [1.1-2.5]), chronic disease (AOR=1.6 [1.1-2.4]), home-living children (AOR=3.3 [1.4-7.8]), and poor material working conditions (AOR=1.5 [1.2-2.1]). The high level of fear of COVID-19 (AOR=3.1 [1.8-5.1]) was independently associated with serious mental distress. Living in a rural area (AOR=0.4 [0.3-0.8]), previous COVID-19 infection (AOR=0.5 [0.4-0.8]) and going to school on foot (AOR=0.3 [0.2-0.51]) were independently associated with a lower prevalence of serious mental distress.

Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995-2016

Background

Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy.

Aim/Objective

This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia.

Methods

A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant.

Results

Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024).

Discussion

A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.

Prevalence and Factors Affecting Willingness to Accept or Refuse Vaccination against COVID-19 among Healthcare Professionals in Southern Tunisia

BACKGROUND

The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. Health care professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. This study aimed to estimate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors. Methods: This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of HCP in Southern Tunisia, on March-April 2021. Results: Among 300 participants, the COVID-19 vaccine acceptability rate was 65.3%. Factors independently associated with vaccine acceptability were age groups <30 years [Adjusted Odds Ratio (AOR)=4.36; p = 0.002)], urbanity of residence (AOR = 3.44; p = 0.027), medical professional category (AOR = 2.69; p = 0.023) and caring for coronavirus infected patients (AOR = 2.32; p = 0.047). Belief that COVID-19 vaccination is important to work safely as a health care provider (AOR = 3.26; p = 0.013), should be available for all HCP (AOR = 17.98; p = 0.004) and has been quickly developed before it has been thoroughly vetted and tested for efficacy and safety (AOR = 5.88; p < 0.01) were independently associated with willingness to accept vaccine. Planning to get a COVID-19 vaccine for the next years and recommending it to the family were independent predictive factors of accepting COVID-19 vaccine ((AOR = 6.88; p < 0.001) and (AOR = 25.03; p < 0.001), respectively).Conclusion: The acceptance rate of vaccination against COVID-19 among Tunisian HCP is still low in South Tunisian hospitals. Socio-demographic, cultural and professional factors predisposing to the vaccination willingness were highlighted. Combating the vaccine hesitancy of HCP through enhancing sensibilization campaigns is essential to promote vaccination in general population.

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.

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Les effets indésirables des équipements de protection chez les professionnels de santé

Contexte

Les professionnels de santé (PDS) étaient obligés de porter les équipements de protection individuels (EPI) au cours de leur exercice en pandémie, afin de minimiser le risque de transmission du virus émergent. L'objectif de cette étude était de quantifier la prévalence de survenue des effets indésirables (EI) relatifs au port des EPI chez les PDS et d’étudier les facteurs qui lui sont associés.

Méthodes

Il s'agissait d'une étude transversale ayant inclus un échantillon représentatif de 300 PDS randomisés dans le CHU Hedi Chaker de Sfax, Tunisie, durant la période août-septembre 2021. Le recueil des données était réalisé par un questionnaire auto-administré anonyme.

Résultats

Au total, 218 sujets étaient de sexe féminin (72,7 %), l’âge moyen était de25,6 ± 3,49 ans. Selon la profession, 202 cas étaient des médecins (67,3 %) et 26 sujets avaient une ancienneté ≥ 10 ans (8,7 %). Les EI relatifs au port des EPI étaient notés chez 87 PDS, soit une prévalence de 57,2 %. L'analyse multivariée a montré que les facteurs indépendamment associés aux liés au port d'EPI chez les PDS étaient le sexe féminin (Odds Ratio Ajusté (ORA)=1,8 ; p=0,048), avoir des maladies chroniques (ORA=0,29 ; p=0,001) et avoir une infection antérieure par la COVID-19 (ORA=0,46 ; p=0,004). L'utilisation fréquente d'eau de Javel ou autre produit de désinfection sans protection et l'utilisation d'eau chaude en milieu de travail étaient indépendamment associées à un risque élevé d'effets indésirables ((ORA=2,22 ; p=0,003) et (ORA=2,83 ; p=0,005), respectivement). De même, la durée d'utilisation des EPI > 4 heures par jour (ORA=1,98 ; p=0,039), ainsi que l'utilisation de visières et/ou de lunettes en milieu de soins (ORA=1,84 ; p=0,045) étaient statistiquement plus associés à la survenue de EI chez les PDS.

Discussion/Conclusion

La prévalence des EI relatifs au port des EPI était importante. Des multiples facteurs lui étaient associés notamment professionnels. Des formations adéquates et répétitives destinés aux PDS portant sur le bon usage des EPI demeurent indispensables pour gérer ce problème.

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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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Connaissances, attitudes et des pratiques des professionnels de santé vis-à-vis de la vaccination contre la COVID-19

Introduction

Devant la pandémie mondiale de COVID-19, un des seuls espoirs réside dans le développement d'un vaccin efficace. Les professionnels de santé (PDS) étant les plus exposés à cette maladie, ils sont les premiers à se faire vacciner. Cependant, la perception des PDS de ce vaccin n'était pas suffisamment évaluée. L'objectif de cette étude était d'étudier les connaissances, les attitudes et les pratiques face à la vaccination anti-COVID-19 chez les PDS.

Matériels et méthodes

Il s'agissait d'une étude observationnelle transversale ayant inclus un échantillon représentatif randomisé de 300 professionnels de santé dans un CHU durant la période de Mars-Avril 2021. Des scores préétablis sur 100 étaient utilisés pour évaluer les connaissances, les attitudes et les pratiques des PDS.

Résultats

Au total, 223 PDS étaient des femmes (74,3 %). L'âge moyen était de 29,5 ans ± 8,26. Selon la profession, 178 PDS étaient des médecins (59,3 %). Les valeurs moyennes /100 des scores des connaissances, des attitudes et des pratiques étaient de 54,32 ± 11,37, 83,34 ± 13,18 et de 75,91 ± 11,95, respectivement.

L'analyse multivariée par régression linéaire a révélé que les facteurs indépendants associés à la connaissance étaient la profession médicale (β=0,25 ; p<0,001) et le contact direct avec des patients testés COVID-19 positifs (β=0,136 ; p=0,015).

Pour les attitudes, l'urbanité de la résidence (β=(0,13) ; p=0,022), la profession médicale (β=0,29 ; p<0,001), le statut marié (β=0,12 ; p=0,025) et l'infection antérieure par la COVID-19 (β=(-0,14) ; p<0,001) étaient indépendamment assoicés au score de l'attitude.

L'ancienneté > 20 ans (β=0,152 ; p=0,008), le contact direct avec des patients testés positifs (β=0,112 ; p=0,049) ainsi que la profession médicale (β=0,165 ; p=0,004) étaient des facteurs indépendants prédictifs des pratiques vis-à vis la vaccination antiCOVID.

Conclusion

En dépit d'un score relativement faible des connaissances vis-à-vis de la vaccination anti-COVID, des scores élevés des attitudes et des pratiques étaient observés chez les PDS. Cette variabilité était expliquée par des facteurs socio-démographiques et professionnels qui incitaient cette population exposée constamment au risque professionnel d'infection à la vaccination afin d'assurer des soins sécurisés.

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Epidemiological profile and performance of triage decision-making process of COVID-19 suspected cases in southern Tunisia

Introduction

During an epidemic, screening processes can play a crucial role in limiting the spread of the infection. The aim of this study was to describe the epidemiological profile of COVID-19 suspected cases and to evaluate the performance of the triage process in predicting COVID-19 in Southern Tunisia.

Methods

It was a prospective study including all patients consulting to the Hedi Chaker University Hospital departments from March to June 2020. A clinical triage score (CTS) was used to assess the risk of the infection and to refer patients to the appropriate part of the facility accordingly.

Results

Overall, 862 patients were enrolled, among whom 505 patients (58.6%) were classified as suspected cases (CTS ≥4). Of these, 46.9% (n = 237) were of mild form. Samples were collected from 215 patients (24.9%), among whom five were COVID-19 positive, representing a positive rate of 2.3%. The in-hospital cumulative incidence rate of COVID-19 was 580/100000 patients. The total daily incidence decreased significantly during the study period (p < 0.001, chi-square for linear trend = 25.6). At a cut-off of four, the CTS had a sensitivity of 40%, a specificity of 32.4%, and negative and positive predictive values of 95.8% and 1.4%, respectively.

Discussion

Although the triage process based on the CTS was not as performant as the RT-PCR, it was crucial to interrupt virus spread among hospitalized patients in “COVID-19-free departments”.

Connaissances, attitudes et pratiques des médecins de première ligne en matière d´aide au sevrage tabagique à Sfax (Tunisie), 2020

Introduction

le médecin de première ligne doit jouer un rôle clef dans la lutte antitabac. Les objectifs de cette étude étaient d´évaluer les connaissances, les attitudes et les pratiques des médecins de première ligne en matière d´aide au sevrage tabagique, évaluer leur statut tabagique et déterminer les obstacles auxquels ils font face dans l´aide au sevrage tabagique.

Méthodes

nous avons mené une étude transversale, durant le mois de novembre 2020, auprès d´un échantillon représentatif de médecins de première ligne exerçant au niveau du gouvernorat de Sfax.

Résultats

au total, 115 médecins de première ligne étaient inclus avec un sex ratio (H/F) de 0,91. L´âge médian était de 43 ans (Intervalle interquartile = [34-55 ans]). Parmi les répondants, 26 (22,6%) ont déclaré être des fumeurs. Nous avons noté que 98 médecins enquêtés (85,2%) n´ont pas eu de formation en postuniversitaire sur l´aide au sevrage tabagique. Cependant, 71 (61,7%) avaient une idée sur la thérapie de substitution nicotinique. Concernant les attitudes, 73 répondants (63,5%) étaient convaincus qu´il est de la responsabilité des médecins d´aider leurs patients à arrêter de fumer. Par rapport aux pratiques, 45 médecins (39,1%) interrogeaient systématiquement tous les patients sur leurs habitudes tabagiques. Les activités les moins exécutées de la stratégie des 5A étaient les composantes «Aider» (14%) et «Organiser un suivi» (17,4%). Le désintérêt des patients était jugé, par 61 médecins enquêtés (53%), un obstacle important pour l´aide au sevrage tabagique.

Conclusion

il est nécessaire d´évaluer et d´améliorer l´application de la stratégie nationale de lutte anti-tabac, surtout en ce qui concerne la formation des médecins de première ligne.

Childhood asthma : factors predicting severity and persistence of symptoms

BACKGROUND

Asthma is the most common chronic disease in infants. In young children, asthma still raises many questions and many points are still being debated.

AIM

The aim of this study is to identifies, in asthmatic children, factors predictors of severity and persistence of symptoms.

METHODS

A retrospective study of asthmatic infants<3 years enrolled in the pediatric department of Sfax over a period of 5 years (2007-2011). We were interested to social and environmental factors, the allergic background, clinical severity of the disease, results of allergic skin tests, treatment and respiratory outcome.

RESULTS

We collected 180 children with a sex ratio of 2.2. Family history of atopy and exposition to passive tobacco were noted in 45 % and 52% of cases respectively. The mean age of onset of wheezing was 6.6 months. Skin tests were positives in 32% of cases. At the time of diagnosis, asthma was classified intermittent (21%), mild to moderate (55.6%) and severe (22.2%).  Inhaled corticosteroids was initiated in 142 infants (78.8%). Skin tests performed in 84 patients, were positive in 32%. Factors associated with severe asthma were passive smoking, early age of onset, number of hospitalizations for exacerbation and existence of an aggravating factor. Factors predictors of persistence were an early age of onset, caesarean delivery, passive smoking and positive skin tests.

CONCLUSION

Factors associated with persistence of asthma at the individual level remains uncertain. However, atopy and passive smoking are major indicators.

Magnitude of general obesity, abdominal obesity and related risk factors among medical students

Introduction

Obesity is recognized to be one of the greatest public health problems worldwide. In addition to physical health problems, obesity is also linked to an increased risk of mental health disorders. We aimed to estimate the magnitude of overweight/obesity among medical students, to identify their risk factors and to assess their impact on mental health.

Methods

We conducted a cross-sectional questionnaire survey among 524 medical students randomized from different levels, at the Faculty of Medicine of Sfax, Tunisia, on October 2019.

Results

The prevalence of combined overweight/obesity and abdominal obesity were 21.9% and 22.3%, respectively. The independent risk factors of overweight/obesity were male gender (OR = 3.2; 95% confidence interval (CI) = [1.96-5.2]), internship (OR = 2; 95% CI = [1.1-3.9]) and residency (OR = 3.2; 95% CI = [1.7-6]) levels, as well as moderate (OR = 3.4; 95% CI = [1.4-8.3]) and high (OR = 6.7; 95% CI = [2.6-16.9]) stress scale. However, daily fresh vegetables (OR = 0.4, CI95% = [0.2-0.8]) and high-fiber cereals whole-grain bread (OR = 0.5; 95%CI = [0.28-0.83]) consumption, light (OR = 0.37; 95% CI = [0.16-0.86]), moderate (OR = 0.24; 95% CI = [0.06-0.89]) and vigorous exercise (OR = 0.091; 95% CI = [0.01-0.74]) were independent protective factors of overweight/obesity. Severe consequences of obesity were noted, such as less ability to concentrate (37.9% vs 47.6%; p = 0.024), living under stress (72.2% vs 60.6%; p = 0.023), feeling unhappy and depressed (57.4% vs 44.7% p = 0.016), losing confidence (45.2% vs 20.5%; p &lt; 0.001) and inability to enjoy normal activities (53.9% vs 38.7% p = 0.03).

Conclusions

Unhealthy lifestyle was relatively high among students with obesity. Our study confirms the data from the literature, and underlines the need to set up a plans including nutrition and lifestyle education in their curriculum.

Key messages

Unhealthy lifestyle was relatively high among students. The need to set up a plans including nutrition and lifestyle education.

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.

Chronological trends and causes of deaths among reproductive-age-women in Southern Tunisia

Introduction

Mortality data of women with reproductive age (WRA) data are important indicators of the health system performance. This study aimed to determine the magnitude, trends and main causes of WRA deaths.

Methods

The study used longitudinal hospital-based surveillance design for the period 2014-2020 in Southern Tunisia including all WRA (15- 49 years) who died in public health facilities in this region.

Results

During the 7-year-period, there were 331 WRA deaths, and this number increased sharply with age (χ2= 21.7;p&lt;0.001). Non-communicable diseases were the leading causes of deaths (41.7%) and were statistically more frequent in older women (52% vs 37.5%;p&lt;0.001) and urban regions (48.9% vs 36.6%;p=0.025). Concerning communicable diseases and maternal deaths, they were statistically more common in rural regions (12.4% vs 5%;p=0.026 and 17% vs 8.8%;p=0.031,respectively). There were 45 maternal deaths, with an average maternal mortality ratio (MMR) of 51.39/100,000 Live births(LB)/year. There was a slowly declining trend in the MMR during the reference period, without significant change (χ2=0.7;p=0.4), with a peak of 97.37/100,000LB in 2016. Direct obstetric deaths constituted 73.9% of all maternal deaths, among which the leading causes were obstetric haemorrhage (66.7%) and eclampsia (14.3%). Among the indirect causes, cardiovascular diseases (37.5%) and infections (16.6%) were the most common.

Conclusions

Mortality indicators among WRA remained sustainably high in Southern Tunisia, despite the declining curve. The causes of death varied according to age groups and access to health facility. Strengthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Key messages

High mortality indicators among WRA remained sustainably in Southern Tunisia. Stregthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Burnout among health care workers during COVID-19 pandemic: prevalence and risk factors

Introduction

During COVID-19 pandemic, health-care workers (HCW) have been exposed to multiple psychosocial stressors. Although the problem of burnout, which overlaps with the symptoms of depression, remains urgent, few studies have addressed it comprehensively. The objective of this study was to determine the prevalence and the factors associated with burnout among HCW.

Methodes

We conducted a cross-sectional study on March-April 2021 using a self-administered questionnaire distributed to HCW who were involved in COVID-19 management patients. The 22-item Maslach burnout inventory was performed to measure the prevalence of burnout defined as follows: high score of emotional exhaustion (≥27) plus high score of depersonalization (≥13) or low score of personal accomplishment (≤31).

Results

Overall, 250 HCW were included in this study. The sex ratio was 0.17. Their median age was 34 years (interqurtile range (IQR) = [30-40 years]). The average number of work experience was 11.1±3.4 years. There were 46 cases (18.4%) with a chronic disease. Among the study population, 131 HCW (51.4%) were infected with covid-19. The overall burnout prevalence was 45.6%. Female gender (Odds ratio (OR)=4.3; p < 0.001) and unmarried status (OR = 3.3; p < 0.001) were statistically associated with burnout. Participants in the burnout group had statistically higher number of working hours per day (≥6 hours) (OR = 3.2; p = 0.003), of night shifts per week (4±1 vs 3±1; p = 0.04), but lower number of working experience years (7±0.6 vs 12±1; p = 0.017). History of chronic diseases (OR = 1.8;p=0.021), witnessing a COVID-19 death while working (OR = 3.1; p < 0.001) and suffering from sleep deprivation (OR = 1.9; p = 0.034) were statistically more frequent in the burnout group of HCW.

Conclusions

The findings of this study indicated that the burnout syndrome was highly prevalent among HCW. More psychological support should be provided for this population in order to provide a high-quality of care for patients.

Key messages

Highly prevalent of burnout syndrome.

Psychological support should be provided.

Diabetes screening among School Teachers: Exploring the Ignored Dimension of School Health Program

Introduction

The rising prevalence of diabetes is a serious public health concern globally, with its complications and associated health expenditures. The school teachers have chronic stress, predisposing them to many chronic diseases. The aim of this survey was to assess the prevalence and the predisposing factors influencing diabetes among secondary school teachers.

Methods

A cross-sectional analytical study was carried out on a three-stage randomized sample of 258 secondary school teachers of 12 public schools on march 2021. A self-administered and pretested questionnaire was performed to assess sociodemographic characteristics and a Glucometer using glucose sticks was used to measure fasting blood sugar level. Diabetes and pre-diabetes were defined according to the International Diabetes Federation.

Results

Overall, 136 participants were females (52.7%) giving a male to female ratio of 0.9. The median age was 49 years (Interquartile range (IQR) = [43-53]). Of all teachers, 228 cases (88.4%) were married, 190 cases (73.6%) were from urban areas and 63 cases (24.4%) had a chronic disease. There were 29 (11.2%) active smokers. We noted that 23 participants were diabetics, giving a prevalence of fortuitous discovery diabetes of 8.9%. The prevalence of pre-diabetes was 10.5%. In multivariate logistic regression, higher prevalence of diabetes was independently associated with daily consumption of coffee (Adjusted odds ratio (AOR)=1.8; p = 0.048); frequently pasta consumption (&gt;3 times/week) (AOR=1.8; p = 0.012); family history of diabetes (AOR=2.5; p = 0.032), work seniority &gt;30 years (AOR= 2.2; p = 0.041) and higher body mass index (AOR=3.2; p = 0.02)

Conclusions

Our study results indicated that the prevalence of diabetes was relatively high among school teachers, addressing the urgent need for adopting healthy lifestyle. The School health program can be utilized as an effective tool to screen non-communicable diseases and to strengthen primary preventive care in school.

Key messages

Diabetes screening and associated factors. School teachers.

What are the determinants of stress, anxiety and depression among university students?

Introduction

University students (US) are supposed to face academic, living conditions and mental challenges during their cursus. These challenges with stressful events of graduate education could potentially cause depression, anxiety and stress. The main objectives of the present study were to explore the prevalence of depression, anxiety and stress among US and to identify their determinants.

Methods

A cross-sectional-questionnaire based study was conducted among a randomized sample of 1071 US in Sfax Universities, on April 2021. Data collection was performed using an anonymous questionnaire including a short version of depression, anxiety and stress scales (DASS-21).

Results

A total of 1071 US participated in the study with a mean age of 22.2 ± 2.5 years. The prevalence of depression, anxiety and stress were 69.2%, 75.4% and 45.5%, respectively. Severe or extremely severe depression, anxiety and stress were noted among 312 (29.1%), 468 (43.7%) and 195 (18.2%) US, respectively. Both depression and stress were significantly more frequent among US having a low monthly income (OR = 1.5; p = 0.045 and OR = 2.2; p = 0.042, respectively) and those who were not satisfied of their university (OR = 2.1; p = 0.002 and OR = 2.2; p = 0.008, respectively). Tobacco use was associated with higher score of depression (OR = 3.8; p = 0.046) and higher score of anxiety (OR = 1.53; p = 0.007). In addition, having a chronic disease was statistically associated with stress, anxiety and depression (OR = 2.8; p &lt; 0.001; OR = 2.2; p &lt; 0.001 and OR = 2.3; p &lt; 0.001, respectively).

Conclusions

A substantial proportion of US are suffering from depression, stress and particularly from anxiety. These findings suggested an urgent need for establishment of preventive measures and interventions to learn how to cope with these conditions positively to improve the mental health of students.

Key messages

Stress, anxiety and depression. University students.

Predictors of hypertension self-care practice in primary health-care facilities of Sfax

Introduction

Unmanaged hypertension is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of hypertension complications. This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors in Sfax, Southern Tunisia.

Methods

It was a cross-sectional study conducted in Sfax, Southern Tunisia from March to April 2020. A total of 6 primary health care facilities was approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire. Statistical analysis was performed using SPSS.24.

Results

A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65 years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were age over 65 (AOR=9.5; p &lt; 0.001), university educational level of the participants (AOR=21.2; p &lt; 0.001), as well as receiving a health education, by healthcare providers (AOR=2.5; p = 0.012) and family members (AOR=4.36; p = 0.004). Advanced hypertension stage (II and III) (AOR=0.45; p = 0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; p = 0.027) and COPD (AOR=0.27; p = 0.016) were independently associated with poor HTN self-care practice.

Conclusions

Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning hypertension self-care education

Key messages

Hypertension self-care practice. Hypertensive patients.

What are the predisposing factors of depressive disorders among school teachers?

Introduction

Teachers' psychological wellbeing is important for both teachers and student's development, but is highly stressful, particularly in special education. Chronic stress is associated with a range of mental health problems including risk of depression, which could lead to low quality of life and dropout. This research aimed to determine the prevalence of depression and their predisposing factors among school teachers.

Methods

A cross-sectional study was conducted on a randomized sample of 258 secondary school teachers in Sfax, Southern Tunisia on march 2021. The instrument used for depression measurement was adopted from the generalized anxiety disorder assessment (GAD-7).

Results

Among 258 school teachers, 136 were females (52.7%). The mean age was 47.5±8.1. Overall, 47 teachers (18.2%) had a work seniority above 30 years. According to the work conditions, 118 cases (45.7%) had problems with their students, 30 cases (11.6%) had problems with parents and 10 subjects (4%) had conflicts with their colleagues. The prevalence of depression was 44.6%. Moderate and severe depression were respectively noted in 72 (27.9%) and 43 (16.7%) teachers. In multivariate logistic regression, female gender (Adjusted odds ratio (AOR)=2.1; p = 0.004), history of chronic disease (AOR= 2.6; p = 0.001), working outside the family's region of residence (AOR= 1.8; p = 0.048), active smoking (AOR= 1.9; p = 0.042) and having problems with students at school (AOR=2.2; p = 0.039) were independently associated with higher prevalence of depression.

Conclusions

The prevalence of self-reported depression among school teachers was notably high, which may hamper their relationships and effectiveness with students. The most prominent risk factors were related to unhealthy lifestyle and lack of social support with students. Therefore, managing work conditions and establishing appropriate consulting and supporting programs are urgently required.

Key messages

Depression disorders. School teachers.

Prevalence survey on antimicrobial use & multidrug resistance in tertiary level university hospital

Introduction

Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH).

Methods

It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected.

Results

Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p &lt; 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p &lt; 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p &lt; 0.001). and central vascular catheters (8.6% vs 2.2%; p &lt; 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%).

Conclusions

This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Key messages

High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.