[Epidemiology of smoking in the male population in Tunisia. HSHS Study 6]

OBJECTIVES

To determine the prevalence of smoking in the male population of Hammam Sousse (Tunisia), to describe its modalities and to analyse its determining factors.

METHODS

This was a "community-based" study, carried out on a random sample of households, including a population of males aged 20 or over. The data were collected, at home, using a specific support consisting of a lifestyle questionnaire, a physical examination, and a biological assessment, oriented towards cardiovascular risk factors. Smoking behaviour covered both forms of cigarettes and Narghile. "Current smokers" included all men declaring that they smoked at the time of the survey, including "regular smokers", who smoked daily at the time of the survey, and "occasional smokers", less than once a day. The group of "non-smokers" at the time of the survey was the sum of "ex-smokers" and those "who had never smoked". The prevalences were calculated after their weighting according to age and the adjusted odds ratios were measured following a multivariate study by logistic regression.

RESULTS

The study population was composed of 481 men with an average age of 49.6±16.35 years and a median of 49 years. Mean body mass index and systolic blood pressure were 26.9 kg/m2 ±4.20 and 151.9 mmHg±24.36, respectively. After adjusting for age, the proportions of current users, former users and subjects who had never used tobacco (all forms combined) were respectively 50.4% (95% CI [49.49-51.3]), 17.4% (95% CI [16.71-18.08]) and 30.9% (95% CI [30.06-31.73]). Daily cigarette consumption was characterized by an average onset at age 20.1±6.91 years, an average duration of 27.0±15.22 years and an average amount of 17.6±9.8 cigarettes smoked per day. After adjusting for age, level of education, and socioeconomic level, smoking behaviour was attributed to a single independent risk factor: the presence of a smoker in the family, with an adjusted OR of 45.17 (p (p<10^-3) for regular cigarette smokers, and 29.66 for regular tobacco users of all forms.

CONCLUSION

Smoking would be a real endemic in Tunisia, threatening the cardiovascular health of the country. The national health system is called upon to strengthen its action plan for the prevention and control of smoking, in all living environments: family, school, work, health centre, etc.

Epidemiology of dyslipidemia in Tunisia, HSHS 3 study (Hammam Sousse Sahloul Heart Study)

INTRODUCTION

Dyslipidemia is a major cause of morbidity and mortality worldwide because it increases the risk of cardiovascular diseases.

AIM

To determine the prevalence of dyslipidemia and its components in the general population of Hammam Sousse (Tunisia) and to identify its risk factors.

METHODS

This was an analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based» cross-sectional study on cardiovascular risk factors including dyslipidemia, with a random sample in two-stages, proportional-probability clusters. All subjects above 20 years underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. Dyslipidemia was defined by: total cholesterol ≥5.2 mmol/l, hyper LDL (Low Density Lipoprotein) cholesterolemia ≥4.1 mmol/l, hypo HDL (High Density Lipoprotein) cholesterolemia <1.03 mmol/l for men and <1.29 mmol/l for women and hyper-triglyceridaemia: ≥2.26 mmol/l. Multivariate logistic regression analysis was conducted to determine factors independently associated with dyslipidemia.

RESULTS

The study population was composed of 481 males (M) and 960 females (F), with a sex ratio of 0.5. Mean cholesterol was higher in women (5 mmol/l±1.01) than in men (4.8 mmol/l±0.92). Only 24.9% of men and 29.1% of women had normal HDL cholesterol levels. Women had higher levels of hypercholesterolemia and LDL cholesterolemia than men (p<10-6). Multivariate analysis showed that dyslipidemia was independently and statistically significantly associated with age ≥40 years (p<10-3), physical inactivity (p<10-3) and obesity (p=0.025).

CONCLUSION

As a result of the epidemiological situation of dyslipidemia, the promotion of an active lifestyle seems essential. In addition, nutritional education improves the lipid profile by promoting weight loss and balancing lipid consumption.

Epidemiology of metabolic syndrome in Tunisia. HSHS 5 study

OBJECTIVE

To measure the prevalence of metabolic syndrome and its components in the HSHS cohort (Hammam Sousse, Tunisia), in 2009, and to identify its determining factors.

METHODS

This was a descriptive epidemiological study of the "community based" type having focused on a random sample of people aged 20 and over. The metabolic syndrome was defined according to the criteria of the "International Diabetes Federation" (IDF 2005) and those of the "National Cholesterol Education Program-Adult Treatment Panel III" (NCEP-ATP III, 2001).

RESULTS

The study involved 1441 people including 960 women (66.6%). The age- and sex-adjusted prevalences of increased waist circumference, blood pressure, blood sugar and triglycerides, and decreased HDL-cholesterol were respectively 63.2%, 95%CI[62.5-63.8]; 47.7%, 95%CI[47.4-48.6]; 25.7%, 95%CI[25.1-26.2]; 11.9%, 95%CI[11.4-12.3] and 65,6%, 95%CI[65.0-66.2], according to IDF thresholds and 37.4%, 95%CI[36.3-37.6]; 45.7%, 95%CI[45.4-46.6]; 13.8%, 95%CI[13.4-14.2]; 8.4%, 95%CI[8.0-8.7] and 61.9%, 95%CI[61.2-62.5], according to those of the NCEP-ATP III. The prevalence of metabolic syndrome adjusted for age and sex was 36.5% 95%CI[33.0%-38.9%] according to the IDF definition and 23.0% 95%CI[20.4%-25.6%] according to that of NCEP-ATP III. The multivariate study by logistic regression made it possible to retain three significant independent determining factors of the metabolic syndrome: age ≥40 years, low level of physical activity and family history of diabetes mellitus with respectively adjusted ORs of 3.77 95%CI[2.70-5.27], 1.39 95%CI[1.01-1.89], 1.62 95%CI[1.21-2.15], according to IDF and 5.87 95%CI[3.88 -8.88], 1.47 95%CI[1.07-2.01] and 1.45 95%CI[1.07-1.96], according to NCEP-ATP III .

CONCLUSION

With this high prevalence rate of the metabolic syndrome, the establishment of an action plan would be essential. This plan should be based on the combination of the promotion of physical activity and screening for the components of the metabolic syndrome, particularly in subjects aged 40 or over, with a family history of diabetes mellitus.

Epidemiology of obesity in Tunisia: HSHS4 study (Hammam Sousse Sahloul Heart Study)

INTRODUCTION

The HSHS study is a community-based survey focused on cardiovascular risk factors.

AIM

The objectives of this specific analysis were to determine the prevalence of obesity and overweight in the general population of Hammam Sousse (Tunisia) and to identify their predisposing factors.

METHODS

HSHS was conducted with a random sample of households, composed by the EPI (Expanded Program on Immunization) technique. All people aged 20 and over, met on the day of the survey, at their homes, were included. Obesity, overweight and weight overload were defined with reference to Body Mass Index (BMI): Obesity (BMI≥30 kg/m²), Overweight (25≤BMI (25≤BMI <30 kg/m²), weight overload (BMI≥25 kg/m²). Physical activity was evaluated according to the level of energy equivalents (Metabolic Equivalent Task) or MET, this level was considered low below 600 MET min/week. The calculated prevalences were accompanied by their 95%CI (Confidence Intervals). The multivariate study was conducted by logistic regression, measuring the adjusted Odds Ratio (ORa) Results: The study population was composed of 481 men and 960 women, (sex-ratio=0.50). The age ranged from 20 to 96 years with an average of 49.6±16444 years in men and 46.6±16.2 in women (p <0.05). After adjusting for age and sex, the prevalence rates of overweight, obesity, and weight overload were respectively 36.18%, 95%CI [35.38%-36.62%], 28.11%; 95%CI [27.42%-28.58%] and 64.28%; 95%CI [63.38%-64.62%]. Obesity was determined, in addition to female sex, age 40 or over and low level of education, by low level of physical activity (ORa=1.56; 95%CI [1.21-2.03], p<10^-2).

CONCLUSION

In adults, the prevalence of obesity and overweight were high and determined by insufficient physical activity. The results of this study, which can be extrapolated to other Tunisian cities, should motivate the general population to establish a heart health promotion plan, in partnership with civil society.

Editorial quality of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia)

OBJECTIVE

To assess the writing quality of the theses defended at the Faculty of Medicine of Sousse (FMSo).

METHODS

This is a bibliometric, transversal and exhaustive study done on all theses defended at the FMSo between 2001 and 2005. The writing quality of the thesis was assessed, via double reading, by a grid applied to its abstract. This grid was composed of 20 items detailing the principles of scientific writing. A thesis was considered "satisfactory" when the writing score was ≥15 / 20.

RESULTS

During this five-year period, 670 theses was defended at the FMSo (an average of 134 theses per year), which in 93% of cases were research ones. All these theses were written in French except for one. On a 20-point scale, the average thesis editorial score was 14.1 ± 2.2. The writing quality was judged satisfactory in 47% of the theses. The objective of the thesis, research design and study population were mentioned, respectively, in 81%, 77% and 91% of theses abstracts. However, the descriptors chosen were MeSH words in only 42% of the time; Data sources and standard deviation were mentioned in only 25% and 9.6% of the abstracts, respectively.

CONCLUSION

The writing quality of the thesis at the FMSo suffered mainly from documentary, methodological and statistical insufficiencies. The introduction of a scientific medical writing module in the curriculum of the FMSo would be essential for the optimization of the medical thesis.

Epidemiology of diabetes mellitus in Tunisia. HSHS 2 study (Hammam Sousse Sahloul Heart Study)

BACKGROUND

National epidemiological studies on diabetes mellitus are rare, ancient and often carried out schools or clinics settings.

OBJECTIVES

To determine the prevalence of diabetes mellitus and identify its risk factors in the adult population of the city of Hammam Sousse (Tunisia) during the year 2009.

METHODS

This study is a part of analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based» cross-sectional study on cardiovascular risk factors including diabetes mellitus, with a two-stage proportional probability cluster random sample. All subjects aged 20 years and more underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. The diagnosis of diabetes mellitus was defined by a fasting blood glucose level ≥7 mmol/l. Overweight was defined by a Body Mass Index (BMI) ≥ 25 kg/m². A multivariate logistic regression analysis was conducted to determine independent risk factors associated with diabetes mellitus.

RESULTS

The population was composed of 481 males (M) and 960 females (F), a sex ratio of 0.5 with mean ages respectively of 49.6±16.35 years and 46.6±16.18 years. The prevalence of diabetes mellitus adjusted by age and sex was 12.1% (95%CI[11.7-12.5]); M: 12.7% (95%CI[12.1-13.3]), F: 11.5% (95%CI[10.9-12.1]). The prevalence rate of patients newly detected with diabetes mellitus was 1.9% (95%CI[1.7-2.1]): M: 1.8% (95%CI[1.6-2.0]), F: 2.1% (95%CI[1.8-2.4]). The multivariate study revealed five independent factors significantly associated with diabetes mellitus. In addition to non-modifiable factors (male gender, age ≥40 years old, low schooling level and family history of diabetes), diabetes mellitus was 2 (95%CI[1.3-3.2]) times more prevalent in overweight cases.

CONCLUSION

In deep trouble of this epidemiological situation of diabetes mellitus, it is urgent to launch a universal intervention strategy based on the promotion of a healthy lifestyle motivating regular physical activity and a low-calorie diet.

Epidemiology of arterial hypertension in Tunisia: Hammam Sousse Sahloul Heart Study (HSHS)

INTRODUCTION

Tunisia is experiencing a double burden of morbidity, characterized by the explosion of cardiovascular diseases and their risk factors including arterial Hypertension. The objective of this study, based on the HSHS cohort (Hammam Sousse Sahloul Heart Study), was to determine the prevalence of hypertension in the general population and to identify its predisposing factors.

METHODS

HSHS is a cardiovascular health promotion initiative in the city of Hammam Sousse (Tunisia). The study was conducted via a random sample of households, using the WHO PEV technique, made up of 33 clusters, of 33 households each. All people aged 20 and over, included, benefited from a questionnaire, a physical examination and a biological assessment. The Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) were measured from the average of the last two measurements, by an OMRON type tensiometer, of suitable width. These prevalences were adjusted according to sex and age group, by their weighting coefficients in the general population, and they were accompanied by their 95% CIs. Binary logistic regression was conducted to identify independent factors associated with hypertension.

RESULTS

The study population was composed of 481 men (33.4%) and 960 women (66.6%), with an average age of 49.6±16.35 years in males (M) and 46.6±16.18 in females (F). In addition to the family history of hypertension, the sufficient weekly consumption of vegetables and fruits was low (M: 32.4%, F: 24.9%). The adjusted rate of hypertension in the adult study population was 32.5%, 95%CI[31.9-33.1] (M: 36.4%, 95%CI[35, 5-37.3]; F: 28.4%; 95% CI[27.6-29.2]), reaching in the age group of 60 years and above: M: 74.6% (95%CI[66.9-82.3], F: 82.7% (95%CI[73.8-83.6]) Multivariate analysis identified five independent factors significantly associated with hypertension: male sex (ORa=1.55 [1.18-2.03]), age over 40 years (ORa=6.54[4.70-9.11]), low level of schooling (ORa=1.80 [1.36-2.38]), low physical activity (ORa=1.42[1.07-1.88]) and high socio-economic level (ORa=1 .84 [1.30-2.63]).

CONCLUSION

The HSHS study confirmed the high prevalence of hypertension, and the extent of its low detection and control. Hence the need for a universal approach to health promotion, oriented towards the general population, piloted by its local organizations, based on the adoption of a healthy lifestyle, and centered on physical activity.

Epidemiology of elderly dependency in Tunisia. HSHS study 7

AIM

Measure the functional autonomy of elderly people and identify its components and determinants in the HSHS (Hammam-Sousse Sahloul Heart Study) population (phase 2009, Tunisia).

METHODS

This study was concerned with the quality of life of elderly people aged 65 years or more, living at home from the HSHS cohort divided into two groups: young-old (65-74 years old) and old-old (≥75 years old). The autonomy was assessed using the "Activities of Daily Living" (ADL) scale ranging from 0 to 6, the "Instrumental Activities of Daily Living" (IADL) scale ranging from 0 to 8 and, the combined scale ranging from zero to 14, iso-weighted at one point per activity. Autonomy in daily activities was retained for an ADL score=6, and an IADL score (F=8; H=5). Subjects with an overall score (sum of ADL and IADL) of 10-14 points were considered globally autonomous.

RESULTS

The population study was predominantly female (sex-ratio=0,6) with an important proportion of old-old (M=43%, F=37%). Autonomy rates were by ADL (M=57.4%, F=36.1%, p < 10-2), IADL (M=16%, F=23.9%), and by combined score (M=60.6%, F=69%, p=NS). The typology of dependency was dominated by transferring (M=35%, F=61%) and bathing (M=14%, F=19%) for ADL activities, and shopping (M=36%, F=49%) and the use of means of transport (M=22%, F=43%) for IADL activities. After adjustment, autonomy in daily activities was attributed to two independent factors: male sex (ORa=3.98, CI95% [1.328-11.971]) and age group 65-75 (ORa=4.04, CI95% [2.039- 8.025]). Autonomy in instrumental activities was associated with age group (ORa=31.5, CI95% [4.087-233.514]). Finally, overall autonomy (current and instrumental) was associated independently after logistic regression, with four independent factors, two of which were not modifiable: being female (ORa=3.1, CI95% [1.2-8.1]) and 65 to 75 years (ORa=6.2, CI95% [3.1-12.3]) and two modifiable factors: no recent hospitalization (ORa=3.8, CI95% [1.4-10.4]) and a sufficient level of physical activity (ORa=2.6, CI95% [1.3-5.3]).

CONCLUSION

The physical dependency rate of the elderly is very high in Tunisia. The promotion of physical activity, the extension of similar studies and the development of could improve the support of these people.

Descriptive Statistics in Health Sciences

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

Bibliometric profile of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia)

OBJECTIVE

Describe the bibliometric profile of medical dissertations in Sousse Faculty of Medicine (SOFM) in Tunisia.

METHODS

This is a cross-sectional bibliometric study of all dissertations defended from 2001 to 2005. The data were collected through a reading grid applied to the cover page, conclusion, and summary of the thesis. The specialty of the dissertation has been attributed to its first director. Themes were defined by the "essential descriptor", chosen from the descriptors used for the indexing.

RESULTS

The 670 theses collected, all written in French except one in Arabic, were original, pedagogic or bibliographical works in respectively 93.3%, 6.4%, and 0.3% respectively. "Community and Preventive Medicine" was the discipline that generated the most theses with a proportion of 8.9%. About half (48%) of the dissertations were supervised by two directors. The first director was a University Hospital Professor or an Associate Professor of Conferences, respectively in 34% and 42% of cases. The chairman of the thesis jury belonged to the same specialty as the first director and was from the same department in respectively 54% and 41% of cases. Four "essential descriptors" were frequently cited as indexation of the dissertation: "tumor", "CD-Rom", "trauma", and "diabetes". These dissertations were "clinical" type in 68% of cases, of which around 80% were "case studies".

CONCLUSION

The doctoral dissertation in SOFM was characterized by the orientation towards clinical and epidemiological research and the preference for general medicine and community health themes. It's often recourse to a basic research estimate and its writing in French would be two factors limiting its scientific promotion and its social influence.

Evidence-Based Medecine (EBM)

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

How to read, according to a Critical approach, a scientific medical article? VIP Strategy (3x3)

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l'honneur de continuer d'une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d'édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l'acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d'une manière standardisée, les modes d'usage des concepts, des outils et des méthodes, utilisés d'une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu'à la phase rédactionnelle et d'autre part lors des différentes phases de la rédaction médicale scientifique, depuis l'étape de la recherche documentaire jusqu'à l'étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

Global university performance. Bibliometric analysis of the ARWU platform (2003-2020)

OBJECTIVES

Describe the 2020 report of the ARWU "Academic Ranking World Universities" classification and identify, accordingly, the roadmap of academic excellence, particularly in the countries of the Greater Maghreb.

METHODS

This is an in-depth reading of the 2020 results of the ARWU bibliometric platform (launched in 2003) from top 1000 world-class universities. Six criteria were used in this ranking: 1. Alumni (10%): students who received Nobel / Fields prizes; 2. Award (15%): professors who have won the Nobel / Fields prizes; 3. HiCi (20%): Most cited scientists; 4. PUB (20%): number of publications 5. TOP (20%): proportion of publications in the most influential periodicals; 6. PCP (10%): Per Capita Performance.

RESULTS

The 2020 ARWU ranking was characterized by the domination of the "Top 10" ranking by the United States, particularly the "Harvard University", the Asian boom of 55% of the "Top 1000" ranking (Chinese universities evolved from 16 in 2004 to 81 in 2020 in the "Top 500" list) and finally an African incubation of academic excellence, manifested by the selection of nine South African institutions (including the "University of Cape Town ", world rank between 201-300), and the re-entry for the first time of a Maghreb university in the" Top 1000 "list, Tunis El Manar (rank between 901-1000), with the following scores: N&S: 1 , 4; Pub: 26.1 and PCP: 10.3, for a total score of 37.8 points.

CONCLUSION

This report proves once again, the promising academic perspectives of Asia and Africa in the inclusion of the "Top 1000" list of the ARWU ranking. The roadmap for academic excellence would thus be based on the triad of centering scientific publications, in prestigious journals and by national author networks.

Preparation of the Structured Summary of a Biomedical Scientific article

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

The 5x5 approach in scientific biomedical writing

Cette série…

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l'honneur de continuer d'une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d'édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l'acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d'une manière standardisée, les modes d'usage des concepts, des outils et des méthodes, utilisés d'une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu'à la phase rédactionnelle et d'autre part lors des différentes phases de la rédaction médicale scientifique, depuis l'étape de la recherche documentaire jusqu'à l'étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

Eating disorders: Prevalence and associated factors among health occupation students in Monastir University (Tunisia)

BACKGROUND

Despite their high prevalence and severity among youth, national researches concerning eating disordered behavior among undergraduate students remains rare. Hence, it is imperative to determine the amplitude and to identify the risk factors of eating disorders (ED) to enable effective interventions.

AIM

To assess prevalence and associated factors of (ED) among health occupation students in the university of Monastir during 2013.

METHODS

A cross sectional study using a self-administered questionnaire which was distributed by approaching directly students. The following items were collected: demographic, socioeconomic and educational characteristics; self-esteem; previous dieting; perceived stress score(Cohen's scale); depression (Beck Depression); sleep quality; sport practice; cyber addiction (Orman scale) and alcohol regular use (CRAFT-ADOPSA questionnaire). SCOFF questionnaire was used to identify students at risk of ED.

RESULTS

A total of 974 students were included in the study. The mean age of students was 22.8 (Standard Deviation=2.2) with a sex ratio of 0.43. The prevalence of ED according to SCOFF questionnaire was 35%; 95% CI [32.0-38.5]. It was higher among female (39.8; 95% CI [35.8-43.7]) compared to male (24.3; 95% CI [18.8-29.7]) with a statistically significant difference (p<10-3). The risk factors associated independently with an eating disorder were "Previous dieting" (aOR=4.13; 95% CI [2.79-6.12]),"Sex" (aOR=1.77. 95% CI [1.13-2.77]) and "Repeat a year" (aOR=1.76; 95% CI [1.09-2.85]).

CONCLUSION

The prevalence of health occupation students at risk of ED was high. These results emphasizes the need for diversified and adapted prevention and health education policies as well as a need for a systematic screening of ED among students in order to start an early treatment that can improve their prognosis.

The satisfaction of patients hospitalized in the surgical departments of a general hospital. Case study of Sahloul hospital in Sousse (Tunisia)

OBJECTIVE

Measure the overall and specific satisfaction rates of patients hospitalized in surgical services in Sahloul University Hospital in Sousse during the year 2018.

METHODS

The study population was recruited by a quota sample of hospitalized patients in the surgical departments of Sahloul University Hospital in Sousse. Data collection was done via a patient satisfaction questionnaire, administered to outgoing patients. The questionnaire was composed of 33 items exploring technical, administrative, logistical and relational dimensions. Overall patient satisfaction, called "reactivity", was defined by a concomitant positive response to the three questions exploring satisfaction, recommendation and loyalty.

RESULTS

A total of 735 patients hospitalized in six surgical departments were included (general surgery, orthopedics, maxillofacial surgery, urology, neurosurgery and cardiovascular surgery). The rates of "satisfaction", "recommendation" and "loyalty" of the patients were 71%, 70% and 69% respectively, equivalent to an "overall positive reactivity" of 62%, 95% CI [58,5%-65.5%], particularly low in the orthopedic department (43%). The logistics dimension was the least appreciated by patients, including room's condition, with almost 23% overall and 17% in the orthopedic department.

CONCLUSION

The responsiveness of patients hospitalized in the surgical services of Sahloul University Hospital was low, particularly for items related to the hotel services in the hospital. Furthermore, plans to improve the quality of care and support the performance of public hospitals should pay close attention to the logistical dimension of patients' hospital stays.

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.

Thirty years of Tunisian publication of «case reports» in General Surgery (1989-2018)

OBJECTIVE

To describe the bibliometric profile of Tunisian "case report" publications in general surgery over the last thirty years (1989-2018).

METHODS

This is a descriptive bibliometric study on "case reports", general surgery, Tunisian affiliation, indexed in the Medline database, between January 1, 1989 and December 31, 2018. The themes of Search articles were defined by referring to their major keywords used for their indexing.

RESULTS

During 30 years of study, Medline indexed 188 papers in "General Surgery" type "case reports", signed by 80 authors in first position and 71 authors in last position, belonging to ten academic specialties and 19 professional affiliations. These papers were published by 60 journals, including the Ugandan magazine "Pan African Medical Journal", which published 23% of these "case reports" alone. The number of major indexing keywords was 299 words, mainly "Echinococcosis", "Pancreatic Cancers" and "Echinococcosis of the liver", together accounting for 18.1% of articles.

CONCLUSION

The plethora of "case reports" in Tunisian general surgery publications over the last three decades was accompanied by a preferential edition in the journal "Pan Afr Med J" and a thematic focus on hydatid cysts and cancers pancreatic. Hence the importance of strengthening the capacity of Tunisian surgeons in research methodology and scientific medical writing.

Bibliometrics of Tunisian publications on respiratory tract diseases from 2010 to 2014

AIM

To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014.

METHODS

This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords.

RESULTS

A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms» (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease» (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary» (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively.

CONCLUSION

Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.

Ramadan and Health. Bibliometric study of the biomedical literature indexed in «Medline» database

OBJECTIVE

To describe both editorial and thematic profile of biomedical publications related to the theme «Ramadan and Health», indexed in «Medline» database till December 31th 2018.

METHODS

This is a bibliometric study via «Medline» database using the following documentation query: «Fasting» [Majr] AND («Islam» [Majr] OR Ramadan [All Fields]). Data was collected through the «Medline» Material Safety Data Sheets from the NLM Library. Publications' themes have been defined by major descriptors (Majr). The generic descriptor corresponded to the Majr word hierarchically superior in the «Medline» Mesh descriptor thesaurus.

RESULTS

A total of 508 articles were captured, of which 13% were reviews and 5% were randomized controlled trials. These publications were published by 272 journals belonging to 38 countries, and signed by 108 authors in first position and 398 in last position. The number of major descriptors used to index these publications related to «Ramadan and Health» was 484. Endocrine System Diseases (Diabetes mellitus) and Human Activities (Exercise) were the main major generic keywords, indexing respectively 28% and 20% of this literature.

CONCLUSION

«Ramadan and Health» is increasingly, a theme of scientific and biomedical research of great interest worldwide in order to manage health problems, especially diabetes mellitus. Expanding the scope of its applications to other global burden of disease's areas would be useful.

Disciplinary and thematic mapping of Maghreb publications in "infectiology". Bibliometric study (Tunisia, 2010-2014)

AIM

To describe the essential bibliometric characteristics of Tunisian publications in "infectiology", during the five-year period 2010-2014.

METHODS

This is a descriptive bibliometric study, on the papers of "infectiology", indexed in "«Medline»", based on their data sheets. Were included all the articles written by Tunisian researchers regardless of their position in the list of co-signers. The themes of the publications were explored through the key words "major" and "generic" in the three chapters of the descriptors: "Bacterial Infections and Mycoses", "Parasitic Diseases", and "Viral Diseases".

RESULTS

A total of 846 publications in "Infectiology" were analyzed, of which 66% were written in English and 31% were "case reports". They were signed by 536 authors in first position belonging mainly to microbiology (20.7%), parasitology (20.1%) and virology (7.1%). The 391 co-signatories in last position belonged to 44 specialties, of which pediatrics, internal medicine and infectious diseases respectively occupy the 4th, the 9th and the 10th positions. These publications were edited in 258 journals, mainly "Tunisie Medicale" (9%) and "Pan African Medical Journal" (3.8%). The greatest interest of the Tunisian researchers in infectious diseases have been staphylococcal / tuberculosis infections, chronic viral hepatitis C / human influenza, and echinococcosis / leishmaniasis.

CONCLUSION

In Tunisia, infectious diseases research has been relatively prolific and concordant with the population's health needs. Infectious diseases physicians should build their network of care, research and education with biologists, while focusing their research on multicenter and high-level studies.

Bibliometrics of Tunisian publications in "General Surgery" (Medline, 2009-2018)

OBJECTIVE

To describe the bibliometric characteristics of Tunisian publications in "General Surgery", indexed in "Medline" database from 2009 to 2018.

METHODS

This is a bibliometric study conducted through a comprehensive documentary query applied to the "Pubmed" portal and using the "Medline" database. The essential themes of a publication have been defined by referring to its major keywords.

RESULTS

A total of 173 publications were included in this study, representing a productivity rate of 14 articles / 100 surgeons' teachers-year. These publications were co-authored by 65 authors in first position and published by 55 journals in 15 countries, including mainly the national journal "Tunis Med" during the first five-year period 2009-2013 (27%) and the Ugandan magazine "Pan Afr Med J" during the second five-year period 2014-2018 (33%). Case reports were the most widespread type of publication in Tunisian "General Surgery", during the two periods of the study, respectively in 63% and 51% of cases. English was the major language with 57% of publications. Among the 259 major descriptors used to index the "General Surgery" articles, the occurrence of "Pancreatic Neoplasms" and "Echinococcosis, Hepatic" was respectively 3% and 2%.

CONCLUSION

During the decade 2009-2018, the Tunisian research in "General Surgery" was not very prolific and was mainly "case reports" but it was directed toward population health problems; Hence the interest of a thorough training of surgeons in research methodology and scientific medical writing.

Management crisis of health personnel in the great Maghreb. Mauritania case study

OBJECTIVE

To describe the number and distribution of health personnel in Mauritania during 2017, according to their academic grades and administrative assignments.

METHODS

This is a quantitative study of the number and uses of health human resources in Mauritania, based on the 2017 data from the Personnel Register of the Ministry of Health. The number of doctors, midwives and nurses in the six administrative regions of Mauritania and its "wilayas", were standardized according to the size of the population (health workers /10 000 inhabitants). Interregional inequalities in the allocation of health personnel have been studied through the correlation between the percentages of the health professions and the populations of the regions affected.

RESULTS

In 2017, the number of health workers in all categories was 6608 in Mauritania, a ratio of 17.5 / 10000 health workers / inhabitants, ranging from 8.6 in "Gargot" wilaya to 37.3 in the wilaya of "Inchiri". The densities of specialist physicians, general practitioners, midwives and nurses were respectively 0.9, 0.84, 1.8, and 3.32 per 10,000 inhabitants, respectively. In the Nouakchott region, covering 28.5% of the Mauritanian population, 76.5% of specialist doctors and 56.8% of midwives, had ratios (health workers / 10 000 inhabitants) two and three times higher than national levels.

CONCLUSION

This study documented on the one hand the persistence of the shortage of health personnel in Mauritania in 2017, in all its professional categories, and on the other hand the inequalities of their distribution in its administrative zones, with a relative abundance in the region of Nouakchott.

Cancers in the Central Maghreb: epidemiology from 1990 to 2017 and trends in 2040

OBJECTIVE

To describe the epidemiology of cancers in terms of global burden of disease, incidence, prevalence and typology in the three Central Maghreb countries from 1990 to 2017, as well as their trends from 2017 to 2040.

METHODS

This is a descriptive and predictive study of the epidemiology of cancers in the Central Maghreb (Tunisia, Algeria and Morocco) from 1990 to 2040. The epidemiological data: incidence, prevalence, specific mortality rate and Disability Adjusted Life Years were collected via the Global Burden of Disease Database created by the Institute of Heath Metrics and Evaluation. These parameters were expressed in terms per 100,000 inhabitants.

RESULTS

In 2017 and for the three Central Maghreb countries, cancers represented the second leading cause of death, with an overall specific mortality rate of 69/100,000 and an overall incidence rate of 116/100,000 inhabitants. The Disability Adjusted Life Years rate varied from 1516/100,000 in Algeria to 1992/100,000 in Morocco. In the three Central Maghreb countries and during the year 2017, lung cancer was the first cancer in terms of mortality, regardless of age and sex, followed by colorectal cancer in Tunisia and breast cancer in Algeria and Morocco. These three cancers will remain in 2040 the most important in terms of mortality rate with lung cancer topping the list in Tunisia and Morocco with respective mortality rates of 30 and 16/100,000.

CONCLUSION

Cancers are currently, and in the next two decades, an important component of the GlobalBurden of Disease in Central Maghreb countries. The typology is dominated by lung, breast and colorectal cancers. The establishment of a Maghreb cancer registry would be a fundamental component of the Maghreb cancer plan.

Epidemiology of Type 2 Diabetes in the Greater Maghreb. Example of Tunisia. Systematic review of the literature

AIM

Describe epidemiologic profile of Diabetes Type 2 (DT2) in the Tunisian population, through published and indexed studies in Medline.

METHODS

We carried out a systematic review, through the Medline database, of the main publications related to DT2 among Tunisian patients. This research included prevalence, risk factors, clinical and biological characteristics, and complications of DT2.

RESULTS

The prevalence of DT2 varied from 9.9% in 1996 to 15.1% in 2005 and would reach 26.6% in 2027. It was significantly associated with age and urbanization. The genetic factor was incremented in 58.9 to 75% of cases and obesity in a quarter or more. Neuropathy and diabetic retinopathy were the main degenerative complications affecting the Tunisian diabetic patient in more than half of the cases. Poor compliance was observed in 41% of diabetics and only 16.7% of patients were well controlled.

CONCLUSION

The epidemiological situation of DT2 in Tunisia is worrying, hence the need for a promotional approach to a lifestyle that is favorable to health and an integrated management that is consistent with international standards.

Development of a Balanced Scorecard for the monitoring of hospital performance in the countries of the Greater Maghreb. Systematic Review

BACKGROUND

Despite the wealth of knowledge on hospital performance, the majority of health facilities in the Maghreb don't have yet a Balanced Scorecard for its measurement.

OBJECTIVE

Elaborate, through a systematic review of the biomedical literature, a Balanced Scorecard for hospital performance, consisting of indicators of quality of care, highly recommended and suitable for the professional and managerial contexts of Greater Maghreb health systems.

MATERIALS AND METHODS

  This is a "systematic review" study on the topic of indicators to measure hospital performance. A documentary query combining the "Mesh Major Topic" for the two following descriptors "hospitals" and "health quality indicators", has been applied to the "Medline" database over a period of ten years (2004-2013). A focus group composed of clinicians, managers and representatives of civil society, was formed for the selection of a Balanced Scorecard of health facilities in Maghreb, composed of 20 systemic indicators.

RESULTS

An in-depth reading of 166 articles included in the study identified 926 quality of care assessment indicators. It is in one of three cases "systemic" indicators applicable to multi-purpose health facilities, and in one case of two, it is"process"indicators focused on a health care activity. Following the work of the focus group, a Balanced Scorecard for hospital performance was developed in a consensual manner. Among these indicators, 18 explored the "care" dimension (average length of stay, bed occupancy rates, turnover beds rates, occupational blood exposure rates, unplanned admission rates, discharge rates, prolonged admissions rates, antibiotic prescription rates, mortality rates, health care-associated infection rates, readmission rates, pressure ulcer rates, patient / staff ratio, staff turnover rates, maintenance of medical records, time sending of the report of hospitalization, staff burnout rates, patients' satisfaction rates), and two indicators were related to training functions and research (number of hours of staff training, publication rates).

CONCLUSION

The use, by health care facilities, of this Balanced Scorecard, based on the current data from the literature and adapted to the specific professional context of Greater Maghreb, would be a preliminary condition for the start-up of a strategy to measure and improve hospital performance in the Maghreb countries.

Bibliometry of biomedical scientific publications in Mauritania (Medline:1992-2016)

BACKGROUND

As part of the preparatory work for the elaboration of a strategic plan for the development of scientific research in Mauritania, an overview of national biomedical research was recommended by the supervisory authorities.

AIM

Describe the bibliometric profile of biomedical scientific publications in Mauritania, indexed in Medline database, over the past 25 years.

METHODS

A bibliometric study was carried out on Medline Database covering the period from 1 January 1992 to 31 December 2016. Were retained, the scientific papers whose one of the author's address, at least, was a Mauritanian one. The fields of the Medline display format were used to describe the following items: authors, addresses, journal, language, article type, and Mesh terms. The assignment of a publication to an author was limited to the first and last position. Only first institutional affiliation mentioned in the authors' addresses was considered to classify the establishments' productivity. International co-operation has been studied through the compilation of all co-author addresses.

RESULTS

Between 1992 and 2016, Medline had indexed 141 Mauritanian articles, 74 of them was published during the previous five-year period (2012-2016). These papers covered essentially the following disciplines: "Infectious diseases", "Community health", "Parasitology", "Veterinary Medicine" and "Marine Sciences" It mainly consist of an original article (79%), written in English (57%) and published without financial support (72%). Mauritanian articles have been published in 72 journals in 12 different countries. Three journals « Bulletin de la Société de Pathologie Exotique », « Pan African Medical Journal » and « Malaria journal » have accounted 23 % of the publications ; 36% of the papers have been published in French journals. The research subjects of the Mauritanian biomedical literature was carried out via 215 major keywords, five of them represented 22% of the publications: «Malaria», «HIV infections», «Anopheles»,  «Camels», and «Goat diseases »". For 112 scientific articles (79%), the first author were Mauritanian, as for the rest (n = 29) the authors were coming from 15 different countries, mainly from France, Senegal and the Arab Maghreb. In 48% of the articles, the affiliation of the first author was one of four following structures: « the National Hospital Centre in Nouakchott», «The National Center for Livestock and Veterinary Research», « the Faculty of Science and Technology » and «the National Institute for Research in Public Health». A partnership with an international team was noted for 40% of publications, particularly with France, Italy, Senegal, Burkina Faso and Tunisia.

CONCLUSION

During the last past 25 year, the biomedical publication feature, inconsistently growing since 2012, has been characterizing by the adequacy of research themes with the population's health needs, an international visibility and an extensive networking with many foreign research structures. Strengthening Maghrebian collaboration in the fields of research training and Multi-centric research would be a fine support to the national dynamics of biomedical research.

Place of the "Public health" in the Tunisian medical research on the cardiovascular diseases: a bibliometric study (Medline: 1988-2017)

BACKGROUND

  The management of the cardiovascular diseases, main public health problem in Tunisia, is generating many difficulties that a socially responsible research should reflect them. The aim of this study is to assess dimensions of public health of Tunisian research on the cardiovascular diseases during thirty last years.

METHODS

we conducted a bibliometric study relating to the public health information of the Tunisian cardiovascular papers indexed in the Medline database between January 1st 1988 and December 31st 2017. The following qualifiers were selected to define the public health dimension of paper: "epidemiology", "mortality", "statistics and numerical data", "economy", and "prevention and control".

RESULTS

During thirty years (1988-2017), 176 references were identified and only 136 Tunisian publications were retained following the application of the inclusion criteria (first author affiliated in a Tunisian structure of health or research). The two medical specialties of "cardiology" and "Preventive medicine and Community" produced 47% of these articles. The selected publications were mainly original articles, monocentric studies, analytical, and written in French language for the national journal "La Tunisie Medicale". Among the 136 selected articles, 34 (25%) explored the ischemic heart diseases. "Epidemiology" and the "Prevention/Control" were two dimensions of the "Public health" the most studied in the Tunisian publications on the cardiovascular diseases, respectively in 84% and 44% of the cases.

CONCLUSION

The Tunisian publications in the cardiovascular field accompanied the epidemiologic transition along the three last decades. While they were focusing on the epidemiology and the prevention of the ischemic heart diseases. Other dimensions of public health must be treated on the set of the cardiovascular diseases, such as the economics and etiologics studies.

Smoking behavior among students of health sciences at the university of Monastir (Tunisia)

OBJECTIVE

Measure the prevalence of smoking among students of health sciences Faculties in Monastir (Tunisia) and identify factors associated with smoking behavior.

METHODS

A cross-sectional study based on a self-administered questionnaire conducted among students registered in their second, fourth and sixth year at the Faculties of Medicine and Pharmacy in Monastir, in 2013. Smoker was the subject who, at the time of the survey, smoked at least one cigarette per day. Academic difficulties were used to denote any of the following incidents that a student may experience: passing exams at the retake session, revalidating an internship or repeating a school year. A logistic regression analysis was used to identify factors associated with smoking.

RESULTS

The number of participants was 634 (285 Medical students and 349 Pharmacy students); they were 170 males and 464 females. The prevalence of smoking was 15%; 95% IC [12.1-17.7]. It was nearly five times higher among male compared to female students (35.3%; 95% IC [28.1-42.5]) vs 7.5%; 95% IC [5.1-9.9]); It was also higher among Pharmacy students than among Medical students (18.9%; 95% IC [14.8-23.0]) vs 10.2%; 95% IC [6.7-13.7]). In the multivariate analysis, the Faculty of Pharmacy (ORa=3.081; 95% IC=[1.7-5.7]), the male sex (ORa=6.929; 95% IC [3.9-12.0]) and the academic difficulties (ORa=1.854; 95% IC [1.02-3.38]) were found to be significantly associated with smoking.

CONCLUSION

The level of tobacco use found among Medical and Pharmacy students is alarming. This serious problem has a negative impact on their behavior and can hinder their role model as future health professionals. Greater efforts are needed to develop anti-smoking programs, to educate students and to offer psychological support to deal with school difficulties.

Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity

BACKGROUND

The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities.

OBJECTIVES

To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability.

METHODS

This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Data covering the period from 1990 to 2016, examined the three major categories of health problems "communicable, maternal, neonatal and nutritional diseases", "noncommunicable diseases" and "injuries", as well as the three types of risk: metabolic, environmental / professional and behavioral.

RESULTS

Since 1990, cardiovascular diseases have consistently been the leading cause of death in the three Maghreb countries. During the period 1990-2016, and at varying speeds, the positions of communicable and neonatal diseases declined, while noncommunicable diseases (particularly cardiovascular diseases, cancers, mental disorders, diabetes and neurological disorders) increased significantly, to be at the top of the list of components of the global burden of disease.In 2016, road accidents have been ranked eighth in the ranking of the main components of the overall burden of morbidity in Tunisia and Morocco and ninth in Algeria. During the same period, the environmental and behavioral risk factors registered an overall decrease in the three Maghreb countries, in contrast to the metabolic risk factors that experienced a gradual and homogeneous increase in the Greater Maghreb.

CONCLUSION

This GBD analysis confirmed the rather old and fairly advanced epidemiological transition in Maghreb countries, leading to a real "triple burden" threatening the stability and sustainability of national health systems. Hence the urgency of supporting the following five projects: the curriculum reform of the faculties of health sciences, the development of the second line of care, the participative management of health services, universal health coverage and the implementation of a comprehensive and integrated strategy for prevention and health promotion.

Alcohol consumption among health sciences students at the University of Monastir (Tunisia, 2014)

BACKGROUND

Studies conducted on characteristics of alcohol consumption and associated risk factors among health occupations students are scarce in the southern shore of the Mediterranean. The aim of this study was to assess the prevalence of alcohol use and misuse across a large sample of college students in Monastir university.

METHODS

A cross sectional study was performed between April 2013 and September 2013. An anonymous self-administered questionnaire was filled out by health occupations students from pharmacy, dentistry and medicine faculties .Data on socioeconomic characteristics and lifestyle were collected. Alcohol consumption patterns was studied via AUDIT-C and ADOPSA scales in order to assess respectively risky alcohol consumption and alcoholic disorder.

RESULTS

A total of 974 students were included. The mean age of students was 22.8 years (SD = 2.2) with a male-female ratio of 0.43. The overall prevalence of alcohol consumption, risky alcohol consumption, alcoholic disorder were respectively 14.1% (95%) CI [12.2-16.5]; 52.5% (95%) CI [43.4-61.2] and 79.1% (95%) CI [71.9-85.6].

CONCLUSION

This study highlights that health occupations students are not speared from presenting unhealthy behaviors like alcohol use and misuse Although prevalence of alcohol consumption is low the risky patterns of this consumption is alarming. and higher than described in similar population in other countries.

Tunisian documentation of «Public Health» in post revolution, with a taste of freedom. For a fair, participatory and efficient National Health System

CONTEXT

Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach.

OBJECTIVE

To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition.

METHODS

During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. These documents were: the "2011 Health Map" of the Department of Studies and Planning of the Ministry of Health, the "Societal Dialogue Report on Health Policies, Strategies and Plans" (2014), and the "Report on the right to health in Tunisia" (2016).

RESULTS

The reading of this sample of the Tunisian Public Health literature of the post-revolution brought out three consensual ideas: 1. The constitutional principle of the "right to health" (article 38 of the constitution) with its corollary the State's obligation to ensure access to comprehensive, quality and secure care; 2. The challenge of social "inequalities" of access to care, reinforced by a regional disparity in the distribution of resources, particularly high-tech (specialist doctors, university structures); 3. Advocacy for a National Health System, based on a universal health coverage for its funding and citizen participation in its governance.

CONCLUSION

The new Tunisian Public Health literature, in post-revolution, calls on all stakeholders in Preventive and Community Medicine to replace their segmental, technical and hospital practices with a new approach, centered on the implementation of a National Health System that is based on a socialized financing of care and citizen participation in its management.

Which indicators used to assess quality performance in Intensive Care Units? A systematic review of medical literature

OBJECTIVE

Collect, through a literature review, the indicators recommended for the measurement of performance in the Intensive Care Unit (ICU) and determine their typology.

METHODS

This systematic review was conducted in Medline, using the following search strategy: ("Critical Care"[Mesh] or "Critical Care Nursing"[Mesh] or "Intensive Care Units"[Mesh]) and "Quality Indicators, Health Care"[Mesh] and (hasabstract[text] and "2012/01/01"[PDat]: "2016/12/31"[PDat] AND "humans"[MeSH Terms] and [English(lang) or French(lang)]).

RESULTS

Overall, a total of 176 articles were selected for inclusion, of which 140 articles were available. The most frequent journal was: "Critical Care Medicine" (12%). Half of the articles have been published in USA. The analysis of these articles allowed the development of a list of 92 performance indicators in the ICU. The majority of quality indicators were global (63%) and used in a polyvalent ICU (86%). Regarding the domain, the indicators were distributed as follows: 19% "input", 40% "process" and 41% "output".

CONCLUSION

This study proposes a set of close to one hundred most-studied ICU performance indicators related essentially to "process". This study is only the first step in a performance improvement quality. The next step will be to use these indicators to develop a performance dashboard of the ICU based on clinical expertise.

Bibliometric profile of Tunisian medical publications written in English and indexed in Medline

BACKGROUND

English is becoming nowadays the universal language of science. Rresearch published in English can be considered as a bibliometric indicator of the scientific productivity.

AIM

We sought to describe the evolution of the Tunisian medical publications written in English over the period from 2004 to 2014.

METHODS

Medline's database was consulted using a research query associating the names of the country and the main university cities both in French and in English. The articles with a Tunisian health affiliation were retained but the articles of dentistry, pharmacy and non-medical fields were not included.

RESULTS

We counted 979 English language Tunisian medical articles published during the three tracer years of the study: 2004, 2009 and 2014. The increase rate was about 38% between 2004 and 2014. The contribution of medical fields in English language publications was important but showed a clear decrease over time. The retrieved articles did not have the same distribution according to the specialties and the institutions. The distribution according to the journals showed that these articles were mainly published by foreign journals with an increasing impact factors between 2004 and 2014.

CONCLUSION

The English language Tunisian medical productivity had shown an important increase over time but many specialties and institutions still not enough implicated in this production.Therefore, increasing research funding, improving the physicians' research methodology and English writing capacities are likely needed to improve the Tunisian medical output.