[Predictive factors for the level of knowledge, attitudes and quality of life of Tunisian diabetics : 1007 cases]

AIM OF THE STUDY

To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life.

RESULTS

We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D.

CONCLUSION

Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations.

[The macrophage: chief of tuberculosis immune response]

With nearly eight million new cases each year and two million deaths, tuberculosis (TB) remains a major health problem worldwide. The limited protection afforded by the only available vaccine, Bacille Calmette-Guerin BCG, and the emergence of multi-resistant strains to antibiotics along with the advent of AIDS, are three main causes that contributed to the increase of TB incidence during the last decade. The World Health Organization (WHO) estimates between 2000 and 2020, nearly one billion people will be newly infected with Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis, and 200 millions of them will develop the disease, of which 35 million will die if there is no improvement in controlling infection. Such improvement requires an increase in our knowledge of the fundamental biology of this very complex disease and in particular a better understanding and characterization of the types of interactions between mycobacteria and the immune system. The alveolar macrophage (MØA), the first immunological barrier that opposes the mycobacteria, plays a key role in the evolution of infection. In addition to the recognition and immediate elimination of the bacteria by phagocytosis and secretion of microbicidal products, MØA is extremely important in orchestrating the immune response and the establishment of a specific response provided by T cells. This review summarizes the state of our knowledge about the mechanisms deployed by the macrophage to contain Mtb infection with a focus on apoptosis as an innate immune response against this pathogen. We also describe the mechanisms developed by Mtb, during its coexistence with humans, in order to escape the macrophage response.