AB0919-PARE WHAT DO OLD PEOPLE THINK OF THEIR RHEUMATOID ARTHRITIS TREATMENTS?

Background:

Managing chronic diseases such as rheumatoid arthritis (RA) is a challenge on a daily basis for rheumatologists and convincing our patients to properly take their medication may be difficult especially with elderly. First step comes with our patients’ education and suppressing misbeliefs and misconceptions.

Objectives:

To study beliefs of elderly RA patients on DMARDs and see what they really think of their treatments.

Methods:

A cross-sectional study was conducted in a rheumatology clinic over a period of 4 months. Patients over the age of 65 having RA and being treated with conventional DMARDs or biologics were questionned about their medication. The belief about medicines questionnaire (BMQ) was used to assess different beliefs. It is a validated questionnaire of 18 items. Patients responded freely to each item using a Likert scale. The clinician later collected the data and 4 scores were calculated (concern (c), necessity (n), overuse and harm), thus classifying patients on 4 different groups as follows: accepting if n≥ 15 and c<15, ambivalent n≥ 15 and c≥15, indifferent if n< 15 and c <15 and skeptical if n<15 and c≥ 15.

Results:

Forty elderly patients joined the study. The median of age was 66 years. They were mostly women (82.5%) with other comorbidities in 55% of the cases. The mean of DAS 28 score was 4.65± 1.77 and the mean of the VAS pain score was 5 out of 10. Only 17.5% of the patients were on remission or low disease activity. Radiological destructions were detected in 87.2% of the patients and deformities in 60% of them. Rheumatoid factor and/or citrullinated peptide antibodies were detected in 81.6% of the cases.95% of the patients were on methotrexate (MTX), 12.5% on Sulfasalazin and 12.5% on biotherapies. Corticosteroids were prescribed in 85% of the patients. Responses to the BMQ specific and general questionnaire are showed in table.1. The mean score of concern was 15.33±3.8, the mean score of harm was 13.44±2.9, the median of the necessity score was 18 and the median of the overuse score was 13.5. Analysing patients’ beliefs, the majority of them were ambivalent towards their DMARDs (44.4%), 33.4% were accepting, 11.1% were skeptical and 11.1% were indifferent.

Table 1.

BMQ responses

BMQ specificDo not agree at all %Do not agree %Incertain %Agree %Agree very much %My health at present depends on my RA medicines5.622.2%27.844.40Having to take RA medication worries me5.644.4038.911.1My life would be impossible without my RA medication5.616.722.233.322.2Without my RA medication i would be very ill11.122.216.738.911.1I sometimes worry about the long-term effects of my RA medication27.811.111.144.45.6My Ra medication is a mystery to me5.633.35.6505.6My health in the future will depend on my RA medication5.616.727.8500My RA medication disrupts my life5.638.95.644.45.6I sometimes worry about becoming too dependent to my RA medication038.911.144.45.6My RA medication protects me from becoming worse016.75.661.116.7BMQ generalDoctors use too many medicines016.727.844.411.1People who take medicines should stop their treatment for a while every now and then11.144.422.222.20Most medicines are addictive05.622.261.111.1Natural remedies are safer than medicines11.111.127.822.227.8Medicines do more harm than good11.127.827.827.85.6All medicines are poisons5.622.227.822.222.2Doctors place too much trust on medicines5.616.733.327.816.7If doctors had more time with patients they would prescribe fewer medicines011.122.233.333.3

Conclusion:

Elderly RA patients should me more reassured about the safety of DMARDs and the importance of taking them and try to establish a better patient-doctor relationship.

References:

[1]Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 1999; 14: 1–24.

[2]Aikens JE, Nease DE, Nau DP, et al. Adherence to Maintenance-Phase Antidepressant Medication as a Function of Patient Beliefs About Medication. Ann Fam Med 2005; 3: 23–30.

Disclosure of Interests:

None declared

POS0481 DOES OLDER REALLY MEAN WISER?

Background:

One of the main challenges in Rheumatoid arthritis (RA) is to maintain remission or low disease activity by adhering to the prescribed treatments. However, it is believed that adherence to long term treatments is inadequate in chronic diseases. Does this apply to older people too?

Objectives:

To assess treatment adherence among an elderly RA population and to study determining factors of non-adherence

Methods:

A cross-sectional study over a period of 4 months was conducted in a rheumatology clinic (September 2020-December 2020). Consenting elderly over the age of 65 presenting with RA were included. Exclusion criteria involved associated connective tissue diseases and troubles communicating. During clinical visits, sociodemographic information, clinical, radiological and therapeutic data were collected. Treatment adherence was assessed by the 5-item compliance questionnaire of rheumatology (CQR-5). Patients were also asked about the degree of satisfaction vis-à-vis the therapeutic effect detected. Univariate and multivariate analysis were conducted using the statistical tool SPSS.20.

Results:

Forty patients consented to join the study, 82.5% of them were women. The median of age was 66.5 years old with a minimum of 65 and a maximum of 83. Comorbidities were noted in 55% of the patients. 75% of the patients had health insurance. The mean pain score was 5 out of 10 on a visual analog scale (VAS). The mean DAS 28 was 4.65±1.77 with 72.5% of the patients having an active disease. Deformities were reported in 60% of the cases and bone destruction on radiographs in 87.2% of the cases. Methotrexate was the most prescribed treatment in 95% of the cases and biologics in 12.5% of the cases. The median number of pills taken (on the day of MTX) was 12.5 (min=6; max=23). Up to 35.5% of the patients were not satisfied with treatment results. 90% of the patients took their medication because they had fewer problems afterwards. 72.5% of them did not dare to miss their RA treatment. 95% of them had their pills stored in the same place to not forget them, 97.5% took their medication because they had complete confidence in their rheumatologist and 92.5% of them hung on to what the doctor told them. The overall results of the CQR-5 revealed that 72.5% of the patients were adherent to their RA medication and 27.5% of them were non-adherent. The study of factors associated to non-adherence showed that being younger (p=0.01), not having a health insurance (p=0.014), having comorbidities (0.03), and not being satisfied with treatments’ results (p=0.014) were associated to non-adherence. Multivariate analysis showed that risk factors associated to non-adherence were elevated pain scores (odds ratio=4.11, p=0.042), not having health insurance (odd ratio=7.54, p=0.006) and having to take many pills at once (odds ratio=4.48, p=0.034). Being older was a protector factor of non-adherence (odds ratio=0.81, p=0.034).

Conclusion:

Adherence among RA elderly patients is optimal and they have good trust in their medication and confidence in their rheumatologist. Older seems wiser when it comes to treatment taking behaviors in RA.

References:

[1]Hughes LD, Done J, Young A. A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs. BMC Musculoskelet Disord 2013; 14: 286.

Disclosure of Interests:

None declared

[Recidives of Mycetoma after Amputation in Dakar (Senegal)]

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

Differences between surgical team members in terms of teamwork, workload and stress

Background

Within Operating Rooms (OR), teams consisting of professionals with different training and backgrounds are expected to function optimally in a high-risk environment that is scattered with stressors, that often appear simultaneously and are usually related to the ever-present time pressure which is often paired with ineffective teamwork and an ever-increasing workload and stress. This study aimed to investigate whether there are significant differences in teamwork; workload; and stress levels between surgeons, anesthesiologists, and scrub nurses.

Methods

This was an observational cross-sectional study, conducted over 3 months in 2018, in Sahloul University Hospital; in 4 ORs with different specialties. We used a validated observation sheet to asses teamwork (Observational teamwork assessment for surgery tool) during the intraoperative phase. At the end of each operation, stress and workload of the surgical team members were measured. All ethical considerations were taken into account.

Results

Overall, 160 participants from the concerned ORs participated in the study and 50 operations were observed. Most of the participants were nurses (45.6%). Concerning teamwork, in fact, surgeons received significantly higher scores on all of the dimensions. The mean global teamwork score for surgeons was 4.87 (SD = 0.75, p &lt; 0.01) on a scale of 0 to 6. Moreover, ANOVA test showed that surgeons experienced higher workload with a mean of 66.88 (SD = 25.98, p &lt; 0.01). However, nurses were significantly more stressed than both anesthesiologists and surgeons.

Conclusions

This study offered a practical method to evaluate, simultaneously, teamwork, workload and stress in the OR and revealed differences across team members as surgery unfolds. Given the importance of care delivery in the ORs, the findings of this study can be used to lead targeted interventions to enhance the surgical team performance.

Key messages

There were significant differences between surgical team members in terms of teamwork, workload and stress. Surgeons had higher teamwork and workload; however, nurses had the highest stress.

Evaluation of the impact of intra-operative distractions on teamwork, stress and workload

Background

Within the OR, distractions occur on a regular basis, which affects surgical workflow and results in discontinuation of urgent tasks. In addition, engaging into distractions in the OR may not only increase stress and workload, but also impair teamwork performance. This study aimed to observe the occurrence of intra-operative distractions in ORs and to evaluate associations between distractions, teamwork, workload and stress.

Methods

This observational cross-sectional study was conducted in Sahloul University Hospital; more specifically in four different surgical units: orthopedic, urology, emergency and digestive surgery and over a period of 3 months in 2018. Using validated observation sheets, distractions and teamwork were recorded and rated in real-time during the intraoperative phase of every case. Besides, stress and workload of OR team members were measured at the end of each operation. All ethical considerations were taken into account.

Results

Fifty cases were observed and 160 participants were included in this study. In total, we recorded 933 distractions that occurred once every 3 minutes, on average. The mean global teamwork score was 3.85 (SD = ±0,67) on a scale of 0 to 6, the mean workload score was 58.60 (±24,27) and the mean stress score was 15.29 (SD = ±4,00). The highest rate of distraction was significantly related to external staff entering or exiting the OR during non-teaching cases (M = 9.43, SD = 3.56; p = 0.006). Surgeons also experienced significantly higher workload with a mean of 66.88 (SD = 25.98,p&lt;0.01).

Conclusions

This study highlighted a serious problem which is, often, ignored or underestimated. Taking into consideration the results, we recommend the implementation of systemic interventions on a daily basis to reduce the number of distractions in the OR.

Key messages

Distractions happened in all of the included operations. Stress and workload among nurses got higher as work environment distractions increased.

Polysubstance use among adolescents in Tunisia

Background

Poly-substance use is a global public health problem associated with significant adverse social and health effects. Adolescents are increasingly affected by this risky behaviour. The objective of our study was to describe the poly-substance use and to determine the association between the different types of substance use among middle school students in the Region of Kairouan in Tunisia.

Methods

A cross-sectional study was conducted in 2017 among middle school students in the Region of Kairouan in Tunisia using a self-administered questionnaire for data collection.

Results

A total of 494 students participated in the survey. Tobacco, alcohol, cannabis and psychotropic drug uses were reported respectively by 7.9%, 7.3%, 6.3% and 14.3% of the students. Among the surveyed students, the poly-consumption of the four substances: alcohol, tobacco, cannabis and psychotropic medication without medical prescription was reported by 2.83% of the students. Among these poly-consumers, 57.1% were male. Poly substance use was found to increase with the level of study (21.4%, 28.6% and 50% respectively in grades 7, 8 and 9). In our study, among the smokers, 64.1% reported alcohol use, 69.2% reported cannabis use and 43.6% reported psychotropic drug use. Associations between tobacco use and other substances use were significant (p &lt; 10-3). This association was significant for both boys and girls. In addition, 71% and 26% of alcohol users were respectively cannabis and psychotropic drug users. Alcohol use was significantly associated with cannabis and psychotropic drug use (p &lt; 10-3). This association was significant for both boys and girls.

Conclusions

Adolescents are particularly vulnerable to multiple risky behaviors including substance use. Appropriate prevention and control strategies based on a participatory approach involving parents, teaching and medical staff should be put in place to combat this scourge.

Key messages

Despite a relatively low prevalence of poly-substance use among the surveyed students, a particular attention should be drawn to the phenomenon of psychotropic drug use without medical prescription. There is an urgent need for the implementation of an effective substance use prevention program in school settings in Tunisia where monitoring is one of its core components.

Obstetric referrals to the regional maternity of Kasserine (Tunisia)

Background

A large proportion of maternal deaths are related to the health care system, including the failure of the referral system between maternity wards. The objectives of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian regional care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme guidelines.

Methods

A descriptive study was carried out at the regional maternity facility of the regional Hospital of Kasserine in 2018, among parturients referred during a period of three months. Data collection was carried out prospectively from medical records, transfer documents, interviews with parturients and with the nursing staff of the reference maternity hospital. The ICD-10 was used to code recorded indications and diagnoses for referrals.

Results

A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity in this facility. There were 26 reasons for referrals and the most common was Maternal care for pelvic organ abnormalities (19.7%) and premature rupture of membranes (12.8%). 34.4% of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (71.4%) did not conform to the list of referral indications of the NPP. Twenty-eight diagnoses were retained after referrals: the most common was Maternal care for pelvic organ abnormalities (15.8%). In 42% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital.

Conclusions

The referral system must be analyzed in order to ensure a maximum level of safety for the mother-child couple through the formalization of the protocols and the promotion of the role of peripheral maternity facilities, which are the structures of first recourse.

Key messages

The current referral system in the region of Kasserine still faces several challenges that need to be addressed in order to make it more effective. Maternal referral systems are an effective measure to help to reduce preventable maternal deaths, they should be continuously assessed and revised.

Tunisian Nurses experiences of their humanitarian mission in the ''Choucha” Refugee Camp

Background

Participation in a humanitarian mission can be considered as a heroic work especially for health professionals. In 2011, a refugee camp was set up in southern Tunisia. The objective of this study was to describe and better understand the experience of Tunisian nurses in the Choucha refugee campbased on the Meleis transition theory.

Methods

We conducted a qualitative, phenomenological study among 14 nurses using an interview guide. Data analysis was carried out according to the method of Giorgi, from which 5 core themes and 28 sub-themes had emerged.

Results

This studydescribed the experience of nurses as a passage between 4 different phases: before, during, after the passage to the refugee camp and the memory.Five core themes emerged from our research:1) Trigger events: 3 sub-themes were evoked for the reason of participation: motivation, commitment and expectations; 2) Professional and interpersonal relationships marked the integration of the interviewees despite some misunderstandings, 3) Coping, 4) The impacts are mostly positive, and 5) Feelings that expressed emotions and nostalgia. For the transition, the last stage, which is the appreciation of the past moments, indicated the passage from an unbalanced state to stability.

Conclusions

Looking at the lived experience of the nurses and the transition experience described by the participants, this study found that the lack of training of the nurses previous to the humanitarian mission was the major barrier to making a healthy transition. These findings can contribute to raise the awareness, preparation and education of nurses to improve the experiences of future caregivers who will participate in humanitarian missions.

Key messages

It seems essential to set up training program focusing on preparation and debriefing of nurses to support them in achieving a healthy transition in their humanitarian mission in refugee camps. Training health care professionals before their participation to humanitarian mission in refugee camps can be among the factors that enhance the quality of care provided to refugee populations.

A picture of the adolescents dietary habits in Tunisia

Background

Adolescence is one of the main growth periods of life during which dietary needs are specific and where diet quality is important for healthy development. Nonetheless, unhealthy eating behaviours are common among adolescents including over consumption of unhealthy fast food, sugar and fat and skipping meals. Exposure to unhealthy eating can lead to chronic conditions such as obesity and diabetes. In this context, we conducted this study to describe the quality of the diet of middle school students in the Region of Kairouan in Tunisia.

Methods

This is a cross-sectional study conducted in 2017 among middle school students in the Region of Kairouan. Data collection was carried out using a self-administered questionnaire.

Results

In this study, 494 students were included. In terms of food type, fast food meals (sandwiches) were the most preferred type of food (52.6%). Daily consumption of vegetables and fruit was reported by 48.8% of students. Among the participants, 46.8% reported daily consumption of olive oil. Daily water consumption was less than one liter for 32% of the college students. Daily coffee and/or tea consumption concerned 53.8% of respondents. In the current study, 39.3% of the students reported that they consume more than three meals per day and 26.7% declared that they often skip the breakfast. In our study, 62.8% of the participants had reported their dissatisfaction with their nutrition education, 54.9% sought to know the food composition and 57.9% reported that they have a willingness to adopt a healthy eating.

Conclusions

A quality and diversified diet can cover the specific nutritional needs of adolescents. A diet inspired by the Mediterranean food is to be encouraged. Further studies should be conducted among adolescents to evaluate the impact of a healthy and balanced diet on health and school achievement.

Key messages

The quality of diet of Tunisian adolescents is to be improved. Effective comprehensive programs for healthy lifestyle promotion are needed to improve the eating behaviour among Tunisian adolescents.

Herbal medicine use and its associated factors in the region of Sousse (Tunisia)

Background

Patients use medicinal plants as the first-line treatment for many chronic and acute medical conditions. The lack of access to conventional health care, historical, cultural and economic considerations contributes to the important use of these plants. The purpose was to identify medicinal plants used by primary Health Care Centers' visitors in the region of Sousse (Tunisia) and to assess its associated factors.

Methods

A cross-sectional descriptive study was conducted among Primary health care centers' visitors of the region of Sousse (Tunisia) in 2018. We randomly selected 18 primary health centers and 50 participants were chosen from each center. Data were collected using a pre-tested questionnaire, filled through a direct interview with participants which explores: socio-demographic variables and medicinal plants' use (name of plants, symptoms, methods of preparation, routes of administration, plant source, tolerance and side effects).

Results

900 persons were included with a female predominance (72.4%). The median age of participants was 48 years ranging from 18 to 93. 65.2% (n = 587) of them report using medicinal plants to heal. The most common sources of information were family (90.5%), beliefs and traditions (56.4%). Fifty-three (53) plants were used to treat different disorders. The most used plants are: verbena (81.6%), rosemary (53.3%), mint (52%) and thyme (45.1%). The most reported treated symptoms were: flu and gastro-intestinal disorders. Plants utilization was associated to: lower age, female gender, marital status, high level of education and social existence of protection coverage.

Conclusions

Plants use should be based on well-conducted scientific results specifying the mechanism of action of plants, the therapeutic and toxic dose through researches on local plants samples and extracts.

Key messages

It seems essential to train health professionals on herbal therapy during their studies and practice. The further step after this picture of the herbal medicine use in the Region of Sousse, is to evaluate the safety and the efficacy of their use.

Association between smoking cessation and quality of life among patients with COPD in Tunisia

Introduction

Smoking cessation is the most important step to limit the complications of chronic obstructive pulmonary disease (COPD). Outcomes from studies that assessed the association between health-related quality of life (HRQL) and smoking cessation have been controversial. This study aimed to assess the relationship between HRQL and smoking cessation in patients with COPD in Tunisia.

Methods

A cross-sectional study was carried out in the two main primary care centers in the center of Tunisia over a period of three months (April-June 2016). Clinic and socio-demographic data were collected from patients' records. HRQL was assessed by the Medical Outcomes Study Short-form 36 (SF-36). This instrument is composed of two dimensions: physical and mental components. The questionnaire outcomes were described as means and standard deviation. T-test was performed to assess the statistical difference between the dependent and categorical variables.

Results

A total of 249 COPD patients participated in the study with a mean age of 67.77±11.13. Of this sample, 169 (67.9%) ceased smoking. The average period of smoking cessation was 10 years. The mean of total HRQL score in patients who ceased smoking was lower in comparison to patients who did not quit smoking (40.65±24.49, 43.37±24.49; respectively). The T-test reported a significant difference between the physical component of HRQL and smoking status. Patients with current smoking status had a better physical component score in comparison with patients who quit smoking (43.76±22.62, 37,86±18.21, p = 0.04, respectively). No significant differences were found between smoking cessation, mental component, and HRQL total score (p = 0.89, p = 0.39; respectively).

Conclusions

This study revealed that smoking cessation was associated with the physical component of HRQL. The smoking dependence in patients with COPD could explain this finding. Health care professionals should work harder on effective smoking cessation strategies.

Key messages

These findings suggested that HRQL was better among patients who did not quit smoking. Patients who did not cease smoking reported better physical status and poorer mental status in comparison with patients who quit smoking.

Adolescent’s substance use and suicidal thoughts in Tunisia

Background

Experimentation with substance use is common during adolescence. Substance use may result in many health-related problems and contribute to adolescent suicidal behavior. We conducted this study to examine the relationship between substance use and suicidal ideation.

Methods

This is a cross sectional study conducted among a representative sample of 2020 adolescents enrolled in Tunisian secondary schools using a self-administered questionnaire.

Results

The prevalence of tobacco, alcohol and cannabis use was respectively 3.7% (95% CI [2.87%-4.52%]), 4.4% (95% CI [3.5%-5.29%]) and 0.8% (95% CI [0.40%-1.18%]) Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months. Tobacco (Odds Ratio = 2.61; 95% CI = 1.59–4.29), alcohol (Odds Ratio = 2.77; 95% CI = 1.76–4.36), and cannabis use (Odds Ratio = 4.98; 95% CI = 1.85–13.96) were significantly associated with suicidal thoughts among adolescents (p &lt; 10-3).

Conclusions

This cross study has shown a significant association between substance use and suicidal ideation. This relationship can be bidirectional and suicidal ideation and substance use may affect each other.

Key messages

In his study, the prevalence of substance use was relatively low and was associated with suicidal ideations. The reciprocal link between the two problems and their co-occurrence should be taken into account when planning preventive substance use and suicide programs.

Obstetrical complications treated in the maternities of the region of Sousse (Tunisia)

Background

About 800 women die each day worldwide due to complications related to pregnancy, childbirth or in the postpartum period. The objective of this study was to describe the activity of the public maternities in the Governorate of Sousse (Tunisia) and to identify obstetrical complications treated in these facilities.

Methods

A cross sectional study of all public health facilities, which performed deliveries in Sousse was conducted in 2017 (Five maternities: one University maternity and four peripheral ones). Data were collected by reviewing clinical records and registers of these maternities for the year 2016.

Results

In total, in the health visited structures, there were 13427 deliveries in 2016, the majority of them (78.8%) took place at the university maternity of Farhat Hached hospital. Of these deliveries, 3397 were performed by caesareans (25.3%). In 2016, there were three maternal deaths and 69 very early neonatal deaths. There were 2036 direct obstetric complications treated in the five maternities visited. The most frequently encountered direct complications were: ’obstructed/prolonged labor’ (41.21%), ’severe pre-eclampsia/eclampsia’ (19.5%) and ’ante and postpartum haemorrhage’ (15.18%). The most encountered indirect obstetrical complications were: gestational diabetes and anaemia.

Conclusions

The reduction of maternal and neonatal mortality requires the existence of a functioning basic health care system that provides all pregnant women and their newborns with timely access to skilled care, particularly when a complication occurs. The provision of this qualified care requires also the presence of qualified personnel working in a suitable professional environment.

Key messages

The majority of obstetrical complications occur in university maternity and this is due to excessive references from peripheral maternities. Peripheral maternities need to be strengthened with material and human resources.

Suicidal ideation among Tunisian adolescents and the association with adverse life experiences

Background

Youth suicidality is a significant public health problem. Understanding the factors leading to suicide is essential to implement effective preventive efforts. In this context, this study was conducted to assess the link between suicidal ideation and adverse life experiences among Tunisian school aged youth.

Methods

A cross-sectional survey was conducted among a sample of 2020 secondary school adolescents in 2016. An anonymous self-administered questionnaire was used to collect data. The adverse life events measured were: domestic violence, parental divorce, physical aggression, sexual abuse and a familial antecedent of suicide.

Results

Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months with no gender difference (16.3% among girls and 17.3% among boys, p = 0.62). Among the participants, 26.7% experienced at least one adverse life experience. Those who reported domestic violence (Odds Ratio = 8.93; 95% CI = 6.84–11.66), parental divorce (Odds Ratio = 3.02; 95% CI = 1.57–5.79), physical aggression (Odds Ratio = 6.97; 95% CI =5.14–9.46), sexual abuse (Odds Ratio = 8.69; 95% CI =3.94–19.15), familial antecedent of suicide (Odds Ratio = 8.17; 95% CI = 5.75–11.60) were associated with increased odds of suicide ideation.

Conclusions

The prevalence of suicidal ideation observed in the survey area was relatively high and associated with all the measured life adverse events. These factors should be included in a suicide screening tool to be integrated in a suicide prevention program.

Key messages

Suicidal ideation among adolescents was associated with all the measured life adverse events. Identifying adolescents at higher risk of suicide and help them to cope with their adverse experiences could be effective to prevent taking action to attempt suicide.

School bullying among Tunisian adolescents: prevalence and psychosocial outcomes

Background

Bullying is a serious public health concern affecting the emotional well-being of pupils. We conducted this study to examine the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior.

Methods

This is a cross-sectional study conducted in 2015 among a representative sample of pupils enrolled in 14 colleges in Sousse using the revised Olweus Bully/Victim Questionnaire.

Results

We included 1584 students aged between 11 and 15 years. The prevalence of bullying and victimization was 16.0% [95% CI: 14.2%, 17.8%] and 11.3% [95% CI: 9.7%, 12.9%] respectively. Four groups of students were identified, 11.7% were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy (38.3%, p &lt; 10-3) and liking school (30.0%, p &lt; 10-3). They were more likely to be aggressive (56.2%, p &lt; 10-3) and disintegrated in the class (30.6%, p = 0.002). Among the victims, 11.1% reported that their parents contacted the school several times to stop their victimization. The majority of the middle school students perceived that their classmates (54.1%) and teachers (39.5%) did nothing to counteract the bullying behavior.

Conclusions

The school institution is expected to be for pupils a highly meaningful space for social, emotional and academic development. Parents, teachers and students should learn effective ways to handle the bullying problem since it has been emphasized that the most effective programs are comprehensive targeting students, schools, families, and the community.

Key messages

This is the first study conducted in Tunisia to highlight the extent of school bullying. Our findings can help to raise awareness of parents, school staff and policy makers about bullying.

[Clinical and pathological profile of the pleural malignant mesothelioma: A retrospective study about 30 cases]

BACKGROUND

The malignant pleural mesothelioma (MPM) is a rare tumour usually associated to asbestos exposure. The delay between the exposure and the occurrence of the cancer can reach 40 years. This caused the pick of incidence described in many countries including Tunisia. The diagnosis is suspected based on clinical features but positive diagnosis is microscopic. Our aim was to describe the clinical and microscopic features of MPM through a single institution experience.

PATIENTS AND METHODS

We conducted a retrospective study about 30 MPM diagnosed over a 20-year-period (1995-2015). We included only patients with complete records including clinical, radiologic and microscopic features. All the microscopic diagnoses were reviewed by 2 pathologists. A mean of 12 slides per case was reviewed. The diagnosis was based on the 2015 WHO classification.

RESULTS

The mean age of the patients was 61 years, average 22 to 80 years. The sex ratio was 6,5. An asbetose exposition was reported in 21 cases. The most frequent symptoms was chest pain reported in 25 cases. Physical exam was normal in 9 cases. It revealed pleural syndorm in most patients (60 %). Imaging findings consisted mainly in diffuse pleural thickening in 17 cases. Twelve tumours were classified as stage I, 3 stage II, 14 stage III et 1 stage IV. Pleural biopsy was performed using needle in 18 cases, through thoracoscopy in 16 cases, thoracotomy in 3 cases and allowed the diagnosis in respectively 7 cases/18, 16 cases/16 and 3 cases/3. A lymph node biopsy was performed through mediastinoscopy in one case and yelded the diagnosis. The diagnosis was performed on surgical specimen in 2 patients: one bullectomy and one right upper lobectomy. The microscopic exam concluded to an EM in 17 cases, sarcomatoid mesothelioma (SM) in 4 cases and biphasic mesothelioma (BM) in 9 cases. Pan-cytokeratin antibody was used in all cases in association with 2 antibodies with positive diagnostic value and 2 antibodies with negative diagnostic value. It was repeated in 15 cases and the most used antibodies were the anti-calretinin and the TTF1. This was due to the lack of fixation in one case and in order to reach a quality criteria in the other cases. Surgical resection was possible in 2 patients. 15 patients were lost of view after a mean follow-up period of 3 months. Thirteen patients died before or during the follow-up.

CONCLUSION

This work was about a Tunisian experience in the diagnosis and management of MPM. The major limits faced were the incomplete databases, the small number of patients included. Microsocpic positive diagnosis necessitates a degree of expertise and every laboratory has to determine the most valuable antibodies through its experience in order to optimize the diagnosis and to reduce the delay of diagnosis.

Prevalence of and factors associated with smoking among students in Sousse, Tunisia

Within the framework of the fight against tobacco among young people, we conducted a descriptive cross-sectional study in 2013 to estimate the prevalence of smoking and to identify associated factors among students in Sousse. A questionnaire was administered to a representative sample of 556 students in 5 academic institutions in Sousse randomly drawn. The age of the participants was between 17 and 35 years. The prevalence of tobacco consumption in the past 12 months was 22.1% and consumption during the past 3 months was 65.3%. The average age of starting smoking was 17 years. Smoking prevalence was significantly higher for males (P < 0.001) and those aged over 25 years (P = 0.002). Students from 2 of the institutions were using more tobacco than their colleagues in the other institutions (P = 0.027). The high prevalence of smoking found among the students means that prevention measures are essential; this requires increasing self-esteem and evaluating intervention programmes implemented before smoking the first cigarette.

Derivative spectrophotometric determination of droperidol in presence of parabens

We have developed a fast and accurate method for the determination of droperidol in the presence of methylparaben and propylparaben using derivative spectrophotometry. The first derivative amplitudes at 255.2 nm were selected for the assay. Calibration graph follows Beer's law in the range of 5-35 microg ml(-1). The coefficient of variation (CV) for intra-day and inter-day precision were less than 1.0 and 2.0%, respectively. The method was applied in the quality control of commercial oral and injection solutions and proved to be suitable for routine analysis.