[Cost estimation of medical care management of lung cancer in Tunisia]

Background: Lung cancer management is very expensive for the Tunisian healthcare system.

Aim: The aim of this study was to evaluate the direct costs of treating lung cancer in Tunisia, and to identify the main treatment of high expenditure.

Methods: A retrospective study was conducted in 2012 including all patients admitted between 2008 and 2010 for lung cancer management. The hospital payment system was used to estimate the direct costs of the medical care management of lung cancer.

Results: We collected 549 patients and the majority of patients were diagnosed with advanced stages of the disease: 60% in stage T4 and 59% in stage M1. 26% of patients underwent surgery and 44.1% chemotherapy. The total direct costs of lung cancer management were estimated to be TND 3900 [US$ 1980] per patient.

Conclusions: Chemotherapy accounted for the largest percentage of direct costs [46%] followed by the cost of the hospital stay. Primary prevention, based on the application of policies to control tobacco, is the best strategy to reduce this morbidity

[Emergency department visits for respiratory symptoms in the greater Tunis, between 2007 and 2010]

Background: Asthma and Chronic Obstructive pulmonary Disease [COPD] are considered as a major public health problem worldwide. They are characterized by a progressive evolution with episodes of exacerbations

Objective: The aim of this work was to describe the emergency department visits for asthma and COPD according to sociodemographic characteristics of patients and to assess trends over time

Methods:We conducted a cross sectional study including all emergency department visits of the Abderrahmane Mami hospital during the period between January, 1st 2007 and the 31th of December 2010. We used a standardized questionnaire to collect age; sex and date of emergency department visits with a primary diagnosis of asthma and COPD exacerbation from the emergency register. Data analyses were performed with SPSS 17.0

Results: A total of 9814 emergency department visits were reported over the period of four years, 6499 [66,2%] for asthma and 3315 [33,8%] for COPD exacerbation. The mean age was 52 +/- 21 years; it was for asthma and COPD respectively 48 +/- 21 and 60 +/- 18 years. Aging was associated with a marked decrease in the prevalence of asthma [from 51.0% to 25.6%] and with a marked increase in the prevalence of COPD [from 6.8% to 47.5%]. Men visit most frequently the emergency department for both diseases than women and particularly for COPD where the proportion of men was 75%. The number of visits increased steadily between 2007 and 2010, it peaked in January for asthma and in February for COPD and it was most important on the period from December to May

Conclusion: Asthma was most common among emergency department visits than COPD exacerbation, it affects men and women in a nearly same proportions and it is most frequent in young adults aged between 30 and 65 years. COPD exacerbation is most frequent in men aged over 65 years. Our study suggests that there is significant seasonal variation in the emergency department visits for respiratory illness. These findings suggest that greater attention and most adapted studies should be necessary to explain and to identify factors implied in these variations

High risk areas for echinococcosis-hydatidosis in Tunisia

The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation. The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A [global hydatidosis risk score] was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease. The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases. In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores