[Audit on the quality of school vaccination in the region of Monastir [Tunisia]]

We conducted a clinical audit by observing 55 vaccinators in schools in the governorate of Monastir in 2014. We used a set of criteria by referring to the national immunization programme. The cold chain was respected in most cases. Accumulators, the collector of syringes and needles, cotton balls soaked in alcohol and emergency box were available in 85.5%, 76.4%, 98.2% and 41.8% of cases respectively. Hand washing before immunization session was performed in 29.1% of cases. Waste disposal according to the hygiene rules was done by 40 agents. Health education of students regarding the interest of vaccination was done in 67.3% of cases. Therefore, improvements in hand hygiene practice and education are recommended

[ breast clinical examination. An experience in general medicine]

A Tunisian woman from 27 will be affected by breast cancer between 0 and 74 years of her life. Evolution of this cancer is relatively short. Its mortality is 10% when not detected. The regular practice of clinical breast examination is one of the tools of awareness and adherence to screening women for breast cancer. To describe the results and the obstacles to the realization of the early diagnosis of the breast cancer for the clinical examination by the general practitioner. A forward-looking study realized over 9 months which concerned 105 women of more than 24 years old, consulting for the other motive, in a basic health center. The appropriate statistical tests had been used at the risk of 5 %. The rate of participation was 12 %. The age mean was 46.4 +/- 10 years old. An abnormal clinical examination, was identified at 36.2% of the women. The multi parity decreases the risk of developing a breast clinical abnormality, with OR= 0.14 [IC 95 % [0.035-0.580]] while histories favoring the breast cancer increase this risk with an OR=2.79; [IC 95 % [1.09-7.13]]. The general practice had asked for a radiological examination for 67.5 % of the women. His request was influenced by the result of the clinical examination [OR= 20.42 [IC 95 % [7.01-59.49]]]. Four cases of malignant tumors had been diagnosed. We recommend giving the general practitioners responsibilities for the women gynecological health and for the coordination between the different actors, via a weekly day of prevention

Trends in hospital morbidity among adults in the region of Monastir [Tunisia] between 1996 and 2007

To study trends of hospital morbidity among adults in the region of Monastir during a period of 12 years [1996 - 2007]. We analyzed data from the morbidity database of the university hospital of Monastir [Tunisia] between 01/01/1996 and 31/12/2007. Data were drawn from the register of hospital morbidity implemented in the Department of Preventive Medicine and Epidemiology since 1995. The International Classification of Diseases [tenth revision] was used to identify and classify morbid conditions. During the study period, we collected 150749 admissions with male tendency [sex-ratio = 1.27]. Among these admissions 24.4% were over than 64 years. Morbid conditions were dominated by Ischemic Heart diseases [4.24%] followed by cancers and diabetes mellitus [3.3% and 2.52% respectively]. Chronological trends, using Spearman correlation rank test, showed that overall rate of chronic conditions increased significantly from 4.4% in 1996 to 9.1% in 2007 [r'= |0.88|, p-value < 0.001]. In contrast, the rate of infectious and parasitic diseases decreased from 4.3% to 2.9% [r'= |0.98|, p-value < 0.001]. Morbidity trends reflect the epidemiological transition of our country and call to a backing of the ambulatory system and the development of specific services able to decrease the needs of hospitalizations

[Epidemiological and chronological profile of the parturientes in the extreme ages in the Monastir region between 1994 and 2003]

Pregnancy outside 19-34 years interval is risk factors of the maternal and fetal morbidity and mortality. Tunisia, witch known an epidemiological transition, implanted the national program of perinatality since 1990 and one of its objectives is the surveillance of the high risk pregnancies. The aim of this study is to draw up the epidemiological profile of the parturient in extreme ages in the region of Monastir and to study the chronological tendencies of the associated factors during a decade [1994 -2003]. In all, the study interest 13225 extreme ages parturient, representing 22.5% of all women admitted for delivery in the public maternities of the district. The mean age was 18.6% +/- 0.6 years for the parturient less than 20 years and 37 +/- 2 years for the older than 35 years and more, among them 40% were older primipara. The prenatal care was inadequate for 35.4% of younger women and 47.6% of aged women. During the decade, we notice a significant decrease of the frequency of pregnancy for teenager parturient [from 3 in 1994 to 1.99% to 17.7% in 2003] [p<0.001]. Adequate prenatal care increased and the frequency of parturient without any follow-up decreased [from 17.2 to 2%] [p<0.001]. Given to this demographic and social transition, our healthcare system is called for greater vigilance and a more rigorous application of the recommendations of the national program of perinatality

[Epidemiological profile and chronological tendencies of the multiparity in the sanitary district of Monastir [Tunisia] between 1994 and 2003]

Multiparity, risk factor of maternal and foetal morbidity and mortality, is a worldwide public health problem. In Tunisia, in spite of the activities of the national program of maternal and infantile health implanted since 1966, the multiparity is yet observed in some regions of our country. Is to draw up the epidemiological profile of the multipara woman [parity<6] and the grand multipara [parity >/= 6] in the sanitary district of Monastir and to study the chronological tendencies of the factors associated during a decade [from 1994 to 2003]. In all, 16649 multipara were studied, representing 24% of the total women admitted for childbirth in the public motherhoods of the district. The global means age was 33.3 +/- 4.5 years with a statistical significance between multipara and grand multipara [32.7 and 35.6 respectively]. The prenatal follow up was absent or inadequate for 50.2% of multipara and 62.8% of the grand multipara [p <0.001]. In the decade, the main chronological tendencies are similar in the two multipara groups. Their frequency decreased from 28, 5 to 19% [p<0.001], yet the age and the adequate follow up increased from 32, 6 to 34 years and from 37, 4 to 57, 9% respectively [p<0.001]. Although the multiparity is decreasing and its associated factors seem to improve, the vigilance is asked again in order to avoid the inherent risks

[Validation of the Tunisian version of the health assessment questionnaire [HAQ] in rheumatoid arthritis patients]

One hundred twenty two rheumatoid arthritis patients were consecutively included in the study. Test-retest reliability was assessed in 61 patients based on the intra-class correlation coefficient. For the 122 patients [104 female and 18 male] the median age was 47 years [18-70]. The mean age of the patients who filled in the questionnaire at test and retest times was 45 years [18-70]. Test- retest reliability of the HAQ was 0.84. Internal consistency was 0.94. There was a good correlation between the HAQ and the Lee index [r = 0.75, p <10 -4], the HAQ and the RAQoL [rs = 0.96, p <10 -4]. In a logistic regression model Lee index, RAQoL and age account for the variance of the HAQ. The Tunisian version of the HAQ preserves the metrological properties of the original version and can be used for measuring and following functional abilities of Tunisian rheumatoid arthritis patients

Evolution de la fonction ventilatoire chez les BPCO. Etude analytique de 160 cas

The incidence of chronic obstructive pulmonary disease [COPD] is increasing particularly in developing countries. Their prognosis depend on several factors in particular the one second forced expiratory volume [FEV1] decline. To study FEV1 decline speed and factors affecting it, we carried out a retrospective study of 160 cases of COPD in stable state and heaving at least two FEV1 measures at 6 months of interval in the minimum and. The middle age was 63 +/- 12 yr, 52% was former smokers and 46% current smokers, with middle of 50 +/- 27pack-yr.The FEV1 decline was calculated by linear regression models. The decline average in FEV1 with time was 72 +/- 55 ml/yr. Absolute value was higher than 30 ml/yr therefore more accelerated than general population in 79% of cases. We confirmed by multivariate analysis that age and smoking habit and increased the FEV1 decline. However this last correlated with FEV1% predicted. We concluded that the decline of FEV1 is higher in COPD that in the general population and I slowing it needs smoking stop

Survie et facteurs pronostiques du carcinome bronchique non. a petites cellules: Revue analytique de 211 cas

Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment, provide insights into the disease process and the therapeutic response. The number of possibly useful prognostic factors in the lung cancer is large. This study attempts to observe the survival of non small cell lung cancer [NSCLC] and to find prognostic factors and other variables potentially associated with outcome of lung cancer. It's a retrospective study based on 211 patients with NSCLC. Median survival was 6 months with 95% confidence interval [4,2 - 7,8]. Overall 3 and 5 year survival were respectively 8,3% and 5,2%. Various Prognostic factors have been identified through univariate [Koplan-Meier] then multivariate [Cox] analyses. In addition to the clinical factors such as age, disease extent and performance status, other variables were found of significant prognostic value, like pre-therapeutic leukocyte level. Survival was significantly improved with surgery, radiation and also with chemotherapy, mainly in advanced. stage [IIIB and IV]

[Hospital morbidity in an urban district in Tunisia]

In the health region of Monastir, Tunisia, there is a register of admissions to all public hospitals. Those relating to patients resident in Ksar Hellal District during the year 1995 were identified [N = 1983 admissions to hospital]. This made it possible to establish the population-based pattern of hospital morbidities. The annual hospitalization rate is 6.1%; the rate for patients aged ' 65 years is estimated at 13.1%. Chronic diseases are responsible for 31.5% of admissions to hospital and are predominantly diabetes and asthma. The morbidity pattern reflects a phenomenon of epidemiological transition and calls for the strengthening of ambulatory care and development of specific services likely to reduce the need for hospitalization