Reasons for using emergency departments of major hospitals in Greater Tunis

Tunisia, similar to many countries, has a problem of overcrowd ing of the emergency departments [ED]. This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged >/= 18 years, with stratification according to time of day of presentation to ED [morning, afternoon and evening]. Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients [52.5%] were male and the mean age was 46.0 [SD 18.1] years. The main reasons for choosing the ED were: speed [54.0%] and ease of access [47.7%] of ER and occurrence of an acute episode [26.4%], Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED

[Results and evaluation of 3 years of large scale mammography program in the Ariana state in Tunisia]

To asses and analyse the results of 3 years large scale mammography screening of breast cancer in Ariana state in Tunisia This program, managed by the Family and Population National Office, was addressing to women aged from 49 to 69 years old residing in a area with adds up a population of 459 700 inhabitants including 52 729 women in the target age population. The screening was including a breast clinical examination and a mammography with two incidences face and external profile. The women was invited at their residence or were sensitized in the reproductive health centers, care and base health centers or by a close relation which heard of the program. An enlightened assent was submitted to the women who wished to profit from the screening. In three years, 9093 mammography were carried out of which 8244 were retained in the analyses, that is to say a rate participation of 9, 6%. The rate of women recalled for suspect test was of 18, 1% and it was of 13, 1% among women of more than 50 years. The rate of practiced surgical biopsies was of 0, 5% and the positive predictive value was of 45, 5%. The average time between the date of screening and the result of the screening was 9, 7 days, more important in the event of tests requiring a complementary assessment [61, 7 days]. On the whole 40 cancers were detected by the program, that is to say a rough rate of detected cancers, of 4, 9%, in conformity with the recommendations. The percentage of invasive cancers

[Preliminary results and analysis of feasability of mammographic breast cancer screening in women younger than 50 years of the L'Ariana state of Tunisia]

To report the preliminary results of the feasibility of breast cancer mammographic screening among women younger than 50 years from the l'Ariana state of Tunisia. The National office of the Family and Population [ONFP] launched a protocol on feasibility of breast cancer mammographic screening targeting asymptomatic women aged 40-69 years, from the l'Ariana state in Tunisia. We practiced two oblique and face incidences at the mammography screening unit of the ONFP, whose equipment and control system of quality answered to the European Communitiy for breast cancer screening. We did 5325 mammograms between April 2004 and March 2006. Our targeted population had a 48, 9 years mean age [CI 95% = [48.7 - 49.1]], 60, 3% of them younger than 50 years. There were more young women with high breast denisty [8.2%] compared to the group from 50 to 69 years [2,1%]. The women arising from the 40-49 years cohort had a socio-economic and educational level higher. The complementary rate of examination/explorations was higher in this cohort [19.5%] vs 11.5% for the 50-69 years. The youngest women presented a more often positive test [7.0 vs 5.2%] than the oldest women [p<0.01]. The option to screen breast cancer by mammography in women younger than 40 years in Tunisia is partially justified by the relatively high frequency of this cancer in this age group. Our feasibility poorly useful in screening will be used to sensibilise females to the problematic of breast cancer to obtain a better compliance compared to the older age group of 50-59 years

[Management of breast cancers detected by screening mammography program of L'Ariana state in Tunisia]

To report the epidemiological and anatomoclinical features of breast cancers referred to a department of gynecology from the screening program of l'Ariana state in Tunisia. A longitudinal retrospective Study was done over a period of 4 years [2004 - 2006] at the Unit "A' gynecology department of the maternity of Tunis. We collected all the cases with histologically confirmed breast cancer diagnosed within the mammography screening program of l'Ariana state, referred to our unit for treatment. 10 patients with histologically confirmed breast cancer were collected during the study period, treated at our unit. Mean age of patients was of 48.8 years. Clinical examination was initially negative in 50% of cases. Mean clinical tumor size was 18 mm, while invasive ductual carcinoma represents the most frequent histological type. One patient [10%] had histological axillary involvement. Conservative surgery was performed for 8 [80%] of the 10 patients. This pilot study of mammography screening confined to a Tunisian state, precludes to the future profile of BC In Tunisia, showing that an early diagnosis can lead to a dramatic reduction of mean clinical tumor size, less histological poor prognostic features, more conservative surgery and a slight improvement of survival. A structured extended screening program must be installed to achieve these goals but requires an important financial and human investment

[Estimation of years of life gained within the pilot screening program of L'Ariana stale in Tunisia]

Breast cancer is the principle cancer among female cancer in Tunisia. It represents 30% of the woman's cancers with about 1000 new cases per year. The main intervention control is mass screening living mammography in to reduce breast cancer mortality. Breast cancer screening efficacy in term of breast cancer mortality reduction is closely related to incidence and survival of this cancer. National Office of Family and Population [ONFP] conducted a pilot experience of breast cancer mass screening using the mammography in place. The main objective of this study is to calculate the potential number of life years saved through this pilot experience of the ONFP. For the methodology, we used the software Dismod [Disease Model] or the evaluation of the prevalence and the duration of the cancer of the breast in the governorate, as well as to estimate the number of life years saved. The potential breast cancer mortality reduction is 30% for women aged of 50 at 69 years. and 10% for those aged of 40 at 49 years. Breast cancer incidence in Ariana according to age for the period 1995-1998, has been calculated from the data have of cancer registry of the North of Tunisia. According to Dismod. mean duration in the absence of screening, is 11.12 years for the age group 40 to 49 years and 9.57 or the age group 50 at 69 years. Screening would increase these duration means of 2.22 years and 1.71 years. respectively for age groups 40 to 49 years and 50 at 69 years. The number of life years saved for 1000 women is of 2.97 years. In conclusion breast cancer screening using mammography would be actually little benefit in Tunisia. Mammography should he reserved for the diagnosis of the suspected cases and screening for high risk women

[Reproductive tract infections prevalence among women consulting in the reproductive health center of Ariana]

A transversal study has been performed from June the 7[th] 2001 to January the 4[th] 2002 among 504 women consulting at the Reproductive Health Center of Ariana in the framework of a project in collaboration with Marocco for the prevention of STI. The objec-tif of this projects is to assess STI prevalence and the proportion of asymptomatic carriers. Vaginal, cervical and blood samples have been performed for the screening of most common STI organisms. Urinary samples has been sent to the [Unite de Biologie Moleculaire de L'lnstitut National d'hygiene-Rabat] for PCR test [Chlamydia trachomatis et Neisseria gonorrhoea]. RTI prevalence is 22.6%. IST prevalence [Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae] including PCR is 5,0% Most common IST organism is Trichomonas vaginalis. The high prevalence of asymptomatic carriers make the management of STI difficult and argue for the syndromic approach for STI management

[Arthritis of the hip in spondylarthorpathy retrospective study about 126 cases]

To determine epidemiological and clinical features of arthritis of the hip in a Tunisian population of spondlarthrpathy [SA].This is a retrospective study about patients suffering from SA treated in a rheumatology unit. A radiological investigation of the pelvis was systematically performed on each patient.The study involved 126 cases of SA [83 men and 43 women], with a middle age of 32.6 years. Arthritis of the hip showed within 3.8 years. Total hip arthroplasty was indicated in 18% of cases. Arthritis of the hip in spondylarthropathy is an important cause of functional disability. We insist in our study on the frequency of arthritis of the hip in North Africa and particularly in patients aged under 16 years

[Health transition in Tunisia over the past 50 years]

We describe the dramatic demographic, socioeconomic and health changes witnessed in Tunisia over the past 50 years. Demographically, the gross mortality rate and the infant mortality rate have gone from 19 per 1000 and 150 per 1000 respectively in 1956 to 5.7 per 1000 and 26.2 per 1000 now, and life expectancy at birth going from 50 to 72 years for the same period. Socioeconomically, the urban population has risen from 25% to 62%, the literacy rate from 15% to 73%, and the per capita income has increased 5-fold in real terms. Epidemiologically, the infectious and perinatal diseases prevailing in the 1960s have decreased whereas chronic and degenerative diseases have risen. The proportion of the GNP related to health expenditure has risen from 3.8% to 6.2%. The implication of these changes on the Tunisian health system and the need to adapt in terms of curative care and prevention of risks are discussed

Programmable generator dedicated to the preoperative cochlear stimulation

This study is about specific signal generation useful for preoperative electrical stimulation of the cochlea. The proposed generator was intended to check the state of the cochlea's nervous zones of one candidate to cochlear prosthesis apparatus. In fact, this cochlear stimulator would allow the insertion of an electrode into the round window to verify the state of intact nervous zones. Such clinical diagnosis is a useful preoperative evaluation to assure the effectiveness of this apparatus. Originalities in preoperative stimulation techniques of the cochlea were then presented. The overall conceived system included one electronic stage for signal generation dedicated to the stimulation of the nervous zones, as well as a communication software offering to clinicians the control by a graphical module displayed on a host-computer screen. This study was based on a fundamental criterion that was the flexibility and handiness during clinical experimentation. The system for cochlear stimulation was henceforth an electronic apparatus driven by a processor, a 'micro controller', which could be interfaced to the host-computer. The latter displays a graphical module reassembling all the stimulation possibilities around a great flexibility and handiness. In fact, the 'micro controller' used has allowed the generation of different forms of signals for stimulation: thanks to its programming, it was also possible to adjust with great flexibility different parameters such as the stimulation rhythm, the frequency, the amplitude and the stimulation pulses' shape. The signals' shapes proposed here were various: the rectangular shape frequently used, the triangular shape in staircase with different orders and the serrated shape [saw teeth shape] in staircase with different orders. The two latter shapes give multiple forms when varying the order of the staircase evolution. This great variety in the stimulation signals' shape as well as the provided handiness would permit to clinicians better exploration of the cochlea's nervous zones before chirurgical intervention. This would give more information on hearing capacities of patients and on the implant type [one electrode or multi-electrode]

Epidemiologie et statistique medicale: elements de methodologie [1]

Because of the variability of the studied material, the biomedical research requires an approach based upon the average properties of a group rather than the individual Reponses. The statistics are the very method that answer this requirement. However, the statistical interpretation can be valuable only if the research has been correctly conceived, and particulary if the definition of the problem, the hypotheses and the study protocol have been clearly established. This protocol will define the sort of study adapted to the problem i.e. a descriptive study [cross-sectional unliked studies], etiological [follow-back case-control or prospective studies] or'an evaluating research according to the cases