[Causes of death in Tunisia: estimates of years of life lost]

This study estimated the number of years of life lost [YLL] by cause due to premature death in Tunisia for the year 2006. We adopted the methodology [SEYLL] proposed by Murray and Lopez. The crude rate of YLL was 58.1 per 1000 inhabitants. After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000. Cardiovascular diseases [CVD] [19.3% of total YLL] and cancers [17.8%] dominated the burden of premature mortality, followed by perinatal conditions [13.6%]. Excluding extreme age groups where perinatal conditions [0-4 years] and CVD [> 60 years] dominated the YLL's causes, injuries [road traffic crashes, falls, etc.] and cancers were most responsible for YLL. The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia. The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases

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

[Cost-effectiveness analysis of screening strategies for cervical cancer in Tunisia]

We aimed to identify the most appropriate screening strategy for cervical cancer [periodicity of 3, 5 or 10 years] for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case

[Management of hydronephrosis prenatally diagnosed]

Hydronephrosis, defined as dilatation of the renal pelvis and/or calyces is most frequently detected by prenatal ultrasound. The initial postnatal ultrasound performed in the first 48 hours of life underestimated the degree of hydronephrosis in most newborns. We recommend initial postnatal sonogram at 7 days of life. Hydronephrosis is most commonly assessed by the Society for Fetal Urology [SFU] grading system or anterior-posterior diameter [APD] of the renal pelvis in the transverse plane. This classification is valid by postnatal ultrasound. Even degree of postnatal hydronephrosis was predictive factor for the need for surgery; hydronephrosis does not mean ureteropelvic junction obstruction [PUJO]. The natural history of hydronephrosis has shown that most resolve spontaneously. Investigations are not recommended if APD<10 mm. Antibiotic prophylaxis is not required if vesicoureteral reflux is excluded. Diuretic renography is useful in many cases to evaluate the degree of obstruction and determine differential renal function. With the excellent results of pyeloplasty, it is proposed for babies with congenital PUJO and <40% split differential function. A management algorithm is proposed

Cocci gram positive infection: regain registry

The Gram positive coccus infections were always preoccupying. In Tunisia, the epidemiological, clinics, therapeutic data concerning these infections remain insufficient. The main objective of this national epidemiological investigation achieved in 13 hospital units in Tunisia is to identify the criteria of choice of antibiotherapy and the profile of patients hospitalized for an infection to Gram positive cocci. This study included 450 patients with an average of 45.35 +/- 21.23 years of which 299 [66.4%] of men and 316 [70.2%] hospitalized in care unit. Two hundred fifty eight patients [62.2%] had one or several medical antecedents, and 145 [32.2%] one or several surgical antecedents. The diabetes [18%] and the chronic renal insufficiency [13.2%] were the two most frequent comorbidities. Signs of gravity to the admission were noted at least 14% of the patients and about 20% of the patients had presented a severe sepsis or a septic shock. The staphylococci [65.4%] were the most frequently the Gram positive cocci isolated follow-up by the streptococci [24.7%]. The resistance of the Gram positive cocci to glycopeptides concerned only one stump cf negative coagulase staphylococcus. Staphylococcus aureus is more frequently responsible for infections of skin and the soft cloths, bone and joint infections and severe sepsis. The rate of success clinic is more elevated in the infectious illness services [84.2% vs 55.3% p<0.0001], whereas mortality is more elevated the services of resuscitation [19.3% vs 3% p<0.0001]. The factors of bad prognosis are age>60 years, in the septic shock, the arterial hypotension to the admission, a score of Glasgow<8 to the admission and an infection to Staphylococcus aureus

[Breast cancer in Tunisia: epidemiologic characteristics and trends in incidence]

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry [NTCR] and from the Salah AZAIZ Institute [SAI] Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases / 100, 000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years [11%] could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia

[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

[Breast cancer prognosis in Salah Azaiez Institute of Cancer, Tunis]

We estimated survival rate at 9 years of all [470] women with breast cancer diagnosed at Salah Aza‹ez Institute of Cancer in Tunis to identify the main prognosis factors. Data were collected on residence, socioeconomic level, circumstances of discovery of the tumour, histological type, tumour size, presence of metastases, extension of the tumour, treatment and survival. Comparison of survival curves was done with Log Rank test. Cox model was used for multivariate adjustments and calculation of the hazard ratio [HR] [relative risk of death]. There was a survival rate of 61% at 5 years and of 51% at 9 years. Tumour size > 5 cm was significantly associated with lower survival as was capsular rupture. After stratification for tumour size and age, only surgery and radiotherapy were significantly associated with improved survival

[Knowledge, attitudes and behaviours of women towards breast cancer screening]

The objective of this study was to describe knowledge, attitudes and behaviour of women towards breast cancer screening methods in two regions of north Tunisia. Thus 936 women from Ariana [urban region] and 993 women from Zaghouan [rural region] were selected and answered a questionnaire on their perception of the gravity of breast cancer, the vulnerability of women, the efficacy of screening and their use of screening. The use of screening was significantly more frequent in Ariana for both clinical breast examination and mammography, but screening use was modest. This low use of breast cancer screening contrasts with a positive attitude to breast cancer screening methods. The factors positively associated with use of screening were urban residence, age between 35 and 49 years, educational level and the perception that cancer treatment had advanced in Tunisia

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers]

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians.The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice

[Trends in tobacco consumption in Tunisia]

Because tobacco-related diseases are a growing health problem, we assessed tobacco smoking in Tunisia since 1970 using different sources. The average consumption of tobacco calculated over the period of 10 years [1981-90] was 1493 g per person and per year; equivalent of 75 packets of cigarettes. Cigarettes are the most popular form of tobacco smoking. Cigarette smoking increased from 1981 to 1993 but since has decreased slightly. According to a national study of respiratory diseases conducted in 1996, the current prevalence of tobacco smoking is 30.4% for both sexes: around 52% for males and 6% for females. Average consumption is 17.7 cigarettes/day, irrespective of sex. For young people, the prevalence is 29.21%: 50% for males and 3.9% for females. Young people who attend school smoke less than those who do not [18.1% versus 38.4%]. Most started smoking between 14 years and 18 year

Effects respiratoires de la pollution atmospherique dans deux quartiers populaires du grand Tunis enquete en milieu scolaire

The involve of industries in the city of Megrine have caused a problem of air pollution in this city. The aim of this study was to assess the impact of the air pollution in Megrine on health respiratory of school bodies. Megrine was compared to Ibn Khaldoun city, chosen as a control site. 309 and 592, bodies respectively from Ibn Khaldoun city and Megrine, were include in this study. Every body have to answer to a questionnaire on respiratory symptoms, derived from the British Medical Research Association one. The prevalence of most respiratory symptoms was higher in Megrine compared to Ibn Kaldoun city. The principal differencies were for runing nose [47,9% vs 28,6% p<0,001], chronic cough [32,4% vs 16,3% p<0,001] and wheezing [24,7% vs 13,3% p<0,001]. After adjustement on confounding factors [age. quality of habits, degree of humidity, exposure to pollution result of cooking and passive smoking] the differencies in prevalence respiratory symptoms were also observed

Actes du seminaire d'initiation au logiciel Epi-Info

The Departement of Community Health throught the two sections of Preventive Medecine and informatic, has organised a seminar to teaching the EPI INFO Package [and DOS also]. The EPI INFO package was elaborated by the Centers for Diseases Control [CDC ATLANTA] and the WHO. It is useful to constitute basing data and statistical analysis of these data

Protocole d'echantillonnage d'une enquete epidemiologique de population

Leading sampling for epidemiologic survery sin general population is a very hard task beause of the methodological difficults. Cluster sampling are after used because it's easier to investigate population grouped in clusters. However, the inegality of clusters sample size and the heterogeneity of clusters have to be taking into account, other wise the validity of estimations shoud be affected

Prevalence du goitre endemique dans une region du nord ouest de la Tunisie-1993

The present study include 1675 schoolboys from the six Jendouba districts and 61 schoulboys from Bizerte. All these children were aged between 8 and 10 years. The aim objective was to assess the program against the iodine deficiency disorders applied in Jendouba since 1984. The sample of children from Bizerte was choosen as a control group. All the children included were examined by a physician to search a goitre. A dosage of urine iodine was applied for 221 children from Jendouba and 61 children from Bizerte. The prevalence of goitre was higher in Jendouba than in Bizerte, 36,3% and 3,3% [pv< 0,001] respectively. In Jendouba, the prevalence was higher in the three districts whose are far the sea [districts of Jendouba, Boussalem an Fernana]. Concerning the dosage of urine iodine, more than 99% of all the children in both regions observed a iodine deficiency disorders. Nevertheless the prevalence of severe grade of IDD was higher in Jendouba than Bizerte [46,2% VS 11,5% p< 0,001]. These results call to revise the strategy of the program and extend this program to all the country

Facteurs etiologiques du cancer bronchique primitif en Tunisie

A case control study of lung cancer was conducted to determine whether smoking water pipe or using of drung "canabis" was associated with an increased risk or lung cancer. Cases [n = 110] and controls [n = 110] were matched on age [ +/- 5 ans], sex, and daily cigarettes consumption and interviewed to obtain detailed information on residence and job history. Unadjusted odds ratios were significant for using of drung [OR = 28.8], water pipe smoking [Or = 4.8] and consumption of snuff tobacco [OR = 2.8]. After adjustement with multivariate analysis, association were significant only for using of drung pipe water smoking