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

[Exclusive breastfeeding and mixed feeding: knowledge, attitudes and practices of primiparous mothers]

We assessed the knowledge attitudes and practices of primiparous women with regard to exclusive breastfeeding and the use of formula milk. A total of 260 women were interviewed and the results showed that 41.5% of the women breastfed exclusively while 58.5% bottle-fed only or did so together with breastfeeding. Of those who breastfed, 43.0% did not do so soon after giving birth and did not know about colostrum. Overall, the knowledge, attitudes and practices of the mothers were unsatisfactory concerning the golden rules for successful breastfeeding, the ideal duration of exclusive breastfeeding and the food to include when introducing complementary feeding. This might be due to a low level of schooling and information, hence the need for improving strategies for maternal care during the antenatal and postnatal periods

Health and behaviours of Tunisian school youth in an era of rapid epidemiological transition

To assess youth health behaviours and related quality of life in urban Tunisia, we conducted a cross-sectional survey of a representative sample of 699 secondary-school students. The overweight rate was 20.7%. Most of the sample had an insufficient level of physical activity and were unfamiliar with the recommended frequency of moderate physical activity. Norm-based scores of psychological state were about average, slightly better for boys than girls. Girls perceived themselves to be more stressed than boys. Of all students, 35% declared having smoked a cigarette and 14% having drunk alcohol at least once in their lives. The main sources of health education were mass media [59%] and medical staff [36%]

[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

[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

transition epidemiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie

We aim at analyzing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey [TNMMS]. In order to assess the CVDs [CHDs vs RHDs] trend, two representative samples of Cardiology Departments patients were compared one is selected from the TNMMS and the second from the hospitalizations recorded in 1992. Causes, stay duration, status at the end of the hospitalization, transfer to an other hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectively 58,8% and 38, 2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological. social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities

[Radioclinic aspects of pediatric lumbar disc herniation. Report of 12 cases]

12 cases of disc herniation in pediatric age group are reported. All patients were teenagers [mean 14 years and 6 months]. Trauma was noted in 50 % of cases. Diagnosis was made with 4 months delay. Severe back pain with sciatica associated with spinal stiffness and pseudo-scoliotic attitude were noted in 10 cases. Imaging modalities included CT Scan and myelography demonstrated the disc herniation and radicular compression in all cases. Congenital spinal abnormalities such narrowed central canal and lateral recess were noted in 3 cases and a listel avulsion in 3 cases. L4-L5 and L5-S1 levels are the most common sites involved. 9 children had surgery and 2 hexatrione chimionucleolysis resultats were excellent in 83 % of cases. Disc herniation is a rare pathology in pediatric age group and teenagers; however, frequency is increased because of the intensevly sport practice among young people. Its main characteristics were predominance of trauma, congenital abnormalities spinal, marked physical complaints, an easy CT scan diagnosis and better therapeutic results

[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

Epidemiologie du kyste hydatique en Tunisie [a propos de 4124 dossiers de malades operes entre 1977 et 1982]

A statistic study was made concerning the cases of hydatid cysts operated in the main surgical unities of Tunisia between 1977 and 1982. This represents 11,34 cases per 100 000 inhabitants