[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

Soluble human leukocyte antigen-G [sHLA-G] in Tunisia kidney transplantation

To investigate the relationship between the soluble HLA-G [sHLA-G] and the appearance of acute renal rejection [AR] episodes we have quantify in this study the level of sHLA-G by enzyme-linked immunosorbent assay in 42 kidney transplant patients classified in two groups: G1: 17 patients with acute rejection [AR+] and G2: 25 patients without AR [AR-]. To establish our normal sHLA-G ranges, serum samples from 18 healthy controls were tested. Pre-transplantation sHLA-G levels were significantly increased in patients [mean +/- standard error of the mean, 60.48 +/- 12.18 Units/ml] than healthy subjects [19.11 +/- 4.9 Units/ml] [p=0.001]. Although the difference was not statistically significant, G1 patients [AR+] revealed lower levels of sHLA-G [mean +/- standard error of the mean, 31.25 +/- 6.71 Units/ml] compared to G2 patients [AR-] [53.43 +/- 17.21 Units/ml]. Nevertheless, the course of total sHLA-G levels was nearly identical in patients with and without rejection. Nonparametric analysis revealed that pre-transplantation levels of sHLA-G < 18.00 Units/ ml [sensitivity: 87.8% and specificity of 72.2%] were not related to rejection. Also, multivariate analysis regarding anti-HLA antibody status, recipient age and gender showed that sHLA-G could not be an independent risk factor for renal graft rejection. However, a higher sera levels of sHLA-G seemed to contribute to better kidney allograft survival rate after 10 years of follow-up [significance tendency: p=0.091] as shown by the survival analysis. Because of the small number of subjects studied, these results must be treated with caution. A much larger cohort of kidney transplant patients according to acute rejection would seem necessary to confirm these findings

Association of chemokine and chemokine receptor polymorphisms with activity degree of IBD in Tunisian patients

Crohn's disease [CD] and ulcerative colitis [UC] have complex genetic background that is characterised by more than one susceptibility locus. To detect a possible association between the functional polymorphisms of the chemokine receptors CCR5, CCR2 and MCP-1 genes and susceptibility to CD and UC in Tunisian population, polymorphisms of CCR5-delta 32, CCR5-59029-A/G, CCR2-V64I and MCP-1-2518- G/A were analysed in 194 Inflammatory bowel disease [IBD] patients and 169 healthy blood donors using PCR-RFLP and PCR-SSP methods. The patients were classified in 126 patients with CD and 68 patients with UC. The genotypic and allelic frequencies of all polymorphisms studied, did not reveal significant differences between patients and controls, and among CD and UC patients. However, analysis of CD patients revealed that those without homozygosous G/G genotype are more frequently in remission compared to those with this genotype [OR: 0.4; 95%CI: [0.174-0.928]; p=0.03]. Also, the frequency of the CCR2-64I muted allele was statistically higher in CD patients in remission disease than those in active form [OR: 0.267; 95%CI: [0.09-0.78]; p=0.01]. Adjustment for known covariates factors [age, gender and immunosuppressive regimen] confirmed these univariate findings and revealed that the CCR5-59029-A/G and CCR2-V64I genotype were associated to remission form of CD [OR: 2.63; 95%CI: [1.01-6.80]; p=0.047 and OR: 4.64; 95%CI: [1.01-21.31]; p=0.049 respectively]. In conclusion, the present study supports the involvement of chemokine receptor [CCR2 and CCR5] polymorphisms in activity degree of the IBD disease in Tunisian patients

[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

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%]