Prediction of cardiovascular events in primary Health care: a cross sectional study (Monastir-Tunisia).

INTRODUCTION: We aimed to determine the prediction of cardiovascular events in patients with hypertension and diabetes using the 10-year Framingham score. METHODS: We conducted a cross sectional study in two primary health care centers in Monastir. We included patients with at least one conventional cardiovascular factors. Prediction of cardiovascular event were expressed by median and inter quartile range. RESULTS: We included 409 patients. Age mean was 64 years (SD: 12.3), the sex ratio was 0.44. Patients with type 2 Diabetes were 278 (68%) and 295 had hypertension (72.1%). The global risk prediction at 10 years for cardiovascular diseases was 26.3%, It was 36.6% (26.4-46.8) for tobacco users, 29.7% (18.2-42.5) for patients with hypertension and 29.1 % (18.8-43.3) for those with diabetes. It increased significantly with the number of cardiovascular risk factors. The risk prediction for cardiovascular events, were significantly higher in men than in women (p < 0.01) and in non-controlled patients than in controlled patients (p <0.001). The risk prediction for cardiovascular diseases death was 3.6% (1.3-8.6). CONCLUSION: Thirty percent of patients with hypertension or diabetes will develop cardiovascular diseases in 10 years. We suggest renforcing preventive actions to balance cardiovascular risk factors, including hypertension and diabetes.

Psychiatric emergencies : Factors associated with suicide attempts.

BACKGROUND: Among psychiatric emergencies, suicide attempt is a frequent reason for consultation. The magnitude of this phenomenon is not only related to its increasing frequency or life-threatening, but also to the psychosocial consequences of suicidal gesture both on the patient and his entourage. OBJECTIVES: To determine the prevalence of suicide attempts in psychiatric emergency department patients and to identify associated factors. METHODS: This is a cross-sectional study carried out in the emergency department of Mahdia University Hospital during a three months period, including consultants for whom a psychiatric opinion was solicited. Regarding statistical analyzes, we studied associations between suicide attempt and sociodemographic, contextual, anamnestic and clinical variables. RESULTS: Forty-four suicidal patients were included, with a prevalence of 0.5% of all emergencies. The patients mean age was 26.6 years with a female predominance (sex ratio = 0.29). Self-induced intoxication was the most widely used method (93.2%). Reactional suicidal attempts accounted for 75%. Many factors were significantly associated with suicide attempts: young age, female gender, secondar y level of education, students, presence of trigger factor, family and personal history of suicide attempt and the provenance of the examination request from a physician. CONCLUSION: This  study highlights  a particular  profile  of patients at  high  risk  of suicide,   a codified action is to begin, including all health care providers to prevent  its  occurrence. This primary prevention is only possible through  the  identification of  risk  factors  associated with it.

Predictors of Poor Adherence to Hypertension Treatment.

INTRODUCTION: Hypertension, a cardiovascular risk factor, is likely to lead to many complications. AIM: To describe the therapeutic adherence and to identify the factors associated with poor adherence among hypertensive patients.        Methods: This is a descriptive cross-sectional study of 276 hypertensive patients, followed at « Riadh1 ¼ Ksar Helal primary health center in the Monastir region over a six-month period from July 2016 to January 2017. RESULTS: The mean age of our patients was 64.9 years ± 10.2 with a female predominance (69.9%). The subjects aged 65 and over accounted for 48.5% of the total number. The average duration of hypertension was 10.2 years (± 7.3). It was associated with diabetes in 174 (63%) patients. Compliant patients had a balanced blood pressure (p <0.001), a reduced drug intake (p = 0.001), a reduced tablet number (p = 0.02), and a good socioeconomic status (p = 0.006). Poor compliance is 2.3 times more likely to occur in women than men (<0.05). Having more than three tablets a day increases the risk of poor compliance by 4.2 (p<0.05). Patients with a low socio-economic level were 7 times more likely to be poor-compliant than those with a high socio-economic level (p<0.05). CONCLUSION: Compliance to treatment was unsatisfactory in our hypertensive population, despite its important role in the balance of blood pressure. The family doctor should strengthen the therapeutic education of the hypertensive patient, its active involvement in the management of hypertension and the right choice of well tolerated antihypertensive molecules with the minimum daily intake.