Eating disorders among women in primary care (Monastir, Tunisia).

INTRODUCTION: Eating disorders (ED) are relatively frequent, but convey a high mortality and morbidity. More than half of individuals with ED remain undetected in primary care. The general practitioners (GP) are in a strategic position to detect patients with ED. AIMS: To determine the prevalence of ED in Tunisian women visiting their GP using the SCOFF-F score and to determinate the associated socioeconomic, clinical, and lifestyle factors. METHODS: This is a cross-sectional study of women who consulted two primary health care in the city of Monastir, during 4 months of the year 2020. The SCOFF-F was performed. RESULTS: We included 445 women; the mean age of our patients was 36 ± 12 years. SCOFF-F was positive in 48% of cases CI95% [43-52%], 14% presented with bulimia nervosa and 12% with binge eating disorder. Patients with ED were overweight in 33% of cases, 40% perform a physical activity and 53% eat three meals per day. A family history of ED was 35%. 20% of the patients have a history of psychiatric disorder. In multivariate analysis, performing physical activity to control weight, eating three meals a day, maintaining the current diet without trying to change into a different one, non continous occupation and anxiety increase the risk of ED with respective ORs of 2.34, 4.26, 3.69, 2.09 and 2.09 respectively. Ages between 35 and 60 years, and a history of ED in siblings increases the risk of ED by 1.6. CONCLUSION: Our study concluded that ED was associated with common family behavior, especially among siblings, and with a particular psychological state which are interesting to screen by GP and to focus on targeting family care.

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.

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.

Genetic Variation in the Renin-Angiotensin System and Diabetic Nephropathy in the Tunisian Population.

BACKGROUND: The aim of this study was to evaluate the association of ACE, angiotensinogen (AGT) and angiotensin II receptor type I (AGTR1) polymorphisms with diabetic nephropathy (DN) in Tunisians. METHODS: The study population comprised 236 type 2 diabetic patients: with nephropathy (DN = 47) and without nephropathy (DM = 189). Genotyping of ACE-I/D-rs1799752, ACE-rs4343G>A, AGT-rs5050A>C, AGT-rs 4762C>T, AGT-rs699A>G, and AGTR1-rs5186A>C was performed by PCR-RFLP. Haplotype and statistical analysis were realized using SNP Analyzer2.0 and SPSS20, respectively. RESULTS: Genotype frequencies were in Hardy-Weinberg equilibrium. After adjustment for potential confounding factors (age, gender, diabetes duration, hypertension…), an increased risk for DN was associated with mutated alleles of rs4762 (OR = 10.25, p = 0.001), rs699 (OR = 22.21, p < 0.001), and rs5186 (OR = 11.25, p < 0.001). However, mutated alleles of rs1799752 seemed to be protector (OR = 0.41, p = 0.011). Adjusted ORs of DN associated with the ACE haplotype (DA) was (OR = 9.56, p = 0.047) and with the ACE-AGT haplotype (ATADAA) was (OR = 5.38, p = 0.032). CONCLUSIONS: This study indicates that common variants in ACE, AGT, and AGTR1 seem to play a role in genetic susceptibility to DN in Tunisian population and provides evidence for a disease haplotype: ATADAA.

[Risk factors of children overweight and obesity]. / Facteurs de risque de l'obésité l'enfant.

BACKGROUND: The increase of the prevalence of children obesity in some countries as Tunisia, necessitate to welling known risk factors for obesity, to prevent and early management. AIMS: To determine the prevalence of overweight and of obesity in a group of 4-6 year-old school children in Monastir and to investigate the association with possible risk factors. METHODS: A descriptive transversal study including 121 children aged 4-6 years old (637 males, 698 females), was conducted in 10 Kindergartens in Monastir, in 2011. Personal data such as age, sex, birth weight, breastfeeding history and parental data including parental weights and heights, parental education level and occupation were collected by questionnaires completed by parents. Height and weight were measured with a weighing-scale and body mass index (BMI; kg/m²) was calculated. The prevalence of overweight and obesity was defined based according to the curves of the french reference of Rolland Cachera. RESULTS: Prevalence of overweight and obesity was 9.1% and 11.6% respectively. Parental factors associated with overweight were: parental obesity: 44% vs 17% (p=0.005) (OR = 3.65: 1.27-10.57), artificial feeding: 68% vs 33% (p=0.0016) (OR= 4.25: 1.51-12.27), and the early diversification of food before the age of 6 months: 88% vs 65% (p=0.029) (OR= 3.84: 0.98 - 17.66). Exclusive breast feeding duration ≥ 6mois is probably protector factor against obesity: 0% vs 21% (p=0. 01) (OR=0: 0.00 < OR < 0.78). We found no significant difference between overweight and non-overweight schoolchildren in frequency of high degree educated mother and father, birth weight, breakfast intake, eating habits and exercise. However overweight children intake high-caloric food, low in fiber, with troubles of nutritional comportment, and a sedentary lifestyle. CONCLUSIONS: Risk factors for obesity, well known in most industrialized countries, necessitate to be more understood in Tunisia, to place a preventive strategy included supervision of children weight, nutritional education and promote physical activity and reducing the time spent watching television.

[Handling the cases of school failure in an educational institute in Zaghouan].

AIM: To assess the main reasons for the school failure in a school in Zaghouan, how to handle these issues, to evaluate the work of the school social office. METHODS: A retrospective study included 86 failure cases in a school in Zaghouan, handled by the school social office for three years (2004 - 2007). He have detected the principals causes of school failure, detected by the educational staff or by the listening office. RESULTS: The causes of failure are mainly social (46%) as family problems and low income. These families received financial aids and free treatment cards. Discussions have been made with the parents in order to make them more conscious. The pedagogical reasons (28%) however are usually relationship' problems between the student and his teacher or the student and the administration, the three subjects were informed so that attitudes could be changed in the purpose of helping the student. Twelve students (14%) have a psychological case, depression and over worrying, led in some cases to addiction.These cases were diagnosed and transferred to specialized clinics.Sense and chronic diseases (12%), are considered as health reasons for school failure and caused several absences in the school. The school physicist took care of these cases by handling them medical guidance cards while observing the diagnose progress. As school results, 56 cases turned satisfaisant which is 65 % of all cases. CONCLUSION: The school failure became a priority of the "School Health" institute. That puss to create the school social program, his aim is protecting the students from all dangers, early school leaving and social disintegration, and delinquency. Thus, all parts must be responsible for the school failure, teachers, parents, students,psychiatrists and physicists, as well as introducing the social school work and listening offices and missions to the parents, students and teachers in order to guarantee the success of the operations.

[Smoker teenagers in colleges of Zaghouan]. / Le tabagisme chez les collegiens de la region de Zaghouan.

UNLABELLED: The aim of this study is to evaluate the rate of smoker adolescents in Zaghouan, to seek for the smoking reasons, the used arguments, recording to them, to stop, and show their knowledge about prevention. METHODS: A prospective study included 266 teenagers scolarised: 194 boys and 72 girls (aged from 12 to 16 years) from 3 colleges located in Zaghouan during 2006. A questionnaire was drawn up on these adolescents. It contains three parts: tabagic habits of smoking teenagers, the reasons of smoking and information about prevention. RESULTS: Twenty six percents of students are smokers, this percentage increases with the scholar level. They have parents' authorization in 18% of cases and have at least one smoker in their environment in 74% of cases. From whose who have tried tobacco, 65% became smokers. The most invoked causes are calming character of cigarettes and the pleasure to smoke. The first cigarette is smoked just for curiosity. The middle age of smoking initiation is 12 years. Twenty three percents of smoking students have tried to stop. The reasons are the dangerous character for health and the cost of tobacco. Adolescents prefer to use shocking pictures to self-sensitize (66%). Some pupils suggest calling smoker persons who are victims of tobacco to talk about their experiences. CONCLUSION: Adolescents' smoking is a Public Health priority in Tunisia. The rate of smoking, its cost and its bad health risks encourage us to make preventions, especially the education and information for children and help adolescents to stop smoking.

[Nutritional practices of young children]. / Les pratiques alimentaires des jeunes enfants.

AIM: To evaluate the nutritional practice in a region of Zaghouan, and to show determinants of inappropriate food behaviors. METHODS: A retrospective study included 160 children (aged from 3 to 5 years), from 4 kindergartens situated in the region of Zaghouan, during 2007. A questionnaire was drawn up, filled by parents or medical staff, concerning food behaviors. They are weight up and height. RESULTS: Sixty nine percents (69%) of children were breast fed, during 6-12 months in 50%. Diversified food is early before 3 months in 52% of children, and before 6 months in 70%. They are essentially flour in 53%. Vegetal food is introduced in a median age of 3.5 months, fruits at the age of 4 months. An overweight was found in 12. 5% of the cases, and an obesity in 9.5%. The majority (85.7%) was never breast fed persons, and have abnormal food habits in 91% of the cases: early diversified food rich in flour and low in essential elements. Later, the evaluation of food practice have many failures, exposing the children to obesity, related to caloric food, rich of sugar (87.5%), lipid (75%), low in fiber (37.5%) and eating in front of the television (75%). CONCLUSION: Children food behaviors depend on parents' habits, the medical board dietetics and the composition of industrial production.

[Protective effect of breast feeding in childhood obesity]. / Place de l'allaitement maternel dans la prevention de l'obesite infantile.

THE AIM: To evaluate the frequency of obesity in children scolarised in Zaghouan, and to show the protective effect of breast feeding. METHODS: A retrospective study, included 162 children (aged 2 to 6 years), from 3 kindergartens situated in Zaghouan, during 2006. A questionnaire was drawn up, filled out by parents, concerning the breast feeding, the duration, the family antecedents of obesity, and the nutritional practices. Obesity is defined by an Body Mass Index (BMI) > or =97 centile referring to curve of the centiles of BMI for the age (Rolland Cachera). RESULTS: 86% of children were breast fed. 85 children (52%) were nursed by breast exclusively 6 months or over (A group). 54 (34%) are exclusively breast-fed lower than 6 months (B group). 23 (14%) were never breast fed (group C). An overweight was found in 20 children (12%). This overweight is noted respectively in 8%, 9% and 8/23 in the groups A, B and C. Our results showed that there is a statistically significant relation between the BMI and the breast feeding (P < 10 -8). Breast feeding has probably a protective effect against obesity of the child (Odds Ratio = 0.17). CONCLUSION: Promotion of the breast-feeding and information on its methods and its control are a public health priority, it protects the child and his mother from certain diseases and prevents from childhood obesity. OMS recommends an exclusive breast feeding until the 6 months age, and to continue if possible until the 2 years.