The effect of environmental factors on the incidence of perforated appendicitis.

BACKGROUND: Acute appendicitis is the most common abdominal emergency. Its etiopathogenesis appears to be multifactorial. Several studies suggested a relationship between the development of acute appendicitis and some environmental factors. Air pollution predisposes some people to develop perforated appendicitis. However, data are relatively scarce and the results still controversial. AIM: Determine the seasonal variation of acute appendicitis and study the association between perforated appendicitis and short-term exposure to climatic factors and to air pollutants. METHODS: A cross-sectional study was conducted including patients hospitalized in the general surgery department of Farhat Hached University Hospital in Sousse for acute appendicitis between January 1st and December 31st, 2014. Climatic conditions were collected from the National Institute of Meteorology. Data on air pollution were given by the National Agency for the Protection of the Environment and obtained by the modeling of the atmospheric pollution. For statistical analysis, we used mean concentrations of each environmental factor corresponding to the day of hospital admission and lagged by the 7 previous days. These factors were compared between the group of patients with perforated appendicitis and patients with nonperforated appendicitis. RESULTS: We collected 246 cases of acute appendicitis. Perforated appendicitis was reported in 15.2% of the cases. The incidence of acute appendicitis was higher during summer. Compared to nonperforated appendicitis, perforated appendicitis was significantly associated with the mean relative humidity of the 5 day lag (p = 0.046), rainfall of the 7 day lag (p = 0.043), and consultation delay (p <10-3). Furthermore, perforated appendicitis was significantly associated with the daily mean concentration of carbon dioxide (p = 0.042), the 2- day lag mean concentration of particulate matter less than 10 µ (PM10 ) (p = 0.016), and the 2-day lag mean concentration of ozone (p = 0.048). After multivariate statistical analysis, predictive factors for perforated appendicitis were the consultation delay (OR: 1.621, 95% CI [1.288 - 2.039]; p<10-3) and the 2 day lag mean concentration of PM10 (OR: 1.066, 95% CI [1.007- 1.130]; p = 0.029). CONCLUSION: Short-term exposure to particulate matter was associated with perforated appendicitis. Further large-scale studies are needed to support this conclusion. KEY WORDS: Air pollution, Appendicitis, perforated appendicitis, Climateparticulate matter.

[Profile of tobacco use among the teachers of Sousse, Tunisia]. / Les facteurs déterminants le comportement tabagique chez les enseignants de la ville de Sousse, Tunisie.

OBJECTIVE: To examine the prevalence of tobacco use among the teachers in the region of Sousse (Tunisia) and to identify the factors, which determine this behavior. PATIENTS AND METHODS: It is a transactional study; using a self-administered and pre-tested questionnaire to 800 teachers. RESULTS: The population being studied was made up of 739 teachers including 50.6% of professors. The sample was 35.4% male and the average age was of 45.3±8.1 years. The total prevalence of tobacco use was 17.8% (41.4% among men and 4.7% among women). Half of these teachers smoked in their school establishments and in the presence of their pupils. The multivariate analysis had made it possible to identify four factors, which determine the profile of tobacco use in our teachers; these factors were: the sex, the age, knowledge and attitudes. CONCLUSION: It's necessary to intervene with the teachers of the town of Sousse with specific trainings on the topic of the tobacco use and dispose their adapted tools which will be used in the educational programmes of tobacco use prevention in schools.

[Intervention on smoking in adolescents in Sousse, Tunisia]. / Etude d'intervention sur le tabagisme chez les adolescents dans la région de Sousse, Tunisie.

PURPOSE: To increase knowledge about smoking via a school prevention programme. PATIENTS AND METHODS: This quasi-experimental study included two groups: a control and an intervention group with a pre- and a post-evaluation of knowledge about smoking in each group. The target population consisted of students of 12 to 16 years old in Sousse, Tunisia. To evaluate the intervention, stratified and proportional sampling was used to include 2100 students in the questionnaire. All the students in the intervention group received a standardized program of information about smoking. A pre-tested and self-managed questionnaire in Arabic was used to assess knowledge about smoking, attitudes and behavioural intent before and after the intervention. RESULTS: The intervention group's post-test knowledge and behavioural intent were significantly higher than that of the control group's. No significant differences were found in post-test attitudes between the control and the intervention groups. CONCLUSION: The authors carried out this survey to evaluate the difficulties and resources in order to institute a more complete and durable program.

Tracking of lipids in schoolchildren: a four-year followup, population-based study in Sousse (Tunisia).

OBJECTIVE: Dyslipidaemia, which is now seen as one of the most important cardiovascular risk factors, is becoming more common in the younger population. The aim of this study was to assess the efficacy of tracking serum lipid levels over a four-year period in an urban population of schoolchildren. METHODS: The study began in 1999 with a cohort of 789 schoolchildren. Four years later this group was resurveyed and a further 452 adolescent were recruited to the study. RESULTS: The percentages of boys who were initially in the extreme quartile for total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and triglycerides were 42.5, 54.8 and 40.4%, respectively. Similarly, the percentages of girls in the extreme quartile were 62.7, 53.8 and 38.2%. Four years later, both the boys and girls were still in the extreme quartile for these parameters. Therefore, the best predictor of followup level for each of the serum lipoprotein cholesterol fractions was the corresponding baseline level. Interestingly, the next best predictor in most of the groups was change in body mass index (DeltaBMI) and smoking status. CONCLUSION: Prevention of coronary heart diseases in adults must begin early on in childhood, and should be driven by health education towards achieving a healthy lifestyle.

Predictors of smoking initiation among schoolchildren in Tunisia: a 4 years cohort study.

OBJECTIVE: To identify predictors of smoking initiation among non smoking Tunisian school children; and to propose efficient antismoking strategies in order to prevent smoking initiation. METHODS: It was a cohort study surveying prospectively for four years pupils attending schools in Sousse city in Tunisia. 441 non smoking pupils aged 13-15 years attending secondary schools in Sousse. Data were collected by a self administered questionnaire during class session. Two ways cross tabulation, univariate and multivariate logistic regression analyses were the main analytical methods. RESULTS: 57.1% of the surveyed population were girls, 42.9 % were boys. 63% had at least one of their peers who smoked. Before 1999, 16.6% had already tried to smoke, 29.5% had already experienced alcohol. In 2003, smoking prevalence was 17%. 4.8% were girls; 33.3% of boys; p<0,001). 69.9 % of these smokers declared that they would carry on smoking during the following five years. Predictors which were highly associated with smoking initiation were previous experimentation with alcohol and tobacco, having a smoking best friend, lack of sensitization from the part of the school, believing that smoking makes one feel cool and that tobacco shouldn't be forbidden in public places. CONCLUSION: Intervention programs should target young children to avoid experiencing the first cigarette. Multidisciplinary management including community and school based intervention highlighted by mass media campaigns may provide schoolchildren with skills to resist smoking peers prompts to adopt unhealthy habits such as smoking.