Economic burden of lung cancer in Morocco: A cost of illness study.

INTRODUCTION: Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco MATERIALS AND METHODS: A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months. RESULTS: The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations. The average direct medical cost was 4455.3 USD (95 % CI: 4037.4-4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %. The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001). CONCLUSION: These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.

Cross-cultural adaptation and validation of the Moroccan version of the Glaucoma Quality of Life-15 (GQL-15) questionnaire in patients with glaucoma.

BACKGROUND: Glaucoma is the second leading cause of blindness in the world. In addition, visual impairment and psychological strain have been shown to have a significant impact on quality of life (QoL) in glaucoma patients. Maintaining the quality of life of glaucoma patients has become an important component of treatment. The goal of this study is to develop a Moroccan Arabic dialect version of the Glaucoma Quality of Life-15 questionnaire and to examine its psychometric properties. METHODS: The Glaucoma Quality of Life-15 questionnaire was translated and cross-culturally adapted into Moroccan Arabic dialect and administered to glaucoma patients recruited from the ophthalmology department of the Omar Drissi Hospital, Hassan II University Hospital, Fez. Sociodemographic and other clinical data were collected. Psychometric properties were performed, including internal consistency, which was tested using Cronbach's alpha (α), test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining the convergent and divergent validity of items. RESULTS: The questionnaire was administered to 148 patients with a mean age of 60.91 ± 15.10 years. Over half of the patients were female (58.1%), patients were married (77.7%), illiterate (62.2%) and unemployed (82.3%). The majority of patients had primary open angle glaucoma (68.9%). The mean time to complete the GQL-15 was 3.26±0.51min. The mean summary score for the GQL-15 was 39.50±16.76. Cronbach's alpha for the entire scale was 0.95 (central and near vision 0.58; peripheral vision 0.94; glare and dark adaptation 0.87). CONCLUSION: The Moroccan Arabic dialect version of the GQL-15 demonstrates adequate reliability and validity. Therefore, this version could be used as a reliable and valid tool for quality-of-life assessment in Moroccan glaucoma patients.

Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students.

OBJECTIVES: This study aimed to explore medical students' attitudes, social perception, and knowledge towards mental illness and identify the associated factors. METHODS: A cross-sectional study was conducted in the Medical Faculty of Fez. A representative sample of 420 Moroccan students from the first to the seventh years was selected randomly during the academic year (2018/2019). They completed the Mental Illness Clinicians Attitudes scale (MICA) and a self-questionnaire exploring sociodemographic data, the university course, social perception and knowledge towards mental illness, and the potential consideration of psychiatry as a career. RESULTS: The average age of participants was 21.73 years (SD ±2.60), and 72.4% (n=304) of respondents were female (M/F gender ratio=0.39). The participants held stigmatizing attitudes and negative social perceptions towards mental illness, as indicated by the high score of the MICA scale (mean=57.24; SD ±9.95). Females (p=0.02) and married students (p=0.02) showed significantly more tolerant attitudes. The attitudes of students (p=0.37) who completed the psychiatry clerkship were slightly more favorable (p=0.15). There was no significant difference in attitudes according to the level of study (p=0.06). Students with a lower socioeconomic level tended to be less stigmatizing (p=0.08). The assessment of knowledge about mental illness among students objectified major gaps. A total of 17.9% (n=75) considered psychiatry as a career. CONCLUSION: The attitudes of medical students in this study were stigmatizing, and this should without delay motivate Moroccan research, educational and health authorities to investigate further scientific research in this area to address these attitudes and remedies.

Depression and anxiety in patients with diabetes in a Moroccan region.

AIMS: To estimate prevalence of anxiety and depression in patients with diabetes mellitus and identify their determinants. METHODS: A cross-sectional study was conducted at Hassan II University-Hospital of Fes in 2019-2020. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariate analysis by logistic regression was used to determine factors associated with depression and anxiety, adjusting for confounding factors. All statistical analyses were conducted using EPIINFO7. RESULTS: A total of 243 diabetics were included in the study. The average age of the participants was 48.07±14.25 years, 58% were females and 72% were diagnosed with diabetes type II. The prevalence of depressive symptoms and anxiety symptoms was (18, 1%, CI95%=(13-23)) and (29.6%, CI95%=(24-35)), respectively. The prevalence of depression and anxiety was higher among women than man and increases with increasing duration of the disease. In multivariate analysis, illiterates (OR=3.19, CI95%=(1.46-6.98)), those with depression (OR=3.61, CI95%=(1.78-7.32)), and type 1 diabetics (OR=3.22, CI95%=(1.44-7.21)) are a higher risk of developing anxiety. Depression was associated with older age (OR=2, 65, CI95%=(1, 14-6, 14)), use of insulin (OR=3.77 CI95%=(1.50-9.44)) and anxiety symptoms (OR=4, 27, CI95%=(2, 05-8, 91)). CONCLUSION: High prevalence of depressive and anxiety symptoms in diabetics suggests consideration of psychological aspect in implementation of diabetes managing program.

[Impact of the SARS-CoV-2 pandemic on diabetic macular edema and prognostic factors]. / Impact de la pandémie du SARS-CoV-2 sur l'œdème maculaire diabétique et facteurs pronostiques.

PURPOSE: To assess functional and anatomical consequences of the delay in intravitreal injections for diabetic macular edema (DME) patients during the corona virus pandemic lockdown in Morocco as well as to evaluate factors associated with disease progression. PATIENTS AND METHODS: This cross-sectional study included DME patients who did not complete their scheduled intravitreal bevacizumab injections during the Lockdown period (March 20, 2020 to May 20, 2020). Data recorded included age, duration of diabetes, number of previous intravitreal injections, best-corrected visual acuity, and central macular thickness before and after the lockdown. RESULTS: One hundred and fifty four eyes of 104 patients were analyzed. 57.8% were male. The mean age was 59.4±9.04 years. The mean duration of delay of intravitreal injections was 57.3±6.7 days. The mean number of intravitreal bevacizumab injections received before the lockdown was 2.29±2.1. Worsening of visual acuity was noted in 44.8% of patients and was associated with a lower number of intravitreal injections performed prior to the lockdown (P=0.001) and with glycemic imbalance (P=0.04). An increase in central macular thickness was noted in 26.6% of patients and was associated with a lower number of intravitreal injections (P=0.038). CONCLUSION: The delay in intravitreal injections during the lockdown had negative effects on visual acuity and central macular thickness in eyes with DME. Prolonged delay in intravitreal anti-VEGF injections in diabetic patients should be avoided.

Estimating attributable fraction of lung cancer linked to smoking in Morocco.

The objective of this research was to estimate the attributable fraction (AF) of lung cancer linked to smoking in Morocco. The estimation was based on the SAMMEC (Adult Smoking-Attributable Mortality, Morbidity and Economic Costs) method based on the Levin formula to calculate AF linked to tobacco. Data about frequencies, association measures and relative risks were taken from available sources. The AF of lung cancer linked to smoking was about 87%, and around 3049 cases of this cancer in men could be avoided if tobacco use could be prevented. About a 10% reduction in smoking prevalence would result in a reduction of 346 lung cancer cases. Our study provides additional important elements for further advocacy to policy-makers to implement a tobacco control strategy based on a prevention policy in line with the epidemiological situation which could avoid a huge burden on the country.

Using surveillance data to understand cancer trends: an overview in Morocco.

BACKGROUND: The aim was to use the existing surveillance data sources of cancer in Morocco that could be used to better describe cancer mortality and incidence trends in Morocco. METHODS: National incidence data were derived from population-based cancer registries. Mortality data were collected from the international GLOBOCAN database. RESULTS: An overview of the main results was presented. In general, the most commonly diagnosed cancers in men are lung and prostates whereas in women, breast and cervical cancers are the pre-dominant cancers. Fifty nine percent and of breast and 65.7 % of cervical cancers in women are diagnosed at stages II and III. Cancer remains the second highest cause of mortality in Morocco. CONCLUSION: The data provides a description of the cancer incidence and trends in the Moroccan population. The Moroccan national cancer program should aim for more coherent, consistent and comparable incidence data between different cancer registries in the country, and develop uniform datasets with respect to quality.

INTRODUCTION: L'objectif était d'utiliser les sources de données existantes de surveillance du cancer qui pourraient être utiles pour décrire les tendances d'incidence et de mortalité du cancer au Maroc. MÉTHODES: Les données de morbidité et mortalité nationales et internationales disponibles ont été explorées. Les registres populationnels de cancer couvrent les données d'incidence régionale. Les données de mortalité sont disponibles par les données internationales de Globocan. RÉSULTATS: Un aperçu des principaux résultats a été présenté. Globalement, les cancers les plus fréquents sont le poumon et la prostate chez les hommes; le sein et le col utérin chez les femmes; ces deux cancers représentant 56,3 % de cancers féminins. Les cancers de sein et du col sont diagnostiqués dans 59 % et 65,7 % aux stades II et III. Le cancer est la deuxième cause de mortalité au Maroc. CONCLUSION: Les données fournissent une description de l'incidence des cancers et leurs tendances dans la population marocaine. Le programme national du cancer marocaine devrait viser pour les données d'incidence cohérents et comparables entre les différents registres du cancer dans le pays, et de développer des ensembles de données uniformes par rapport à la qualité.

[Intraprostatic calcifications as natural fiducial markers in image-guided radiotherapy for prostate cancer]. / Calcifications intraprostatiques : marqueurs fiduciels naturels dans la radiothérapie guidée par l'image du cancer de la prostate.

PURPOSE: To establish whether intraprostatic calcifications can serve as natural fiducials for image-guided radiotherapy (IGRT), replacing the implantation of intraprostatic fiducial markers. PATIENTS AND METHODS: Patients with prostate cancer, having intraprostatic calcifications visible on CT scan were selected and underwent intensity-modulated radiotherapy/3D conformal radiotherapy with IGRT in the department of radiotherapy of Henri-Mondor Hospital. All cone-beam computed tomographies (CBCT) were repositioned on intraprostatic calcifications. For each acquired image, displacements of intraprostatic calcifications were calculated with reference to position on planning CT in three directions: lateral, longitudinal and vertical. RESULTS: Between 2011 and 2013, nine patients had 183 CBCT. For each image, three displacements and space coordinates were calculated using a single reference (intraprostatic calcification). Mean lateral, longitudinal and vertical movements were 0.26±5.7 mm, -1±4.6 mm and 0.42±3.5 mm, respectively. CONCLUSION: Studies exploring prostatic movements with fiducial markers as reference and ours with natural fiducials yield similar results. Our data confirm previous studies that have suggested that intraprostatic calcifications can be used as natural fiducials with potential reduction of iatrogenic risks and costs associated with the implantation of fiducial markers.

[Assessment of the methodological quality of theses submitted to the Faculty of Medicine Fez]. / Évaluation de la qualité méthodologique des thèses soutenues à la Faculté de Médecine de Fès.

A thesis in medicine is a scientific work which allows a medical student to acquire a Doctor of Medicine degree. It is therefore recommended that theses presented by students fulfill essential methodological criteria in order to obtain scientifically credible results and recommendations. The aim of this study was to assess the methodology of thesis presented to the Faculty of Medicine in Fez in 2008. We developed an evaluation table containing questions on the different sections of the IMRAD structure on which these theses were based and we estimated the proportion of theses that conformed to each criterion. There were 160 theses on various specialties presented in 2008. The majority of the theses (79.3%) were case series. Research questions were clearly expressed in 62.0% but the primary objectives were pertinent in only 52.0%. Our study shows that there were important deficiencies in the methodological rigor of the theses and very little representation of the theses in publications.

[Assessment of the methodological quality of these submitted to the faculty of medicine Fez]

الأطروحة في الطب هي عمل علمي يتيح لطالب الطب اكتساب درجة دكتور في الطب، لذا يوصى بأن تكون الأطروحات التي يقدمها الطلاب ملبية للمعايير المنهجية الأساسية للحصول على نتائج وتوصيات موثوقة علميا. وتهدف هذه الدراسة إلى تقييم المنهجيات في الأطروحات المقدمة لكلية الطب في فاس في عام 2008 . وقد أعد الباحثون جدولا تقييميا يتضمن أسئلة حول الأقسام المختلفة لبنية الأطروحة:[المقدمة، والطرق، والبحوث، والمناقشة]التي كانت الأطروحات قد استندت إليها، وقدروا النسب المئوية للأطروحات التي تتماشى مع كل معيار. وقد شملت الدراسة 160 أطروحة حول مختلف الاختصاصات، عرضت عام 2008، واتضح أن معظم الأطروحات [79.3 %]كانت عن سلسلة حالات، وكان السؤال الذي يدور البحث حوله مطروحا بوضوح في 62% من الأطروحات، إلا أن الأهداف الأولية لم تكن وثيقة الصلة إلا في 52 % من الأطروحات. وتوضح هذه الدراسة أن هناك مواطن قصور هامة في سامة المنهجيات المتبعة لإعداد الأطروحات، وأن قلة قليلة جدا من الأطروحات قد نشرت

RÉSUMÉ La thèse de médecine est un travail scientifique permettant l’obtention du diplôme de Docteur en médecine. Il est donc recommandé que les thèses présentées par les étudiants remplissent des critères méthodologiques essentiels pour que les résultats et recommandations soient scientifiquement crédibles. L’objectif de ce travail était d’évaluer la qualité méthodologique des thèses soutenues à la Faculté de Médecine de Fès en 2008. Une grille d’évaluation a été élaborée à partir de la littérature. Elle contient des questions sur les différentes sections de la structure IMRED sur laquelle étaient basées ces thèses. Nous avons estimé la proportion de thèses conformes aux critères de la grille. Il y a eu 160 thèses soutenues dans diverses spécialités en 2008. La majorité des thèses (79,3 %) concernait des séries de cas. La question de recherche a été clairement formulée dans 62,0 % des travaux mais l’objectif principal a été jugé pertinent dans seulement 52,0 % des thèses. Notre étude montre d’importantes insuffisances dans la rigueur méthodologique et une très faible représentation de ces thèses dans les publications.

A thesis in medicine is a scientific work which allows a medical student to acquire a Doctor of Medicine degree. It is therefore recommended that theses presented by students fulfill essential methodological criteria in order to obtain scientifically credible results and recommendations. The aim of this study was to assess the methodology of thesis presented to the Faculty of Medicine in Fez in 2008. We developed an evaluation table containing questions on the different sections of the IMRAD structure on which these theses were based and we estimated the proportion of theses that conformed to each criterion. There were 160 theses on various specialties presented in 2008. The majority of the theses (79.3%) were case series. Research questions were clearly expressed in 62.0% but the primary objectives were pertinent in only 52.0%. Our study shows that there were important deficiencies in the methodological rigor of the theses and very little representation of the theses in publications.

[Prolonged corticosteroid-therapy and anxiety-depressive disorders, longitudinal study over 12 months]. / Corticothérapie prolongée et troubles anxieux et dépressifs. Étude longitudinale sur 12 mois.

UNLABELLED: To date, there is little data in the literature describing the anxiety and depressive disorders iatrogenic to corticosteroids. These disorders are common, underestimated, with potentially serious consequences that may jeopardize the patient's prognosis; their management is not consensual. OBJECTIVES: The objective of our work is to determine the prevalence of anxiety and depressive disorders induced by corticosteroids, assessing their accountability to the corticosteroids and studying their risk factors. METHODS: We conducted a prospective longitudinal study over 12months evaluating the prevalence of anxiety and depressive disorders in patients followed for chronic skin diseases treated with prolonged corticosteroid-therapy. Our patients were assessed using standardized instruments: the Mini International Neuropsychiatric Interview (MINI), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI). RESULTS: Of 54 patients included, our study showed a high prevalence of anxiety and depressive disorders estimated at 27%. These disorders were divided into depressive disorder in 16% of cases, and anxiety disorder in 11% of cases. The early onset of these disorders was found during the first weeks of treatment. According to the Beck Depression Inventory (BDI), depression was moderate in 67% of cases; severe with suicide attempts in 22% of cases, and mild in 11% of cases. According to the Hamilton Anxiety Scale (HAS), anxiety was mild in 33% of cases and moderate in 67% of cases. The disorders observed were mainly distributed into: 33% deep pemphigus, 27% lupus, 13% bullous pemphigoid and 13% dermatomyositis. In this study the statistically significant risk factors are dose of corticosteroids and personal psychiatric history of the patient; in addition, there is a high prevalence of disorders in patients whose age exceeds 40 years, female gender, and patients treated for deep pemphigus. The evolution after pharmacological treatment and supportive psychotherapy was favorable in most patients. CONCLUSION: The psychiatric examination prior to prescription of long-term corticosteroid-therapy use should be standard practice to identify patients at risk, discuss the treatment modalities, and provide comprehensive care.

Factors associated with treatment default by tuberculosis patients in Fez, Morocco.

Interruption in tuberculosis (TB) treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters (controls). Of the 320 patients (108 defaulters, 212 controls), 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case (adjusted OR = 4.49; 95% Cl: 1.87-10.8), current smoking (aOR= 2.10; 95% Cl: 1.07-4.14), alcohol use (aOR = 2.92; 95% Cl: 1.04-8.19), being more than 30 minutes away from the health centre (aOR = 3.34; 95% Cl: 1.06-10.5) and perception of having received insufficient explanation about the disease (aOR = 2.87; 95% CI: 1.53-5.36). The rate of defaulting in Fez can be lowered through targeted and realistic measures.

Factors associated with treatment default by tuberculosis patients in Fez, Morocco

Interruption in tuberculosis [TB] treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters [controls]. Of the 320 patients [108 defaulters, 212 controls], 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case [adjusted OR = 4.49; 95% CI: 1.87-10.8], current smoking [aOR = 2.10; 95% CI: 1.07-4.14], alcohol use [aOR = 2.92; 95% CI: 1.04-8.19], being more than 30 minutes away from the health centre [aOR = 3.34; 95% CI: 1.06-10.5] and perception of having received insufficient explanation about the disease [aOR = 2.87; 95% CI: 1.53-5.36]. The rate of defaulting in Fez can be lowered through targeted and realistic measures

First data on direct costs of lung cancer management in Morocco.

BACKGROUND: Lung cancer is the leading cause of cancer morbidity and mortality. Its management has a significant economic impact on society. Despite a high incidence of cancer, so far, there is no national register for this disease in Morocco. The main goal of this report was to estimate the medical costs of lung cancer in our country. METHODS: We first estimated the number of annual new cases according to stage of the disease on the basis of the Grand-Casablanca-Region Cancer Registry data. For each sub-group, the protocol of treatment was described taking into account the international guidelines, and an evaluation of individual costs during the first year following diagnosis was made. Extrapolation of the results to the whole country was used to calculate the total annual cost of treatments for lung cancer in Morocco. RESULTS: Overall approximately 3,500 new cases of lung cancer occur each year in the country. Stages I and II account for only 4% of cases, while 96% are diagnosed at locally advanced or metastatic stages III and IV. The total medical cost of lung cancer in Morocco is estimated to be around USD 12 million. This cost represents approximately 1% of the global budget of the Health Department. According to AROME Guidelines, about 86% of the newly diagnosed lung cancer cases needed palliative treatment while 14% required curative intent therapy. The total cost of early and advanced stages lung cancer management during the first year were estimated to be 4,600 and 3,420 USD, respectively. CONCLUSION: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco. A substantial proportion of the burden of lung cancer could be prevented through the application of existing cancer control knowledge and by implementing tobacco control programs.

Association between smoking status, other factors and tuberculosis treatment failure in Morocco.

BACKGROUND: The association between smoking and tuberculosis (TB) treatment failure has not yet been assessed in Morocco. OBJECTIVE: To evaluate the impact of smoking on the failure rate of patients with TB. METHODS: A cohort of 727 new TB cases was followed between 2004 and 2009. Socio-demographic measurements and smoking status were collected by questionnaire. Treatment failure was defined according to international guidelines. Univariate analyses were used to assess associations of treatment failure with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. RESULTS: The patients' mean age was 35.0 ± 13.2 years. The monthly household income was <€180 for 71.4% of the patients. The rate of treatment failure was 6.9%. Failure was significantly higher among smokers (9.1% vs. 4.5%; P < 0.01), alcohol drinkers (18.5% vs. 4.9%; P < 0.01), and those with a monthly income of <€180 (8.4% vs. 3.3%; P < 0.01). After adjusting for confounding variables, smoking and low income remained significantly associated with treatment failure (adjusted OR 2.25, 95%CI 1.06-4.76, and 3.23, 95%CI 1.12-9.32). CONCLUSION: Smoking is associated with TB treatment failure in Morocco. Anti-smoking interventions should be incorporated into current TB case management.

Knowledge and attitude about antismoking legislation in Morocco according to smoking status.

Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 32.3% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation.

Knowledge and attitude about antismoking legislation in Morocco according to smoking status

Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess knowledge and attitudes about tobacco legislation among Moroccans, according to their smoking status. A cross-sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 323% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation

Burden of smoking in Moroccan rural areas.

The aim of this study was to estimate the prevalence and characteristics of current smoking among rural Moroccans. The population study included 3438 individuals aged 15 years and above from both sexes. The crude prevalence of current smoking (currently smoked and had smoked > 100 cigarettes in lifetime) was 16.9% in the adolescent and adult rural population: 31.0% among men and 1.1% among women. The majority of smokers 74.4% of men and 68.8% of women) began smoking before age 20 years. Multiple logistic regression analysis showed that age, sex, marital status, occupation and region of residence were the strongest determinants of current smoking. These results showed a high prevalence of smoking among males in the rural population of Morocco.

Burden of smoking in Moroccan rural areas

The aim of this study was to estimate the prevalence and characteristics of current smoking among rural Moroccans. The population study included 3438 individuals aged 15 years and above from both sexes. The crude prevalence of current smoking [currently smoked and had smoked > 100 cigarettes in lifetime] was 16.9% in the adolescent and adult rural population: 31.0% among men and 1.1% among women. The majority of smokers [74.4% of men and 68.8% of women] began smoking before age 20 years. Multiple logistic regression analysis showed that age, sex, marital status, occupation and region of residence were the strongest determinants of current smoking. These results showed a high prevalence of smoking among males in the rural population of Morocco

[Cross-cultural adaptation difficulties in health quality of life scales for developing countries: example of St-George respiratory questionnaire validation in Morocco]. / Difficultés de l'adaptation transculturelle des échelles de mesure en santé dans les pays du sud : exemple de la validation du St-George Respiratory Questionnaire au Maroc.

BACKGROUND: In developing countries, quality of life (QoL) is becoming an increasingly relevant question. The use, in these countries, of the validated English scales could resolve an important problem of a lack of QoL tools noted in southern countries. However, this approach raises methodological problems of cross-cultural adaptation. This paper underlines the principal difficulties related to cross-cultural adaptation of QoL measurement scales based on the example of St-George Respiratory Questionnaire (SGRQ) translation from English to the Moroccan Arabic language. METHODS: The SGRQ, initially designed in English, was translated into dialectical Arabic by four translators following the recommended stages of translation and cultural adaptation: translation with conceptual and linguistic evaluation, back translation, comparison of the source and target versions and verification of the new instrument. RESULTS: During this cross-cultural adaptation process, some items were modified to adapt the original questionnaire to the Moroccan culture. Because of the great diversity of the Moroccan dialectal language, some words were, sometimes, translated into two or more equivalents which were put in the brackets in the final version of the SGRQ(m). Some questions were not applicable to all the Moroccan population such as a question about sports that did not concern women. On the other hand, some questions involving the same items posed differently in different dimensions, gave rise to confusion or the impression of repetition in the Moroccan Arabic version. CONCLUSION: The cross-cultural adaptation process, even if carried out in a rigorous way, does not always lead to the best target version and suggests it would be useful to develop new scales specific to each culture and at the same time, to think about the Trans cultural adaptation.