[Prevalence of hepatitis B markers and vaccination status of healthcare personnel: Experience of the Tunis Military Hospital]. / Prévalence des marqueurs de l'hépatite B et statut vaccinal du personnel de santé. Expérience de l'hôpital militaire principal d'instruction de Tunis.

BACKGROUND: Hepatitis B is the main cause of liver disease in the world. Chronic hepatitis B may lead to cirrhosis, liver insufficiency or liver cancer. Tunisia is considered as a country with intermediate endemicity, where hepatitis B presents a real public health problem. The aims of this study were to evaluate the prevalence of viral biomarkers of hepatitis B in healthcare personnel; to look for potential risk factors associated with HbS antigen carriage and to evaluate the prevalence of vaccination in this particular population. METHODS: Sero-epidemiological, prospective and descriptive study, among 2411 healthcare personnel in the Military Hospital of Tunis, during a 5-month period from September 2013 to January 2014. RESULTS: Blood samples were collected from 1497 volunteers among the hospital staff. Two hundred and seventy-one individuals had a positive HbC antibody titer (prevalence 18.1%), including 229 who were positive for HbC and HbS antibodies (prevalence 15.3%), 12 positive for only HbC antibody (prevalence 0.8%), and 30 positive for HBsAg (prevalence 2%). Among HbS Ag carriers, 56.6% reported needle stick and sharp object injuries during their professional careers. Among HbS Ag carriers, there were three patients with a history of acute viral hepatitis with jaundice, and 27 patients (90%) who were asymptomatic and were diagnosed during our study. Among healthcare workers in the hospital, 56.1% were immunized through vaccination (positive HbS antibodies without HbC antibodies), of whom 66% had durable protective immunity (HbS antibodies>100mU/mL). Lastly, 25.8% of the hospital workers remained without any protection against hepatitis B (serology entirely negative) and were then offered a complete vaccination. CONCLUSION: Hepatitis B vaccine is the mainstay of hepatitis B prevention. Safe injection practices, blood safety and promoting wider access to monitoring and screening, care and treatment services for hepatitis B are the best guarantees to prevent and control this disease.

[Tardive dyskinesia induced by classical antipsychotic drugs: a Tunisian sample of schizophrenics]. / Dyskinésies tardives sous neuroleptiques classiques: à propos d'une population tunisienne de schizophrènes.

INTRODUCTION: The term tardive dyskinesia (TD) is used to describe abnormal movement, primarily associated with typical antipsychotic drugs, which are used to treat psychotic states such as schizophrenia. TD is characterised by repetitive involuntary purposeless muscle contractions that force parts of the body into abnormal, and sometimes painful, movements or postures. These movements are involuntary and are difficult or impossible to control. TD usually begins with the face, mouth, lips and tongue, and includes grimacing, lip-smacking, tongue movements and rapid blinking. It may also involve the rest of the body and produce involuntary gestures, tics and writhing movements. TD is severe physically and socially disabling. Schizophrenia is thought to be the psychiatric diagnosis the most frequently associated with TD. MATERIALS AND METHODS: The purpose of this article is to study the characteristics of TD in a Tunisian sample of 157 schizophrenics. A variety of demographic and clinical information was obtained by a questionnaire. Diagnoses of schizophrenia and TD were determined by using DSM-VI-R criteria. TD was assessed using the Abnormal Involuntary Movements Scale (AIMS). RESULTS: The average age in this sample was 37 ± 6 years. The intermediate duration of evolution of the disease was 8 ± 3 years with a medium full number of hospitalizations of 4 ± 3. We found 58% of the paranoid sub-type. The intermediate duration of exposure to classical neuroleptics was 7 ± 3 years. The average of daily neuroleptic amount was 572.9 ± 145.3 equivalent milligrams of chlorpromazine. Extended release antipsychotics were used in 64.3% of cases, with fluphenazine deaconate in 90% and haloperidol deaconate in 10%. Anticholinergics were used by 74.5% of patients, with use of biperidene in 96% of cases. Therapeutic observance was good in 89.2% of patients. The prevalence of TD was an estimated 35%. The average of AIMS score was 17 ± 9, with a minimal score of 3 and a maximal one of 34. The distribution of patients according to severity found a prevalence of 52.7% of subjects with moderate TD, 38.2% with light TD and 9.1% with severe TD. The distribution of patients according to type, according to DSM-IV criteria, found 78.4% of cases with choreiform TD, 17.5% of cases with athetosic TD and 4.1% of cases with rhythmic TD. The intermediate duration of evolution of TD was estimated at 18 ± 6 months with a minimal duration of 3 months and a maximum of 72 months. The distribution of subjects according to duration of evolution of TD found that approximately three quarter of patients presented with TD that had evolved since one duration, lower or equal to one year. The average age of patients at the moment of installation of TD was estimated at 36 ± 6 years with 22 years as a minimal and 46 years as a maximal age. Among them, 81.8% of patients were aged over 30 at the time of the installation of TD. CONCLUSION: The majority of patients with schizophrenia in Tunisia are still treated with typical antipsychotic drugs, and that's why the prevalence of TD remains relatively high.

[Knowledge, attitudes and behaviours of women towards breast cancer screening]. / Connaissances, attitudes et comportements des femmes vis-à-vis du dépistage du cancer du sein.

The objective of this study was to describe knowledge, attitudes and behaviour of women towards breast cancer screening methods in two regions of north Tunisia. Thus 936 women from Ariana (urban region) and 993 women from Zaghouan (rural region) were selected and answered a questionnaire on their perception of the gravity of breast cancer, the vulnerability of women, the efficacy of screening and their use of screening. The use of screening was significantly more frequent in Ariana for both clinical breast examination and mammography, but screening use was modest. This low use of breast cancer screening contrasts with a positive attitude to breast cancer screening methods. The factors positively associated with use of screening were urban residence, age between 35 and 49 years, educational level and the perception that cancer treatment had advanced in Tunisia.

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers]. / Connaissances et participation des médecins et sages-femmes de première ligne vis-à-vis du dépistage des cancers du col utérin et du sein.

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians. The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice.

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers]

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians.The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice

[Knowledge, attitudes and behaviours of women towards breast cancer screening]

The objective of this study was to describe knowledge, attitudes and behaviour of women towards breast cancer screening methods in two regions of north Tunisia. Thus 936 women from Ariana [urban region] and 993 women from Zaghouan [rural region] were selected and answered a questionnaire on their perception of the gravity of breast cancer, the vulnerability of women, the efficacy of screening and their use of screening. The use of screening was significantly more frequent in Ariana for both clinical breast examination and mammography, but screening use was modest. This low use of breast cancer screening contrasts with a positive attitude to breast cancer screening methods. The factors positively associated with use of screening were urban residence, age between 35 and 49 years, educational level and the perception that cancer treatment had advanced in Tunisia

[Health indicators in Tunisia, trends in regional disparities over the last thirty years]. / Indicateurs de sante en tunisie, evolution des disparites inter-regionales au cours des trente dernieres annees.

The measure of health indicators on a regional-scale seems more interesting then the measure on a national-scale. It allows us to study differences between regions and their evolution. In order to know the time trend's disparities between regions, we have studied seven indicators, concerning different types of the World Health Organisation's classification, using data from yearly statistics and results of decennial census. Regional disparities are evaluated by a ratio between the highest regional value and the lowest regional value. This study showed us a global trend to the decline of regional disparities about indicators that we have studied. The improvement of health care resources indicators and socioeconomic's indicators, in the process of time, is associated with the improvement of health status indicators. The study of regional disparities makes possible to target actions for health in order to promote health's equity between regions.