[Smoking cessation attitudes among adult smokers]. / Les attidute envers l'arrêt du tabac chez les fumeurs adultes.

AIM: The failure of attempts to quit smoking was the cause of stagnation even the increasing prevalence of smoking in Tunisia. The aim of our study was to describe the previous quit attempts among smokers, the degree of motivation to the next stop and analyze the associated factors. METHODS: We carried out a survey based on an anonymous selfadministered questionnaire on tobacco, targeting smokers who participated in awareness sessions conducted in public places and universities in the city of Monastir. RESULTS: Nine hundred fourteen smokers had participated in our study. More than 2/3 of them (70 %) had at least one quit attempt, which lasted longer than 6 months for 81 patients (9%) and the last attempt dated for over 6 months for 486 smokers (53%). These previous attempts were unaccompanied and non-medicalized in 97 % of cases. 2/3 of smokers (67%) had a very strong desire to quit smoking, and 41% had a very strong self-confidence to succeed in their attempts. According to multivariate analysis, the presence of previous quit attempts to stop was statistically related to the importance of quitting smoking (OR=2.20,95% CI [1.23 - 3.96]). Selfconfidence to successfully stop was statistically related to the duration of smoking (OR=1.03 , 95% CI [1.01 - 1.06] ) , the strong dependence (OR=0.53 ;95% CI [ 0.29 - 0.97 ]) , and having at least one smoking member of the family (OR = 0.36 , 95% CI [0.15 - 0.86]). CONCLUSION: These results show that the strong physical dependence is a major factor related to the failure of attempts to quit, to the loss of self-confidence to succeed new attempts among smokers and thus, maintain a fairly high smoking prevalence in a country like Tunisia.

[Quality of the medical record notification in primary health care]. / Qualité de notification sur le dossier medical en première ligne.

BACKGROUND: The medical record is a very important tool for organizing, the planning and tracking of care. Her outfit is considered as one of the major criteria for care quality. AIM: compare, the degree of given collected notification on the Structured Medical Record (SMR) in Subjective, Pre-appreciation, Objective, Appreciation and Post-appreciation (SPOAP) and on Not Structured Medical Record (NSMR). METHODS: It is a retrospective, analytic study, including 910 DM. Executed in four primary health centers, at Monastir governorate in 2010. As regards methodology, we conducted a sampling at 3 degrees. The first draw of the month, the second on the weeks, the third is systematic type of medical records with a step of sounding of 2. We collected information about patient's socio-demographic characteristics, the contact patterns, clinical examination of the data, assumptions and diagnostics procedures. We used chi2 test to compare the distribution between SMR and NSMR at the Threshold of 5 %. RESULTS: Four hundred and one SMR (44 %) and 509 (56 %) NSMR were included. The contact patterns was noted on 44 % of NSMR and 93% of SMR (< 10-4). The physical examination had been noted on 67 % of SMR and 8% of NSMR (p < 10-4), the hypotheses diagnoses on 72 % of SMR and 31 % of NSMR (p < 10-4). The conducts had been noted on 98 % of SMR and 95% of NSMR (p < 0,045). The distribution of the motives for contacts, physical acts, hypotheses diagnoses and therapeutic families were different between SMR and NSMR. The medical records was adequate in 52 % of SMR and in 2% of NSMR (p < 10-4). CONCLUSION: The use of SMR improves the notification and the care continuity.

[From demand to decision: Not programmed contact for adult family medicine]. / De la demande à la decision: Contact non programmé de l'adulte en medicine de famille.

BACKGROUND: the study of contact patterns, diagnostics assumptions, physical acts performed and procedures in primary care services orient the training of future GPs. AIM: describe the elements of the contact in the Basic Health Centers. METHODS: It is a transverse study, describing the elements of contact without appointment, the population served by 4 primary health centers, in Monastir governorate. Days of the survey were identified from the list of working days by taking two weeks per month and per season by excluding the days of chronic diseases. Contacts analyzed have been identified by a systematic random sampling with a step of sounding on two. RESULTS: in the term of this study, we brought together 910 contacts. The mean age of consultants was 36 years, the sex-ratio H/F 0,38. The respiratory, ostéo-articular, digestive, neurological and general chapter's complaints represented 74% of motives for contacts. The cough and the complaints of throat represented 25% of the reasons for consultation. The lung examination, Oto-rhino laryngeal and cardiovascular represented 80% of physical examinations. The pharyngitis, the infections of the superior respiratory tracts, acute bronchitises, flu and allergic rhinitis represented the half of the assumptions. Antibiotics, anti-inflammatory and the antipyretic/analgesic accounted for 69% of prescriptions. CONCLUSION: this study allowed us to show the lack of preventive measures in the health center base and highlight the training of future family physicians must be based systems the most prevalent in primary care.

[Nicotine dependance and carbon monoxide intoxication among adult smokers]. / La dépendence nicotinique et l'intoxication au monoxide de carbone chez les fumeurs adultes.

BACKGROUND: The high nicotine dependence is one of the contributing factors to failure of attempts to quit. Moreover, the carbon monoxide (CO) intoxication, proportional to the intensity of smoking, is the basis of cardiovascular complications. OBJECTIVES: To describe tobacco consumption and the degree of CO intoxication, as well as to assess nicotine dependence and identify its determinants in a population of adult smokers. METHODS: This is a descriptive cross-sectional study, based on a selfadministered questionnaire and a dosage of CO in expired air among smokers who participated in awareness sessions conducted in public places and academic institutions in the city of Monastir. Multivariate analysis was based on a binary logistic regression. RESULTS: A total of 914 smokers participated in our survey whose mean age was 29.5 ± 12.4 years. More than 2/3 of cases (68.7 %) were strongly addicted to nicotine. Heavy smokers (consumption > 20 cigarettes / day) accounted for 28 % of subjects aged under 30 and 59% of older adults (p < 10-4). Determinants of strong tobacco dependence were age of first cigarette ( OR = 0.912 ) , duration of tobacco consumption (OR = 1.059 ) , alcohol consumption (OR = 1.764 ) , sedentarity (OR = 2.024 ) and the rate expired CO (OR = 1.059 ) . The mean rate of exhaled CO was 13.1 ± 11.1 ppm. It was positively correlated with Fagerström score (r = 0.5, p < 10-4) and the number of cigarettes smoked before dosing CO (r = 0.6, p < 10-4). In the contrary, it was negatively correlated to the time elapsed between the last cigarette and the test (r = - 0.2, p = 0.001). CONCLUSION: The results of this study focused on smoking addiction and its determinants. They encourage us to strengthen efforts for effective implementation of the WHO Framework Convention of Tobacco control in Tunisia.

[Predictors of smoking relapse among adult in smoking cessation]. / Les facteurs prédictifs de rechute tabagique chez les adultes bénéficiaires d'aide au sevrage.

BACKGROUND: Smoking is a public health problem in Tunisia. The smoking cessation assistance is one of means against this epidemic. Few smokers require this need to quit. PURPOSE: this study aimed at identifying the predictive factors associated to the smoking relapse at the adult. METHOD: We carried out a prospective cohort study, during a period of 18 months, at the smoking cessation center of the University hospital of Monastir (Tunisia). The population study consisted of adult abstinent in smoking cessation interventions. Baseline contained a questionnaire investigating the smoking history, the nicotine dependence and the anxiety / depression state and information of the medical examination at follow-up visits. A phone survey was realized, 21 months after the inclusion beginning, to estimate the rate of smoking abstinence, the deadline average of relapse and these predictors. A multivariate Cox regression was used to identify predictors of smoking relapses. RESULTS: A total of 143 adults were included in our study with a mean age of 44 ± 14 years. The median consumption was 30 cigarettes/ day. The median of initial carbon monoxide expired was 13 ppm. The median period of the medical treatment was 4 weeks. In the survey 74 patients relapse (51,7%) : IC95% [44 -60], with a median deadline of relapse of 11 weeks IC95% [9,1-12,9]. In the multivariate analysis, smoking relapse was associated with a period of treatment less than 4 weeks OR: 2,53: IC95 [1,48-4,32], and with a perception, less than 2 benefits, at the medical examination at follow-up visits OR: 1,54: IC95 [1,02-2,66]. CONCLUSION: The results of this study give us important clarifications, on profits offered by the adult smoking cessation interventions.