[Causes of death in Tunisia: estimates of years of life lost]. / Causes de décès en Tunisie : estimation des années de vie perdues.

This study estimated the number of years of life lost (YLL) by cause due to premature death in Tunisia for the year 2006. We adopted the methodology (SEYLL) proposed by Murray and Lopez. The crude rate of YLL was 58.1 per 1000 inhabitants. After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000. Cardiovascular diseases (CVD) (19.3% of total YLL) and cancers (17.8%) dominated the burden of premature mortality, followed by perinatal conditions (13.6%). Excluding extreme age groups where perinatal conditions (0-4 years) and CVD (> 60 years) dominated the YLL's causes, injuries (road traffic crashes, falls, etc.) and cancers were most responsible for YLL. The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia. The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases.

[Causes of death in Tunisia: estimates of years of life lost]

This study estimated the number of years of life lost [YLL]by cause due to premature death in Tunisia for the year 2006.We adopted the methodology [SEYLL]proposed by Murray and Lopez.The crude rate of YLL was 58.1 per 1000 inhabitants.After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000.Cardiovascular diseases [CVD][19.3% of total YLL]and cancers [17.8%]dominated the burden of premature mortality, followed by perinatal conditions [13.6%]. Excluding extreme age groups where perinatal conditions [0-4 years]and CVD [>60 years]dominated the YLL's causes, injuries [road traffic crashes, falls, etc.] and cancers were most responsible for YLL.The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia.The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases

قام الباحثون في هذه الدراسة بتقدير عدد سنوات الحياة المفقودة نتيجة الموت المبكر، موزعة حسب أسباب الوفيات في تونس في عام 2006 . وقد اتبع الباحثون الطريقة المعيارية لحساب سنوات الحياة المتوقع فقدانها وهي الطريقة التي ابتكرها موري ولوبيز. ووجدوا أن المعدل الخام لسنوات الحياة المفقودة هو 58.1 لكل ألف نسمة، وبعد إضفاء المعيارية بالنسبة للسن بالاعتماد على عدد سكان العالم، حصل الباحثون على معدل 57.7 لسنوات الحياة المفقودة لكل ألف نسمة. وقد غلبت على عبء الوفيات المبكرة كل من أمراض القلب والأوعية [19.3 % من مجمل سنوات الحياة المفقودة]والسرطانات [17.8 %]، وتلاهما وفيات حالات الخداج والحالات المحيطة بالولادة [13.6 %]. وعندما استبعد الباحثون المجموعات العمرية القاصية التي تغلب فيها الحالات المحيطة بالولادة [0 - 4 سنوات]والأمراض القلبية الوعائية [في الأعمار أكثر من 60 عاما]، وجدوا أن الأسباب الغالبة لسنوات الحياة المفقودة هي الإصابات [حوادث التصادم على الطرق والسقوط وغير ذلك]، والسرطانات، فهي الأكثر مسؤولية عن سنوات الحياة المفقودة. وتوضح هذه الدراسة الإسهام الكبير للأمراض غير السارية في سنوات الحياة المفقودة في تونس. ولعل أفضل الطرق للتصدي لهذه الأمراض هي تعزيز الحياة الصحية وتعزيز الوقاية الثانوية في الرعاية الصحية الأولية

Cette étude présente une estimation des années de vie perdues [AVP]du fait d'un décès prématuré, par cause, en Tunisie pour l'année 2006.Nous avons adopté la méthodologie SEYLL [Standard Expected Years of Life Lost]proposée par Murray et Lopez.Le taux brut d'AVP était de 58, 1 pour 1000 habitants; celui standardisé sur la population mondiale était de 57, 7 pour 1000.Les maladies cardio-vasculaires [19, 3 %]et les cancers [17, 8 %]étaient les plus pourvoyeurs d'AVP, suivis par les affections périnatales [13, 6 %]. En dehors des classes d'âge extrêmes prédominées par les affections périnatales [0-4 ans]et les maladies cardio-vasculaires [>60 ans], c'étaient les cancers et les traumatismes [accidents de la circulation, chutes, etc.] qui étaient les plus pout-voyeurs d'AVP.L'étude souligne la part majeure des maladies non transmissibles dans les pertes en années de vie en Tunisie.La promotion d'un mode de vie sain et la prévention secondaire en première ligne semblent les moyens de lutte les plus efficaces contre ces maladies

[Study of psychosocial factors in HIV infected patients in Tunisia]. / Etude des facteurs psychosociaux des patients infectés par le VIH en Tunisie.

We conducted a prospective study using an anonymous questionnaire and semistructured interviews on 60 patients with HIV to assess the psychological and socioenvironmental factors that may result in risk-taking behaviour. The patients were mainly young males (mean age 33.1 +/- 7.0 years) (sex ratio 2.3) deprived in both social and educational terms. Injecting drug use was the predominant risk factor and was characteristic of a first group of young men raised in large families shattered by rural-urban migration, with an antisocial personality. A second group consisted of women, mostly illiterate from traditional rural settings. They had been infected by their spouses who had worked abroad, whether drug users or not. Approaches for the prevention of HIV infection are proposed.

[Study of psychosocial factors of HIV infected patients in Tunisia]

We conducted a prospective study using an anonymous questionnaire and semistructured interviews on 60 patients with HIV to assess the psychological and socioenvironmental factors that may result in risk-taking behaviour. The patients were mainly young males [mean age 33.1 +/- 7.0 years] [sex ratio 2.3] deprived in both social and educational terms. Injecting drug use was the predominant risk factor and was characteristic of a first group of young men raised in large families shattered by rural-urban migration, with an antisocial personality. A second group consisted of women, mostly illiterate from traditional rural settings. They had been infected by their spouses who had worked abroad, whether drug users or not. Approaches for the prevention of HIV infection are proposed

[Breast feeding effect relative to age of onset of celiac disease]. / Effets de l'allaitement maternel sur l'âge de début de la maladie coeliaque.

BACKGROUND: Age at onset and clinical presentation of celiac disease have often been related to the age of gluten introduction into the diet. It has also been shown that breast feeding delays the onset of the disease. PATIENTS AND METHODS: This retrospective study attempts to evaluate the respective contributions of these two parameters in the determination of the age at onset of the symptoms in celiac Tunisian children. RESULTS: One-hundred-sixty-nine children were studied. Mean duration of breast feeding in our population was 9.6 +/- 8.9 months and mean age of gluten introduction was 5.6 +/- 3.2 months. The mean age at onset of the disease was 15 +/- 8.7 months and mean latency time between gluten introduction and onset of the disease was 9.5 +/- 7.8 months. Both variables, duration of breast feeding and age at gluten introduction were strongly correlated to the age at onset of the disease (r = 0.47 and 0.40, respectively). Only breast feeding was correlated to the variable latency time (r = 0.33). Stepwise multiple regression analysis showed that the two variables independently influenced the age at onset with coefficients of regression of 0.90 +/- 0.20 and 0.26 +/- 0.07, respectively. Only breast feeding influenced the latency time with a coefficient of regression equal to 0.26 +/- 0.07. DISCUSSION: Our study confirms the independent effect of breast feeding in the determination of the age at onset of the disease. Breast feeding has two effects: an indirect effect, by delaying the introduction of gluten, and a direct effect, by increasing the latency time between gluten introduction and onset of the disease. CONCLUSION: Prolonged breast feeding, at least until the 6th month, and gluten introduction started at least at the 5th month of life, significantly delay the onset of the disease. Gluten introduction should be done progressively and under breast feeding protection. Introduction of gluten 2 months before weaning has a protective effect.