Perceived stigma among Tunisian healthcare workers during the COVID-19 pandemic

BACKGROUND AND OBJECTIVES

Stigma was a major issue during the COVID-19 pandemic. It posed a serious threat to the lives of healthcare workers (HCWs) who were expected to experience higher levels of stigma and increased psychological distress. This is the first survey to investigate forms and correlates of perceived stigma in Tunisian HCWs during the COVID-19 pandemic.

METHODS

A cross-sectional web-based survey was conducted between October 8th and November 10th 2020, among 250 Tunisian HCWs. Data were collected using an online questionnaire using the Google Forms® platform. We used a self-reported instrument measuring COVID-19-related stigma, and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the perceived adequacy of social support from three sources: family, friends, and significant other.

RESULTS

The mean stigma score was 18.6±8. Participants sometimes to often experienced stigma in their relationships with friends (22%), neighbors (27.2%), parents (22,4%), and in social activities (30.8%). This stigma was perceived mainly through avoidance (68.4%), and rarely through verbal (6%) or physical aggression (1.2%). The mean MSPSS total score was 5.26±1.24. In multivariate analysis, depression history (P<0.001), long working experience (P<0.001), having presented ageusia/anosmia (P=0.007) and lower total social support scale (P<0.001) were significantly associated with higher perceived stigma score.

CONCLUSION

Our findings showed that HCWs perceived stigma in professional, societal and familial domains. Social support from family, friends and others seemed to protect against perceived stigma. Proper health education targeting the public appears to be an effective method to prevent social harassment of both HCWs and COVID-19 survivors.

L'influence de la COVID-19 sur la santé mentale des enseignants Tunisiens

Contexte

Au fur et à mesure que le virus du SARS-COV 2 se propageait, un climat de panique et de suspicion s'installait partout notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à étudier l'association de la COVID-19 et l'atteinte mentale grave chez les enseignants Tunisiens.

Méthodes

Une étude transversale moyennant un auto-questionnaire était menée sur un échantillon représentatif des enseignants du niveau secondaire entre mars et avril 2021 à Sfax, Tunisie. La santé mentale était estimée par l’échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Au total, 525 enseignants participaient à l'étude. Parmi eux, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile=[41-53]). Quatre cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La prévalence de la COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux cents enseignants avaient peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N=314). Les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA)=1,6 ; p=0,02), un antécédent de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence d'atteinte mentale grave.

Discussion/Conclusion

Les résultats de cette étude suggèrent que la COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial demeure une obligation à planifier.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Les effets indésirables des équipements de protection chez les professionnels de santé

Contexte

Les professionnels de santé (PDS) étaient obligés de porter les équipements de protection individuels (EPI) au cours de leur exercice en pandémie, afin de minimiser le risque de transmission du virus émergent. L'objectif de cette étude était de quantifier la prévalence de survenue des effets indésirables (EI) relatifs au port des EPI chez les PDS et d’étudier les facteurs qui lui sont associés.

Méthodes

Il s'agissait d'une étude transversale ayant inclus un échantillon représentatif de 300 PDS randomisés dans le CHU Hedi Chaker de Sfax, Tunisie, durant la période août-septembre 2021. Le recueil des données était réalisé par un questionnaire auto-administré anonyme.

Résultats

Au total, 218 sujets étaient de sexe féminin (72,7 %), l’âge moyen était de25,6 ± 3,49 ans. Selon la profession, 202 cas étaient des médecins (67,3 %) et 26 sujets avaient une ancienneté ≥ 10 ans (8,7 %). Les EI relatifs au port des EPI étaient notés chez 87 PDS, soit une prévalence de 57,2 %. L'analyse multivariée a montré que les facteurs indépendamment associés aux liés au port d'EPI chez les PDS étaient le sexe féminin (Odds Ratio Ajusté (ORA)=1,8 ; p=0,048), avoir des maladies chroniques (ORA=0,29 ; p=0,001) et avoir une infection antérieure par la COVID-19 (ORA=0,46 ; p=0,004). L'utilisation fréquente d'eau de Javel ou autre produit de désinfection sans protection et l'utilisation d'eau chaude en milieu de travail étaient indépendamment associées à un risque élevé d'effets indésirables ((ORA=2,22 ; p=0,003) et (ORA=2,83 ; p=0,005), respectivement). De même, la durée d'utilisation des EPI > 4 heures par jour (ORA=1,98 ; p=0,039), ainsi que l'utilisation de visières et/ou de lunettes en milieu de soins (ORA=1,84 ; p=0,045) étaient statistiquement plus associés à la survenue de EI chez les PDS.

Discussion/Conclusion

La prévalence des EI relatifs au port des EPI était importante. Des multiples facteurs lui étaient associés notamment professionnels. Des formations adéquates et répétitives destinés aux PDS portant sur le bon usage des EPI demeurent indispensables pour gérer ce problème.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity

OBJECTIVES

Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI).

METHODS

A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. The severity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form (UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer.

RESULTS

Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P<0,05). SUI severity was negatively correlated with PFM strength (r=-0,620, P=0,001), isokinetic trunk flexors strength (r=-0,605, P=0,001), and PFM endurance (r=-0,561, P=0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r=0,488, P=0,013).

CONCLUSION

Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found between these two muscle groups may be explained by their synergic activity. These findings suggest that the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI.

LEVEL OF PROOF

3.

Ampleur de l'infection du SARS-COV2 chez les enseignants et son impact sur leur santé mentale

Introduction

Les épidémies engendrent un climat de panique et de suspicion qui se propage plus rapidement que l'agent pathogène lui-même. C'était le cas durant l'épidémie de COVID-19 notamment pour les catégories à risque. Les effets délétères que pourrait avoir la maladie sur la santé mentale des enseignants sont possiblement sous-estimés. Cette étude visait à estimer la prévalence de la maladie COVID-19 chez les enseignants et à étudier son association avec la détresse psychologique.

Matériels et méthodes

Il s'agissait d'une étude transversale moyennant un auto-questionnaire, menée sur un échantillon représentatif de 525 enseignants du niveau secondaire entre Mars et Avril 2021. La santé mentale était estimée par l'échelle de détresse psychologique (K6 de Kessler). Un seuil > 13 de cette échelle définit une atteinte mentale grave.

Résultats

Parmi les 525 enseignants participants à l'étude, 292 étaient des femmes (55,6 %), soit un sexe-ratio de 0,8. L'âge médian était de 48 ans (intervalle interquartile= [41-53]). Quatre-cent soixante-dix-huit cas (91 %) étaient mariés, 132 enseignants (25,1 %) avaient des maladies chroniques et 85 participants (16,2 %) étaient des fumeurs actifs. La notion de contage pour la COVID-19 était notée chez 184 cas (35 %). La prévalence de la maladie COVID-19 était de 20 % (N=105). Le lavage régulier des mains était noté chez 438 enseignants (83,4 %). Le port régulier du masque était observé chez 427 enseignants (81,3 %). Deux-cents enseignants avaient la peur de perdre leur vie à cause de la maladie (38 %). La prévalence d'une atteinte mentale grave était de 59,8 % (N= 314). Dans l'analyse multi-variée par régression logistique binaire, les facteurs indépendants d'une atteinte mentale grave étaient une infection COVID-19 antérieure (Odds ratio ajusté (ORA) =1,6 ; p=0,02), un antécédant de maladie chronique (ORA=2,1 ; p=0,01), la crainte de perdre leur vie par la maladie (ORA=2,3 ; p=0,007). Par ailleurs, le port régulier du masque (ORA=0,46 ; p=0,041) était un facteur indépendant associée à une moindre prévalence de maladie mentale grave.

Conclusion

L'état de santé mentale représente un problème majeur de santé publique pendant cette pandémie. Les résultats de cette étude suggèrent que la maladie COVID-19 avait maintes répercussions négatives sur la santé mentale des enseignants. De ce fait, leur accompagnement psychosocial devrait être pensé par les acteurs communautaires et sanitaires.

Aucun lien d'intérêt

Connaissances, attitudes et des pratiques des professionnels de santé vis-à-vis de la vaccination contre la COVID-19

Introduction

Devant la pandémie mondiale de COVID-19, un des seuls espoirs réside dans le développement d'un vaccin efficace. Les professionnels de santé (PDS) étant les plus exposés à cette maladie, ils sont les premiers à se faire vacciner. Cependant, la perception des PDS de ce vaccin n'était pas suffisamment évaluée. L'objectif de cette étude était d'étudier les connaissances, les attitudes et les pratiques face à la vaccination anti-COVID-19 chez les PDS.

Matériels et méthodes

Il s'agissait d'une étude observationnelle transversale ayant inclus un échantillon représentatif randomisé de 300 professionnels de santé dans un CHU durant la période de Mars-Avril 2021. Des scores préétablis sur 100 étaient utilisés pour évaluer les connaissances, les attitudes et les pratiques des PDS.

Résultats

Au total, 223 PDS étaient des femmes (74,3 %). L'âge moyen était de 29,5 ans ± 8,26. Selon la profession, 178 PDS étaient des médecins (59,3 %). Les valeurs moyennes /100 des scores des connaissances, des attitudes et des pratiques étaient de 54,32 ± 11,37, 83,34 ± 13,18 et de 75,91 ± 11,95, respectivement.

L'analyse multivariée par régression linéaire a révélé que les facteurs indépendants associés à la connaissance étaient la profession médicale (β=0,25 ; p<0,001) et le contact direct avec des patients testés COVID-19 positifs (β=0,136 ; p=0,015).

Pour les attitudes, l'urbanité de la résidence (β=(0,13) ; p=0,022), la profession médicale (β=0,29 ; p<0,001), le statut marié (β=0,12 ; p=0,025) et l'infection antérieure par la COVID-19 (β=(-0,14) ; p<0,001) étaient indépendamment assoicés au score de l'attitude.

L'ancienneté > 20 ans (β=0,152 ; p=0,008), le contact direct avec des patients testés positifs (β=0,112 ; p=0,049) ainsi que la profession médicale (β=0,165 ; p=0,004) étaient des facteurs indépendants prédictifs des pratiques vis-à vis la vaccination antiCOVID.

Conclusion

En dépit d'un score relativement faible des connaissances vis-à-vis de la vaccination anti-COVID, des scores élevés des attitudes et des pratiques étaient observés chez les PDS. Cette variabilité était expliquée par des facteurs socio-démographiques et professionnels qui incitaient cette population exposée constamment au risque professionnel d'infection à la vaccination afin d'assurer des soins sécurisés.

Aucun lien d'intérêt

Magnitude of general obesity, abdominal obesity and related risk factors among medical students

Introduction

Obesity is recognized to be one of the greatest public health problems worldwide. In addition to physical health problems, obesity is also linked to an increased risk of mental health disorders. We aimed to estimate the magnitude of overweight/obesity among medical students, to identify their risk factors and to assess their impact on mental health.

Methods

We conducted a cross-sectional questionnaire survey among 524 medical students randomized from different levels, at the Faculty of Medicine of Sfax, Tunisia, on October 2019.

Results

The prevalence of combined overweight/obesity and abdominal obesity were 21.9% and 22.3%, respectively. The independent risk factors of overweight/obesity were male gender (OR = 3.2; 95% confidence interval (CI) = [1.96-5.2]), internship (OR = 2; 95% CI = [1.1-3.9]) and residency (OR = 3.2; 95% CI = [1.7-6]) levels, as well as moderate (OR = 3.4; 95% CI = [1.4-8.3]) and high (OR = 6.7; 95% CI = [2.6-16.9]) stress scale. However, daily fresh vegetables (OR = 0.4, CI95% = [0.2-0.8]) and high-fiber cereals whole-grain bread (OR = 0.5; 95%CI = [0.28-0.83]) consumption, light (OR = 0.37; 95% CI = [0.16-0.86]), moderate (OR = 0.24; 95% CI = [0.06-0.89]) and vigorous exercise (OR = 0.091; 95% CI = [0.01-0.74]) were independent protective factors of overweight/obesity. Severe consequences of obesity were noted, such as less ability to concentrate (37.9% vs 47.6%; p = 0.024), living under stress (72.2% vs 60.6%; p = 0.023), feeling unhappy and depressed (57.4% vs 44.7% p = 0.016), losing confidence (45.2% vs 20.5%; p &lt; 0.001) and inability to enjoy normal activities (53.9% vs 38.7% p = 0.03).

Conclusions

Unhealthy lifestyle was relatively high among students with obesity. Our study confirms the data from the literature, and underlines the need to set up a plans including nutrition and lifestyle education in their curriculum.

Key messages

Unhealthy lifestyle was relatively high among students. The need to set up a plans including nutrition and lifestyle education.

Magnitude, risk factors of addictive behaviors among school students in Southern Tunisia

Background

The use of addictive product is an important public health problem rapidly spreading around the world threatening the users, their families and environments, causing serious health problems and devastating societies in psychological and economical terms. During adolescence, these substances are harmful to health, affecting the developing of brain. This study aimed at investigating the prevalence, the determinants and the impact of addictive behaviors (AB) among school students (SS).

Methods

This was a cross-sectional study including a three-stage randomized sample of 1210 SS from different public schools of Southern Tunisia, on April 2021, using an anonymous self-administered questionnaire. AB were defined as the consumption of at least one of the following products: tobacco, illicit drugs and alcohol.

Results

Overall, 723 SS were females (59.8%), with a sex ratio (Male/Female) of 2.3. The average age was 15.64±2.05 years. In total, 793 cases (65.5%) were from rural areas. The prevalence of addictive behaviors was 18.7% (225). It was 13.9% (168) for current smoking, 3.1% (37) for alcohol consumption and 1.7% (20) for illicit drug use. Factors independently associated with AB in logistic multivariate analysis were male gender (Adjusted Odds Ratio (AOR)=10.2;p&lt;0.001), secondary school studies (AOR=1.5;p=0.008), age ≥14 years (AOR=2.5;p&lt;0.01) and living alone or sharing home with friend (AOR=2.29;p=0.004). These AB had statistically negative impact on SS, notably for low school marks and academic failure (OR = 2.5;p=0.01 and OR = 1.66;p=0.002, respectively). Moreover, the perceived stress scale was statistically higher among SS with AB (OR = 1.4;p=0.03).

Conclusions

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia, which was correlated with socio-demographic, cultural and educational factors. New preventive and therapeutic strategies should be urgently initiated to ensure a safe educational and psychological environment for SS.

Key messages

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia. Addictive behaviors among SS were correlated with socio-demographic, cultural and educational factors.

Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Introduction

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015.

Methods

We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

Results

We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005).

Conclusions

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients.

Key messages

Non-communicable diseases. Morbidity and mortality.

Chronological trends and causes of deaths among reproductive-age-women in Southern Tunisia

Introduction

Mortality data of women with reproductive age (WRA) data are important indicators of the health system performance. This study aimed to determine the magnitude, trends and main causes of WRA deaths.

Methods

The study used longitudinal hospital-based surveillance design for the period 2014-2020 in Southern Tunisia including all WRA (15- 49 years) who died in public health facilities in this region.

Results

During the 7-year-period, there were 331 WRA deaths, and this number increased sharply with age (χ2= 21.7;p&lt;0.001). Non-communicable diseases were the leading causes of deaths (41.7%) and were statistically more frequent in older women (52% vs 37.5%;p&lt;0.001) and urban regions (48.9% vs 36.6%;p=0.025). Concerning communicable diseases and maternal deaths, they were statistically more common in rural regions (12.4% vs 5%;p=0.026 and 17% vs 8.8%;p=0.031,respectively). There were 45 maternal deaths, with an average maternal mortality ratio (MMR) of 51.39/100,000 Live births(LB)/year. There was a slowly declining trend in the MMR during the reference period, without significant change (χ2=0.7;p=0.4), with a peak of 97.37/100,000LB in 2016. Direct obstetric deaths constituted 73.9% of all maternal deaths, among which the leading causes were obstetric haemorrhage (66.7%) and eclampsia (14.3%). Among the indirect causes, cardiovascular diseases (37.5%) and infections (16.6%) were the most common.

Conclusions

Mortality indicators among WRA remained sustainably high in Southern Tunisia, despite the declining curve. The causes of death varied according to age groups and access to health facility. Strengthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Key messages

High mortality indicators among WRA remained sustainably in Southern Tunisia. Stregthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Burnout among health care workers during COVID-19 pandemic: prevalence and risk factors

Introduction

During COVID-19 pandemic, health-care workers (HCW) have been exposed to multiple psychosocial stressors. Although the problem of burnout, which overlaps with the symptoms of depression, remains urgent, few studies have addressed it comprehensively. The objective of this study was to determine the prevalence and the factors associated with burnout among HCW.

Methodes

We conducted a cross-sectional study on March-April 2021 using a self-administered questionnaire distributed to HCW who were involved in COVID-19 management patients. The 22-item Maslach burnout inventory was performed to measure the prevalence of burnout defined as follows: high score of emotional exhaustion (≥27) plus high score of depersonalization (≥13) or low score of personal accomplishment (≤31).

Results

Overall, 250 HCW were included in this study. The sex ratio was 0.17. Their median age was 34 years (interqurtile range (IQR) = [30-40 years]). The average number of work experience was 11.1±3.4 years. There were 46 cases (18.4%) with a chronic disease. Among the study population, 131 HCW (51.4%) were infected with covid-19. The overall burnout prevalence was 45.6%. Female gender (Odds ratio (OR)=4.3; p < 0.001) and unmarried status (OR = 3.3; p < 0.001) were statistically associated with burnout. Participants in the burnout group had statistically higher number of working hours per day (≥6 hours) (OR = 3.2; p = 0.003), of night shifts per week (4±1 vs 3±1; p = 0.04), but lower number of working experience years (7±0.6 vs 12±1; p = 0.017). History of chronic diseases (OR = 1.8;p=0.021), witnessing a COVID-19 death while working (OR = 3.1; p < 0.001) and suffering from sleep deprivation (OR = 1.9; p = 0.034) were statistically more frequent in the burnout group of HCW.

Conclusions

The findings of this study indicated that the burnout syndrome was highly prevalent among HCW. More psychological support should be provided for this population in order to provide a high-quality of care for patients.

Key messages

Highly prevalent of burnout syndrome.

Psychological support should be provided.

Reluctance and acceptability of Covid-19 vaccination among healthcare professionals

Background

The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. healthcare professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. The aim of this study was to evaluate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors.

Methods

This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of (HCP) at the university hospitals of Southern Tunisia on April 2021.

Results

Overall, 223 cases were females (74.4%). The average age was 29.5 years ±8.26. In total, 178 HCP were doctors (59.3%), 147 HCP (49%) were working in medical services and 58 HCP (19.3%) were in intensive care units. The vaccination acceptance rate was 65.3% (196), while 73 cases (24.3%) were reluctant. Factors statistically associated with vaccine acceptability were female gender (Odds ratio (OR)=2.9;p=0.001), advanced age (30.23±8.27 vs 28.09±8.12;p=0.034), urbanity of residence (OR = 4.5;p&lt;0.01) and direct contact with positive COVID-19 patients (OR = 1.9;p=0.007). Compared to paramedical staff, doctors were more willing to be vaccinated (OR = 4;p&lt;0.01). Belief in the efficacy of the vaccine as effective with few adverse effects (OR = 2.04;p&lt;0.01), as protective against the virus (OR = 4.5;p&lt;0.01) as well as the only solution to stop the pandemic (OR = 2.6;p&lt;0.01) and to decrease serious complications of the disease (OR = 28;p&lt;0.01) were statistically associated with vaccination acceptance.

Conclusions

This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted. Thus, planning vaccination campaigns to raise awareness of the efficacy and the safety of vaccine is strongly recommended to promote vaccination in the general population.

Key messages

This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted.

Diabetes screening among School Teachers: Exploring the Ignored Dimension of School Health Program

Introduction

The rising prevalence of diabetes is a serious public health concern globally, with its complications and associated health expenditures. The school teachers have chronic stress, predisposing them to many chronic diseases. The aim of this survey was to assess the prevalence and the predisposing factors influencing diabetes among secondary school teachers.

Methods

A cross-sectional analytical study was carried out on a three-stage randomized sample of 258 secondary school teachers of 12 public schools on march 2021. A self-administered and pretested questionnaire was performed to assess sociodemographic characteristics and a Glucometer using glucose sticks was used to measure fasting blood sugar level. Diabetes and pre-diabetes were defined according to the International Diabetes Federation.

Results

Overall, 136 participants were females (52.7%) giving a male to female ratio of 0.9. The median age was 49 years (Interquartile range (IQR) = [43-53]). Of all teachers, 228 cases (88.4%) were married, 190 cases (73.6%) were from urban areas and 63 cases (24.4%) had a chronic disease. There were 29 (11.2%) active smokers. We noted that 23 participants were diabetics, giving a prevalence of fortuitous discovery diabetes of 8.9%. The prevalence of pre-diabetes was 10.5%. In multivariate logistic regression, higher prevalence of diabetes was independently associated with daily consumption of coffee (Adjusted odds ratio (AOR)=1.8; p = 0.048); frequently pasta consumption (&gt;3 times/week) (AOR=1.8; p = 0.012); family history of diabetes (AOR=2.5; p = 0.032), work seniority &gt;30 years (AOR= 2.2; p = 0.041) and higher body mass index (AOR=3.2; p = 0.02)

Conclusions

Our study results indicated that the prevalence of diabetes was relatively high among school teachers, addressing the urgent need for adopting healthy lifestyle. The School health program can be utilized as an effective tool to screen non-communicable diseases and to strengthen primary preventive care in school.

Key messages

Diabetes screening and associated factors. School teachers.

What are the determinants of stress, anxiety and depression among university students?

Introduction

University students (US) are supposed to face academic, living conditions and mental challenges during their cursus. These challenges with stressful events of graduate education could potentially cause depression, anxiety and stress. The main objectives of the present study were to explore the prevalence of depression, anxiety and stress among US and to identify their determinants.

Methods

A cross-sectional-questionnaire based study was conducted among a randomized sample of 1071 US in Sfax Universities, on April 2021. Data collection was performed using an anonymous questionnaire including a short version of depression, anxiety and stress scales (DASS-21).

Results

A total of 1071 US participated in the study with a mean age of 22.2 ± 2.5 years. The prevalence of depression, anxiety and stress were 69.2%, 75.4% and 45.5%, respectively. Severe or extremely severe depression, anxiety and stress were noted among 312 (29.1%), 468 (43.7%) and 195 (18.2%) US, respectively. Both depression and stress were significantly more frequent among US having a low monthly income (OR = 1.5; p = 0.045 and OR = 2.2; p = 0.042, respectively) and those who were not satisfied of their university (OR = 2.1; p = 0.002 and OR = 2.2; p = 0.008, respectively). Tobacco use was associated with higher score of depression (OR = 3.8; p = 0.046) and higher score of anxiety (OR = 1.53; p = 0.007). In addition, having a chronic disease was statistically associated with stress, anxiety and depression (OR = 2.8; p &lt; 0.001; OR = 2.2; p &lt; 0.001 and OR = 2.3; p &lt; 0.001, respectively).

Conclusions

A substantial proportion of US are suffering from depression, stress and particularly from anxiety. These findings suggested an urgent need for establishment of preventive measures and interventions to learn how to cope with these conditions positively to improve the mental health of students.

Key messages

Stress, anxiety and depression. University students.

Predictors of hypertension self-care practice in primary health-care facilities of Sfax

Introduction

Unmanaged hypertension is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of hypertension complications. This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors in Sfax, Southern Tunisia.

Methods

It was a cross-sectional study conducted in Sfax, Southern Tunisia from March to April 2020. A total of 6 primary health care facilities was approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire. Statistical analysis was performed using SPSS.24.

Results

A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65 years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were age over 65 (AOR=9.5; p &lt; 0.001), university educational level of the participants (AOR=21.2; p &lt; 0.001), as well as receiving a health education, by healthcare providers (AOR=2.5; p = 0.012) and family members (AOR=4.36; p = 0.004). Advanced hypertension stage (II and III) (AOR=0.45; p = 0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; p = 0.027) and COPD (AOR=0.27; p = 0.016) were independently associated with poor HTN self-care practice.

Conclusions

Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning hypertension self-care education

Key messages

Hypertension self-care practice. Hypertensive patients.

What are the predisposing factors of depressive disorders among school teachers?

Introduction

Teachers' psychological wellbeing is important for both teachers and student's development, but is highly stressful, particularly in special education. Chronic stress is associated with a range of mental health problems including risk of depression, which could lead to low quality of life and dropout. This research aimed to determine the prevalence of depression and their predisposing factors among school teachers.

Methods

A cross-sectional study was conducted on a randomized sample of 258 secondary school teachers in Sfax, Southern Tunisia on march 2021. The instrument used for depression measurement was adopted from the generalized anxiety disorder assessment (GAD-7).

Results

Among 258 school teachers, 136 were females (52.7%). The mean age was 47.5±8.1. Overall, 47 teachers (18.2%) had a work seniority above 30 years. According to the work conditions, 118 cases (45.7%) had problems with their students, 30 cases (11.6%) had problems with parents and 10 subjects (4%) had conflicts with their colleagues. The prevalence of depression was 44.6%. Moderate and severe depression were respectively noted in 72 (27.9%) and 43 (16.7%) teachers. In multivariate logistic regression, female gender (Adjusted odds ratio (AOR)=2.1; p = 0.004), history of chronic disease (AOR= 2.6; p = 0.001), working outside the family's region of residence (AOR= 1.8; p = 0.048), active smoking (AOR= 1.9; p = 0.042) and having problems with students at school (AOR=2.2; p = 0.039) were independently associated with higher prevalence of depression.

Conclusions

The prevalence of self-reported depression among school teachers was notably high, which may hamper their relationships and effectiveness with students. The most prominent risk factors were related to unhealthy lifestyle and lack of social support with students. Therefore, managing work conditions and establishing appropriate consulting and supporting programs are urgently required.

Key messages

Depression disorders. School teachers.

Prevalence survey on antimicrobial use & multidrug resistance in tertiary level university hospital

Introduction

Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH).

Methods

It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected.

Results

Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p &lt; 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p &lt; 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p &lt; 0.001). and central vascular catheters (8.6% vs 2.2%; p &lt; 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%).

Conclusions

This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Key messages

High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Is internet addiction related to self-esteem and insomnia among engineering students?

Introduction

With the availability and mobility of new media, Internet addiction (IA) has emerged as a potential problem in young people which refers to excessive computer use that interferes with their daily life, with harmful behavioral-psychological impact. The aim of this study was to estimate the prevalence of IA among engineering students (ES) and to evaluate its relationship with self-esteem and insomnia.

Methods

In a cross-sectional survey using an anonymous self-administered questionnaire, data was collected from a randomized sample of 305 ES in Sfax, Southern Tunisia. Previously validated and standardized scales including Insomnia Severity Index (ISI) and Rosenberg self-esteem and Internet Addiction Test (IAT) were performed.

Results

Among 305 ES, 185 (60.7%) were females, giving a male to female ratio of 0.6. Their mean age was 22.9 ± 2.6. Prevalence of internet addiction was 41.3% (N=); it was moderate in 102 ES (80.9%) and severe in 24 ES (19.1%). As for insomnia and low self-esteem, their prevalence rates were 59.6 and 28.2%, respectively. Unhealthy lifestyle behaviors including mixing cannabis with tobacco (OR = 11.2; p = 0.02), skipping meals once a day (OR = 3.6; p = 0.041), first use of smartphones at younger age (OR = 2.2; p = 0.042) and spending ≥3 hours per day on line (OR = 3.2; p = 0.032) were statistically associated with internet addiction. Academic failure during the last year (OR = 2.02; p = 0.04) was significantly more frequent among internet addicted ES. Moreover, mental health disorders, notably feeling frequently in depressive mood (OR = 1.9; p = 0.048), insomnia (OR = 1.24; p = 0.007) and low self-esteem (OR = 2.62; p = 0.003) were statistically associated with internet addiction.

Conclusions

Ranking at an alarming rate, internet addiction has been found to have a very strong relationship with insomnia and low self-esteem among ES, and at times it affected their social life and their relationship with their family.

Key messages

Internet addiction among engineering students. Insomnia and self-esteem among engineering students.

Chronological trends of cardiovascular diseases in Southern Tunisia over a fourteen year -period

Introduction

Cardiovascular diseases are the leading cause of death worldwide and in Tunisia. In fact, as a result of progressive urbanization and westernization of lifestyle the spectrum and pattern of cardiovascular diseases CVD along with their risk factors are changing. The aim of this study was to describe the epidemiological profile of CVD hospitalizations, to evaluate their chronological trends and to estimate their future projected trends.

Methods

We retrospectively collected data from the regional morbidity registry of the University Hospital of Sfax, Tunisia, between 2003 and 2016. We included patients with ischemic heart disease (IHD), heart failure (HF) and rhythm and conduction disorder (RCD). Join-point regression analysis was performed to study chronological trends of CVD (Annual Percentage Change (APC); p).

Results

The mean age-standardized hospital incidence rate (ASHIR) was 94.8, 20.6 and 14/100000 inhabitants/year for IHD, HF and RCD, respectively. Trends analysis of CVD showed a significant increase in the ASHIR of IHD from 54.3/100000 inhabitants in 2003 to 123/100000 inhabitants in 2016, with an Annual Percentage Change (APC) of 3.59% (95% confidence interval (CI):0.4-6.7%; p &lt; 0.001). An upward trend was observed for HF, with ASHIR rising from 8.6/100000 inhabitants in 2003 to 22.6/100000 inhabitants in 2016, with an APC of 8.29% (95%CI:4.1-12;p&lt;0.001). For RCD, no significant change in ASHIR was found. Projections showed that the estimated ASHIR would attend 131 and 36.5/100000 inhabitants for IHD and HF, respectively, while RCD would decline to 19.6/100000 inhabitant in 2026.

Conclusions

IHD and HF were rising at an alarming rate and were expected to continue up to the next 10 years. Primary and primary prevention of cardiovascular risk factors, therapeutic education and early management would have a positive impact in the short and long term.

Key messages

The importance of the bidder of cardiovascular diseases. The necessity of primary prevention.

Self-esteem and university students: Findings from a multi-center study

Introduction

Self-esteem refers to the degree to which a person esteem himself or herself. Accordingly, low self-esteem has a remarkable impact on mental health that may influence successful development and life outcomes, especially for young people. The purpose of this study was to determine the prevalence and factors predisposing to low self-esteem among university students (US) in Southern Tunisia.

Methods

A cross-sectional study performing a stratified randomized sample of 8 universities was conducted in Sfax, Southern Tunisia, on April 2021. A structured an anonymous self-administered questionnaire including the 10-item Rosenberg Self-esteem Scale was applied for a total of 1071 US.

Results

Among 1071 US, 759 cases (71%) were females, giving a male to female ratio of 0.4. Their mean age was 22.2 ±2.5 years. There were 1035 single US (96.5%), 246 smokers (23%) and 140 alcohol consumers (13.1%). Students with low self-esteem were identified at a prevalence of 29.5%. Living in a urban region (OR = 1.7; p = 0.004), studying in a private university (OR = 2.5; p = 0.013), having a low monthly income (&lt;2 minimum wage) (OR = 1.6; p = 0.014) and a chronic disease (OR = 2.1; p &lt; 0.001) were major risk factors of low self-esteem. Moreover, daily TV time &gt;4 hours (OR = 5.9; p = 0.009) and absence of leisure activities (OR = 1.8; p = 0.006) were significantly associated with higher prevalence of low self-esteem. Otherwise, practicing physical activity 3 times/week (OR = 0.6; p = 0.04) and high academic performance (OR = 0.8; p = 0.004) were identified as protective factors of low self-esteem.

Conclusions

The findings from the current study highlighted that low self-esteem was ranking at an alarming rate among US. These results therefore suggested the need for a school-based or web-based provision aiming at proactively increasing students' self-esteem and skills for dealing with their academic career and self-confidence.

Key messages

Low self-esteem and its associated factors. University students.

Évaluation de l’efficacité d’une stratégie multimodale sur les connaissances et les perceptions des professionnels de santé en matière d’hygiène des mains en phase pandémique COVID-19 : une étude quasi-expérimentale

Introduction

Réservoir connu de bactéries, les mains sont impliquées dans la transmission des germes entre patients aboutissant à l’accroissement des taux d’infections associées aux soins (IAS) et à l’extension de l’épidémie COVID-19. L’hygiène des mains (HDM) constitue de ce fait le premier moyen de lutte d’efficacité authentifiée contre les IAS. Bien que ce geste soit simple, le manque d’observance de cette mesure parmi les professionnels de santé (PS) est un problème universel. Dans le but d’une efficacité maximale, l’objectif de cette étude était d’évaluer l’impact d’un programme interventionnel sur les connaissances et les perceptions du PS en matière d’HDM.

Matériels et méthodes

Il s’agissait d’une étude quasi-expérimentale de type avant-après, ayant inclus un échantillon représentatif de PS des différents services du CHU, menée durant la 2^e vague de la pandémie COVID-19, août-décembre 2020. L’outil d’évaluation adopté était des questionnaires validés de l’OMS sur les connaissances et les perceptions du PS en matière d’HDM, distribués en deux exemplaires avant l’intervention et 3 mois après. L’intervention consistait en un programme de formation basé sur les cinq composantes de la stratégie multimodale de l’HDM de l’OMS. Un score moyen (SM) global/100 des connaissances était calculé. Pour les perceptions, les réponses étaient basées sur l’échelle de Likert de 4 et 7 points, à partir des deux derniers points la perception était considérée positive.

Résultats

Au total, 100 PS ont rempli les questionnaires, parmi lesquels 45 % étaient du cadre médical et 55 % étaient des paramédicaux. Trente-neuf sujets (39 %) ont suivi une formation antérieure en HDM les trois dernières années. Le SM global des connaissances a significativement augmenté après l’intervention (48,10 ± 16,76 vs 64,92 ± 17,21 ; p < 0,001). Nous avons noté une amélioration significative des SM des connaissances des PS sur le rôle des mains dans la transmission croisée des micro-organismes (65,97 ± 17,75 vs 79,16 ± 13,57 ; p < 0,001) ainsi que des différentes techniques de l’HDM (47,97 ± 12,67 vs 67,38 ± 8,59 ; p < 0,001). Concernant la source la plus fréquente d’acquisition des IAS, le SM des connaissances est resté stable (32,14 ± 6,73 vs 48,21 ± 6,45 ; p = 0,058). Le taux médian d’amélioration des connaissances était de 10,75 (IQR = [2,22–37,59]). Il était significativement plus élevé chez les PS qui ont reçu une formation antérieure (31,85 vs 5,92 ; p = 0,007) et chez les paramédicaux (10,75 vs 4,44 ; p = 0,014).L’efficacité de l’HDM dans la prévention des IAS était perçue comme élevée/très élevée par la majorité des PS avant et après l’intervention sans amélioration significative (93 % vs 95 % ; p = 0,7). De même, la disponibilité de rubans à base d’alcool a été perçue comme l’action la plus utile pour améliorer le respect de l’hygiène des mains (53 % vs 64 % ; p = 0,15).

Conclusion

Cette étude a mis en exergue l’importance du programme de formation instauré auprès des PS en matière d’HDM et la nécessité d’une évaluation continue de leurs compétences afin de réduire la charge des IAS. L’évaluation de cette pratique s’avère indispensable dans le cadre d’une démarche d’amélioration continue de la qualité des pratiques en milieu hospitalier.

Depression in quarantined patients during the COVID-19 pandemic

Introduction

Quarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.

Objectives

To assess the prevalence of depression in quarantined patients, and to analyze the associated factors.

Methods

This was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.

Results

The results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression; 10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).

Conclusions

Psychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

Introduction

Widespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.

Objectives

Predict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.

Methods

A cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.

Results

In total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.

Conclusions

Perceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.

Disclosure

No significant relationships.

Prevalence and predictors of hypertension self-care practice in primary health-care facilities in Southern Tunisia

BACKGROUND

Unmanaged hypertension (HTN) is usually accompanied with complications leading to disability in older adults. It has been demonstrated that self-care practice is essential for blood pressure control and reduction of HTN complications.

OBJECTIVE OF THE STUDY

This study aimed to estimate the level of implementation of HTN self-care practice and to identify their associated factors.

STUDY DESIGN

It was a cross-sectional study conducted in Sfax, Southern Tunisia in April 2020.

MATERIALS AND METHODS

A total of 6 primary health-care facilities were approached for the study participants according to a single-stage cluster sample, by selecting six grapes randomly. A total of 270 participants were recruited, among whom 250 cases (92.6%) completed the questionnaire.

RESULTS

A total of 250 hypertensive patients were included in the study, giving a male to female ratio of 0.77. There were 125 participants (50%) aged over 65years. Overall, 137 cases (54.8%) had a high total self-care practice score. The independent factors of good HTN self-care practice were≥65years [Adjusted odds ratio (AOR)=9.5; P<0.001], university educational level of the participants (AOR=21.2; P<0.001), as well as receiving a health education, by health-care providers (AOR=2.5; P=0.012) and family members (AOR=4.36; P=0.004). Advanced hypertension stage (II and III) (AOR=0.45; P=0.032) and chronic pulmonary diseases, including asthma (AOR=0.42; P=0.027) and chronic obstructive pulmonary diseases (AOR=0.27; P=0.016) were independently associated with poor HTN self-care practice.

CONCLUSION

Advanced hypertension stage, pulmonary co-morbidities, education level and lack of self-care education were predictive factors of poor self-care practice. These findings suggested that such factors should be considered when planning HTN self-care education.

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period

BACKGROUND

Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends.

METHODS

We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants.

RESULTS

We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001).

CONCLUSION

In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

Are lifestyle behaviors correlated to mental health disorders in medical students?

Background

Recently, there has been a renew interest to medical students’ mental health, which may be influenced by several sociodemographic and cultural factors, academic overload, but also by lifestyle behaviours. This study aimed to assess the correlation between major lifestyle behaviors and mental health in medical students.

Methods

A cross-sectional questionnaire survey was conducted among 521 medical students randomized from different levels, at Southern Tunisia Medical School, 2017. The 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) were used to assess mental health and lifestyle, respectively.

Results

The mean values of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. According to SLIQ components, we noted an unhealthy lifestyle in 36.9%, 50.1% and 20.2% for diet, physical activities and stress level, respectively. The prevalence of psychological distress (GHQ-12≥4) was 50.1%. The GHQ-12 items analysis revealed that 235 cases (45.1%) were unable to concentrate, 237 cases (45.5%) felt unhappy and depressed and 195 cases (37.4%) had a loss of sleep over worry. Low family financial situation (Odds Ratio (OR)=1.5;95%CI = [1.1-2.3]), internship level, (OR = 1.8;95%CI = [1.1-3.3]) and medium/poor academic performance (OR = 2.2;95%CI = [1.5-3.2]) were significantly associated with psychological distress. Multivariate analysis showed that unhealthy lifestyle was independently associated with psychological distress (Adjusted OR = 5.8;95%CI = [2.4-14.8]).

Conclusions

Our study highlighted the magnitude of psychological distress in medical students. Unhealthy life style was a potential predictive of mental disorders. These findings are extremely useful for guiding future curricular changes upon entry into medical schools.

Key messages

Mental disorder prevalence ranked at an alarming rate among medical students. Promoting healthy life style represents a reliable tool to sustain a good quality of life for the future-doctors.

What are the determinants of body image distortion and dissatisfaction among Tunisian teenagers?

Background

Body image (BI) is considered as central to many aspects of human functioning including emotions, thoughts, behaviors and relationships. This study aimed to investigate the prevalence and the main determinants of distortion and dissatisfaction among teenagers.

Methods

This was a cross-sectional school-based study using a self-administered questionnaire, conducted among a randomized sample of 1300 school-adolescents in Southern Tunisia, 2018. BI perception was assessed by the Stunkard Figure Rating Scale.

Results

Among 1210 respondents (93%), BI distortion and dissatisfaction prevalence were 44.8% and 42.4%, respectively. Multivariate analysis showed that 16-18 years age group (Adjusted Odds Ratio (AOR)=1.28; p = 0.046), low family financial situation (AOR=1.88; p = 0.014), as well as high frequency of eating pasta (AOR=1.3;p=0.04) and fast-food consumption (AOR=1.7;p=0.042) were independently associated with under-estimated BI. Skipping breakfast (AOR=1.9; p = 0.017) and having one obese parent (AOR=1.9;p=0.01) were independently associated with higher frequency of over-estimated BI. For BI dissatisfaction, independent factors associated with desire to lose weight were female gender (AOR=1.53; p = 0.007), high family financial situation (AOR= 2.1,p=0.008) and having one parent obese (AOR=2.21,p&lt;0.001). Frequent fast-food consumption (AOR=1.9, p = 0.038) and eating between meals (AOR=1.57,p=0.01) were associated with higher desire to gain weight.

Conclusions

Our study highlighted a substantially high prevalence of BI distortion and dissatisfaction among adolescents. Their determinants included socio-demographic factors and lifestyle behaviors. Increased awareness among parents and public health planners may help adolescents improve accuracy of BI attitudes.

Key messages

BI distortion and dissatisfaction are pervasive problems that increased negative affect in adolescents. Promotion of healthy lifestyle including balanced diet and physical activity is warranted.

Is school furniture design a contributing factor to low back pain in adolescents?

Background

Recent evidence showed that low back pain (LBP) is frequent among youth. Individual etiologic factors are most often associated with musculoskeletal overuse and altered postural control. This study aimed to evaluate the association between school furniture design and LBP in school-adolescents.

Methods

A cross-sectional study was conducted using a self-reported questionnaire distributed to school-adolescents aged 12-18 years, in Southern Tunisia, 2018. We performed a stratified three-step sample to obtain a representative sample of 1400 subjects.

Results

The response rate was 87.2% (1221 students). The mean schoolbag weight was 3±1.3 kg. The schoolbag to body weight ratio was 0.05±0.03. The main method of carrying a schoolbag was on both shoulders (57.2%). During the last 3 months, LBP was reported in 391 cases (32%). Multivariate analysis using logistic regression showed that high-school grade was independently associated with LBP (Adjusted Odds Ratio (AOR)=2.7;95% CI = [1.9-3.7];p&lt;0.001). Classroom furniture and layout design independently associated with LBP included too low seat backrest (AOR=1.4;95% CI = [1.12-1.87];p=0.005), too far seat to black(board) distance (AOR=1.5;95% CI = [1.1-2.2];p=0.041), schoolbag to body weight ratio ≥10% (AOR=1.7;95% CI = [1.2-2.4]; p = 0.002) and carrying schoolbag for 30-60 minutes (AOR=1.48;95% CI = [1.1-2.1]; p = 0.029). Otherwise, carrying school bag by hand (AOR=0.25; 95% CI = [0.07-0.89]; p = 0.033) was found to be independently associated with lower prevalence of LBP complaints.

Conclusions

Current design of school furniture is not compatible with the adequate purposed dimensions in students. It increased substantially the risk of LBP, which emphasizes the need for multi-disciplinary approach involving teachers, policy makers and health care professionals.

Key messages

School related LBP may threaten the physical performance and the social life of adolescents. Revising school environments and radical ergonomic interventions are mandatory.

A new combined predicting model using a non-invasive score for the assessment of liver fibrosis in patients presenting with chronic hepatitis B virus infection

OBJECTIVES

Several non-invasive markers have recently been proposed to predict liver fibrosis without percutaneous liver biopsy (PLB). We aimed to evaluate the performance of non-invasive scores and to highlight the value of a new combined score in the prediction of liver fibrosis in chronic hepatitis B (CHB) patients.

PATIENTS AND METHODS

We performed a retrospective study of patients presenting with CHB who underwent PLB between 2008 and 2016. We calculated ASAT/Platelet Ratio Index (APRI), Fibrosis-4 Score (FIB4), GGT-to-platelet ratio (GPR), and ASAT/ALAT Ratio (AAR). Then, we combined APRI and FIB-4 scores into a new combined score. We assessed their performance in predicting liver fibrosis according to the Metavir score.

RESULTS

A total of 179 patients presenting with CHB were included. Multivariate analysis showed that the APRI score was the only independent factor of significant fibrosis (OR=3.78; P=0.02), whereas the FIB-4 score was the only independent factor for severe fibrosis (OR=2.85; P<0.001) and cirrhosis (OR=2.5; P=0.001). At a threshold of severe fibrosis, APRI had the best specificity (75%) and FIB-4 had the greatest sensitivity (74%). Using the combined score, we improved the diagnostic performance of APRI and FIB-4 scores at the three thresholds of liver fibrosis. With this combined score, maximum 25.1% of patients presenting with CHB would undergo PLB.

CONCLUSION

APRI, FIB-4, and GPR scores were well performing to predict liver fibrosis during CHB. The new combined score using APRI and FIB-4 was more accurate at the three-fibrosis thresholds.

[Active smoking: A major risk factor for human non-communicable diseases in a hospital survey]

INTRODUCTION

Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs).

METHODS

We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM).

RESULTS

We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001).

CONCLUSION

Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources.

[Ocular tuberculosis : A case series]

OBJECTIVES

Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis.

METHODS

We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay.

RESULTS

The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae.

CONCLUSION

Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

Techniques et indications chirurgicales des décompressions osseuses de l’orbitopathie dysthyroïdienne

Orbital bony decompression has a definite place in the management of severe manifestations of dysthyroid orbitopathy such as optic neuropathy, exposure keratitis, and exophthalmos. This surgical procedure can be undertaken when medication and radiation therapy fail. Esthetic and functional results are globally satisfying and explain the interest taken in this technique. This article will describe the development of this procedure and will outline the surgical techniques and their complications. It emphasizes the multifactor indications for this procedure.

[Advantages of a double approach to upper blepharoplasty associated with eyelid malpositions]

During upper blepharoplasty, myocutaneous excess and fat pads are treated using an anterior approach. Eyelid malpositions such as involutional ptosis or lid retraction could be associated and should be treated with associated procedures. Aponeurotic surgery on the levator muscle can make use of the same anterior approach, with the major difficulty of dosage. In cases of ptosis with a positive epinephrine test or minor muscular retraction, the Müller muscle-conjunctival surgery via a posterior approach seems to be more reproducible. Double-approach techniques are described.