Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV₁/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19

The 2019-20 coronavirus pandemic (COVID-19) has led to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, no drugs have demonstrated safety and efficacy in randomized controlled trials for patients with COVID-19. Although the association between Hydroxychloroquine and Azithromycin efficacy lack of solid evidence-base, several governments have adopted it for all virology confirmed Covid-19 cases even for those who are asymptomatic. In the following, we aim to discuss some of the ethical issues associated with the use of this treatment association. We mainly tried to discuss the following controversial questions: Is it ethical not to treat a patient while a treatment exists and is used for other indications than Covid-19 for which it's not proven yet? If yes, is a randomized controlled trial to prove the hydroxychloroquine for the Covid-19 treatment, necessary, in the context of covid-19 pandemic? If no, is it the government's right to decide the hydroxychloroquine treatment for all covid-19 patients? And what should be the physicians' attitudes? Finally, what are the government, physicians, and patient's rights and responsibilities? The paper conclude that, since health authorities in some countries recommended this off-label use treatment, physicians are challenged by the requirement of veracity while providing care to their patients and the implications of such a requirement; they are facing the challenge of balancing this guideline and their own conviction. Furthermore, the fundamental principles of beneficence and non-maleficence, and respect for persons should underlie any reflection process to address this dilemma. In addition, in a pandemic context, the limits between the government's, practitioner's and patient's rights and obligations are not clear which could significantly endanger the universal ethical principles in clinical practice. It could also undermine any attempt to develop serious clinical trials to prove the considered off-label drug.

Behavioural, Nutritional and Genetic Risk Factors of Colorectal Cancers in Morocco: Protocol for a Multicentre Case-Control Study

Background: Colorectal cancer (CRC) is the third most common cancer in men and the second in women worldwide and its risk factors are complex. Genetic and environmental factors are strongly involved including lifestyle and eating habits. In Morocco, the number of new CRC cases is increasing. In parallel, cancer risk factors and behaviors of the Moroccan population are changing due to profound societal and technical changes. Aim: To that end we designed a multicenter case control study that aimed to evaluate the relationship between dietary habits, physical activity, genetics factors and the risk of CRC in Moroccan population. Methods: This case control study was conducted between January 2009 and February 2017 in 5 major University Hospital Centers in Morocco (Fez, Rabat, Oujda, Casablanca and Marrakech). Cases were matched with controls by age (±5 years), sex and center. Participants completed a face-to-face questionnaire on sociodemographic data, lifestyle, family history of CRC and no steroidal anti-inflammatory drugs. In addition, participants completed a semiquantitative food-frequency questionnaire (FFQ) was developed to assess food intake in the Morocco population. Pathology tumor samples were collected for 200 cases. For genetic data analysis, DNAs were extracted by manually scraping tissue from unstained slides. To assess the strength of the association between characteristics and the risk of CRC, odds ratios (OR) with 95% confidence intervals were estimated by conditional regression models. All statistical analyses were done using SPSS v20. Results: In total, 3032 pairs (1516 cases and 1516 controls) were recruited. Excluded participants (case/control) were unspecified primitive cancer (7 pairs), participants with missing dietary data (26 pairs) and participants with the lowest and highest 1% of the distribution of the ratio between energy intake and energy requirement (30 pairs). All together, 2906 cases and controls were recruited during the study period. Both cases and controls did not differ significantly with respect to sex 50.7% were women and 49.3% were men ( P = 0.51), the center that recruited the most was Rabat, followed by Casablanca, Oujda, Fez, and finally Marrakech ( P = 1.00). For marital status, being married was most frequent for both cases and controls (76.3% vs 77.0%) ( P = 0.36), alcohol consumption was higher in cases than controls (2.4% vs 1.7%) ( P = 0.12). However, participants in the control group were significantly more moderately active (58.4% vs 52.1%) and more likely to be never smoker (83.8% vs 77.6%). Conclusion: This study is the first large one that has described the risk factors of CRC in Morocco and in North Africa. It gives for the first time results about these risk factors which are drawn directly from this target population. Preventive recommendations could, therefore, be reviewed and adapted to these populations accordingly.

Sedentarity and Colorectal Cancer in Morocco

Background: The colorectal cancer (CRC) ranks third among the most nationally prevalent cancers. Several factors including lifestyle modifications are interacting for the emergency of this disease. Morocco has experienced an epidemiologic transition accompanied by the adoption of an unhealthy lifestyle and the physical activity and the sedentary behavior changes. Aim: This study aimed to identify the association between sedentary lifestyle and the onset risk of CRC in Morocco. Methods: This is a national multicenter study of cases/controls which were matched on the sex, age and the recruiting center. All data are collected through a retrospective questionnaire including socio-demographic characters and the lifestyle behaviors (physical activity and sedentary). A sedentary person is defined as being more than 4 hours in a sitting or lying position, at work, at home, during travel, excluding time spent on sleep. Conditional logistic regression was performed to assess the association between sedentary behavior and CRC risk taking into account confounders. Data entry and data analyses were performed by SPSS software 20. Results: In total, 1453 couples (case/control) have been included in this study. 50.2% had colon cancer and 49.8% had rectal cancer. The average age were respectively 56.45 ± 13.95 years and 55.50 ± 13.70 years. For the sex, there were 49.3% male and 50.7% female in each group (case/control). The majority of the cases and controls fall into the poor class. The majority of the cases (43.7%) are overweight with a BMI between 25 and 29.9, 38.7% have a normal weight with a BMI between 18.5 and 24.9. For controls, patients with normal weight (45.6%) and those with overweight (43%) represent the majority. With regard to sedentary behavior, we note that cases are more sedentary (as being >4 hours in a sitting or lying position, at work, at home, during travel, excluding time spent on sleep) than controls with a percentage of 40.5% cases vs 36.2% of controls and a significant difference between cases and controls with OR = 1.19 (1.03-1.39), P = 10−3. Conclusion: The results of this study indicate that sedentary lifestyle is an overall risk factor for CRC. The issue of sedentary life is a major public health issue. Efforts must be made to address this sedentary problem, which will become an even more important health problem in the age of technology, with the massive use of activities that further entrap sedentary life such as social networks.

Associated Factors for Health Quality of Life in Moroccan Women With Breast Cancers

Background: Breast cancer is the most common cancer among women. Breast cancer is ranked the first female cancer (33.4%) in Morocco; and more than 60% cases are diagnosed at stage III or IV. During the last decade, health-related quality of life (HRQOL) has become an important part of breast cancer treatment. Aim: The objective of this study is to describe self- reported HRQOL in patients with breast cancer and to investigate its associations with socio-demographic and clinical variables. Methods: A prospective study was carried out in the main oncology centers in Morocco. Quality of life was measured using the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C 30 (EORTC QLQ C30) and Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Statistical data analyses were performed using descriptive statistics and multivariate analyses. Results: A total of 1463 subjects were included in the study. The subjects' mean age was 55.6 (SD. 11.2) years, 70% were married. The majority of the subjects had stage II (45.9%) and the few cases had stage IV (12.9%). Participants had a mean score for global health of 68.5. Among functional scales, social functioning scored the highest (mean 86.2, SD = 22.7). The most distressing symptom on the symptom scales was financial difficulties (mean 63.2, SD = 38.2). Using the disease-specific tool, it was found that future perspective scored the lowest (mean 40.5, SD = 37.3). On the symptom scale, arm symptoms scored the highest (mean 23.6, SD = 21.6). Significant mean differences were noted for many functional and symptom scales. Conclusion: Our results emphasize that the general HRQOL of the studied women is fairer than that of the corresponding population in other countries. This study provided baseline information on the quality of life of a large sample of Moroccan women diagnosed with breast cancer.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and Colorectal Cancer Risk in Morocco: A Case-Control Study

Background: Currently, colorectal cancer (CRC) incidence and mortality were rising in African countries; these rates are alarming and should be considered to make prevention policies. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) released 8 recommendations on body fatness, physical activity and diet to prevent against cancer development. Aim: The current study was designed to evaluate the association between the WCRF/AICR recommendations and the risk of CRC in a case-control study among Moroccan adults. Methods: A case-control study was conducted in 5 Moroccan hospital centers, including 1516 cases and 1516 controls. The study was matched on sex, age (± 5 years) and center. The habitual diet was assessed with a validated food frequency questionnaire. Adherence to WCRF/AICR recommendations was evaluated through a score that incorporates 6 components (body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks). Each related component recommendation was rated using a score of 2 levels: (1) when the recommendation was met; (0.5) when the recommendation was partially met; (0) when the recommendation was not met. The overall WCRF/AICR score ranged from 0 (no adherence to WCRF/AICR guidelines) to 6 (high adherence). To categorize this score, we calculated the tertile cut-offs of controls (reference population) for both sexes (men and women separately) that we applied on the whole population. Conditional logistic regression was used to calculate ORadjusted and its 95% confidence intervals adjusted for age, residence, education level, monthly income, family history of CRC, smoking status, BMI, physical activity, total energy intake, and alcohol intake unless the variable was part of recommendation under evaluation. Results: CRC risk was significantly reduced with increasing adherence to each WCRF/AICR recommendation: for body fatness (ORa = 0.47; 95% CI, 0.36-0.63), physical activity (ORa = 0.33; 95% CI, 0.24-0.45), sugary drinks (ORa = 0.58, 95% CI, 0.42-0.80), plant foods (ORa = 0.18; 95% CI, 0.12-0.29) and animal foods (ORa = 0.47; 95% CI, 0.36-0.62). Also a significant inverse association was observed for the highest category of adherence to WCRF/AICR guidelines for CRC risk (ORa = 0.29; 95% CI, 0.23-0.37) compared with the lowest category. Conclusion: The WCRF/AICR index including a combination of 6 components showed strong protective associations for CRC risk in Morocco. These results confirm the importance of promoting the WCRF guidelines among the Moroccan population to prevent CRC incidence.

Is There Any Association Between Processed Meat Consumption and Colorectal Cancer Risk in Morocco?

Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related deaths worldwide. A large body of epidemiologic research show that countries where people eat more red meat and processed meat are also countries where the risk of CRC is high. The processed meat intake was described as a convincing risk factor for CRC according to the recent report of the World Cancer Research Fund published in 2017. In Morocco the incidence of CRC is increased significantly during the last years according to the Cancer Registry of the Greater Casablanca region. In addition to the imported of modern processed meat; this country is characterized also by the presence of their traditional processed meat as: quaddid (obtained by salting and sun-drying of meat) and khlii (obtained from salted-dried meat, which is cooked and conditioned in fat). In contrast, no studies have been conducted previously to evaluate the association between processed meat and CRC risk. Aim: This study aimed to evaluate the association between processed meat intake and CRC risk in Morocco. Methods: A case-control study was conducted in 5 major public health hospitals in Morocco. Each case was matched with a control by age (±5 years), sex and center. Dietary data were collected by a validated Food Frequency Questionnaire including traditional processed meat (quaddid and khlii) and modern processed meat (delicatessen meat). Conditional logistic regression was done to predict the association between processed meat consumption and CRC risk. Results: Among 500 cases and 500 controls matched by age; sex and center, 50.9% were male and 49.1% were female. The mean age was 55.53 ± 14.53 years. Among the cases, 44.5% was diagnosed with colon cancer, and 55.5% with rectum cancer. Most participants live in the urban area; never attend school and are poor. The bivariate analysis was used to evaluate the association between processed meat intake and CRC. We found no statistical significant between the occurrence of CRC and consumption of traditional processed meat (OR = 1.04; 95% CI, 0.74-1.48; P = 0.43). While, this study found strong significant association between modern processed meat and CRC risk (OR = 9.23; 95% CI, 3.91-21.77; P = 0.00). Conclusion: This study support that high consumption of modern processed meat such delicatessen meat increased the risk of CRC. In contrast, this study did not provide evidence that traditional processed meat is related to CRC risk in Morocco. We could explain this association by the low consumption of traditional processed meat in this study sample. In addition, the increases in the urbanization could also reduce the consumption of these types of traditional processed meat. Further studies are needed to evaluate the association between meat consumption and CRC risk in the context Moroccan.

Dietary Pattern in Relation With CRC Risk Among Moroccan Population; A Multicenter Case-Control Study

Background: Colorectal cancer (CRC) is a global public health problem, an estimated of 1.4 million cases were diagnosed worldwide in 2012. Studies in health and nutrition confirmed that dietary factors were strongly associated with CRC risk. Aim: The objective of this empirically study was to reveal unobserved dietary profiles that were associated favorably or unfavorably with CRC risk in Moroccan study population. Methods: This case-control study included a total of 2906 participants in five centers, 1453 cases and 1453 controls, and was gender, age and center matched. Statistical exploratory data reduction methods were performed in this study population based on a specific scientific hypothesis linking dietary behavior and colorectal cancer risk. Principal component analysis (PCA) was applied separately in cases and in controls as individuals and with FFQ nutritional group's heads items as variables. The correlation matrix of food variables was examined to explain most of the variation in the data, reducing a large number of food variables to a smaller set that captures the major dietary factors differences in Moroccan population. Results: Three alimentary profiles were identified for controls based on three principal component analysis, which the first one was highly positive with high cereals, fruits and nuts, legumes, fish, olive oil, dairy products and legumes consumption, and was highly negative with an increasing consumption of poultry and red meat. This component explained 26.5% of the variance in initial data and described a healthy pattern characterized with high fiber intake. In opposite, five principal components were identified for cases that indicated five nutritional profiles with a predominance of dairy products, nuts, fish consumption and low legumes, olive oil and fruits intake: its explained 15.37% of total variance. Conclusion: PCA analysis is a multidimensional factor analysis method that was used in this epidemiologic study to describe the variance in our big database in relation with CRC risk among Moroccan people. This method needs a supervised analysis such as linear discriminant analysis (LDA) to give interpretation and prediction models of CRC risk related to nutritional behavior among this study population.

Dairy products and colorectal cancer in middle eastern and north African countries: a systematic review

BACKGROUND

This systematic review was conducted to explain the association between dairy products and colorectal cancer (CRC) risk in Middle Eastern and North African countries (MENA).

METHODS

The database consulted were PubMed, Clinical Trials, and Cochrane to extract the relevant studies published till the 31stof December 2016, using inclusion and exclusion criteria according to Prisma Protocol. The characteristics of these studies comprised the consumption of all types of dairy products in relation to CRC risk.

RESULTS

Seven studies were included in this review. For dairy products overall, no significant association was found. Regarding modern dairy products, included studies found controversial results with OR = 9.88 (95% CI: 3.80-24.65) and OR_a = 0.14 (95% CI: 0.02-0.71). A positive association was reported between traditional dairy products and CRC risk, to OR = 18.66 (95% CI: 3.06-113.86) to OR = 24 (95% CI: 1.74-330.82) to ORa = 1.42 (95% CI: 0.62-3.25), p_trend = 0.03. Calcium was inversely associated with the CRC risk with OR_a = 0.08 (95% CI: 0.04-0.17).

CONCLUSION

This is the first systematic review which illustrated the association between dairy consumption and CRC risk in MENA region. The results were inconsistent and not always homogeneous. Further specified studies may be warranted to address the questions about the association between CRC and dairy products in a specific context of MENA region.

Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study

OBJECTIVE

To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age ⩾40 years), living in the city of Fez, Morocco.

DESIGN

Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.

RESULTS

Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for <10 pack-years). The prevalence of physician-diagnosed COPD was 3.2%; this was associated with an increase in smoking pack-years.

CONCLUSION

These results emphasise the urgent need to take necessary measures to reduce the prevalence of tobacco smoking.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey

BACKGROUND

Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region.

METHODS

A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses.

RESULTS

A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family.

CONCLUSIONS

The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study

BACKGROUND

Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students.

METHODS

From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria.

RESULTS

A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use.

CONCLUSIONS

The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.

Frequency, types and determinants of degenerative complications of type 2 diabetes in Morocco: "EpiDiaM" cohort inclusion data

Degenerative complications as a result of diabetes impose a heavy disease burden and increase mortality. This study presents epidemiological and clinical profiles of diabetic patients in the EpiDiaM cohort study, which include 1196 diabetic cases recruited from the basic health care network in the city of Fez. The mean age of the participants was 57.5 (SD 10.4) years with 47.1% aged between 50 and 60 years. The majority (77.7%) were women. The mean duration of diabetes was 8 (SD 6.6) years. Hypertension was found in 49.3% of the cohort, 77.9% were overweight or obese and 63.8% had one or more complications. Among those with complications, retinopathy was the most common (69.4%), followed by heart conditions (50.8%), neuropathy (45.6%) and renal disease (4.8 %). The high prevalence of complications emphasizes the need to address the avoidable risk factors and prevent complications.

Dyspnea: a strong independent factor for long-term mortality in the elderly

OBJECTIVE

To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors.

METHODS

DESIGN

Longitudinal study.

SETTING

In Dordogne and Gironde, South Western France.

SUBJECTS

A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included.

MAIN OUTCOME MEASURES

dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes.

RESULTS

The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects , 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10⁻⁴). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10⁻³). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01-1.26]); this risk increases to HR=1.42 (CI95%=[1.25-1.63]) for level-2 and to HR=1.90 (CI95%=[1.61-2.25]) for level-3 and 4.

CONCLUSION

These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.

Burden of smoking in Moroccan rural areas

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