B. Lyoussi

Disease-specific health-related quality of life instruments among adults diabetic: A systematic review

This paper provides a systematic review on health-related quality of life (HRQoL) measures in diabetic patients. For each included study, a description of the measure and its psychometric findings is provided. To evaluate these measures, a databases search (Medline, Scopus and Proqolid) was undertaken to identify relevant publications. Instruments were assessed according to predefined inclusion and exclusion criteria. Sixteen instruments met the inclusion criteria among 1049 references produced: appraisal of diabetes scale (ADS), audit of diabetes-dependent quality of life (ADDQoL), diabetes-39 (D-39), diabetes care profile (DCP), diabetes distress scale (DDS), diabetes health profile (DHP-1, DHP-18), diabetes impact measurement scales (DIMS), diabetes quality of life measure (DQOL), diabetes quality of life clinical trial questionnaire-revised (DQLCTQ-R), diabetes-specific quality of life scale (DSQOLS), elderly diabetes burden scale (EDBS), insulin delivery system rating questionnaire (IDSRQ), quality of life with diabetes questionnaire (LQD), problem areas in diabetes scale (PAID), questionnaire on stress in diabetic patients-revised (QSD-R) and well-being enquiry for diabetics (WED). All those instruments have been developed in northern countries. The shortest instrument (ADS) has seven items and the longest (IDSRQ) has 67 items. ADDQoL was widely translated followed by DHP and PAID. Only authors of ADS and DIMS have not involved patients in the construction of instruments. The authors of instruments: ADS, ADDQoL, DHP, D-39, and PAID reported the item-total correlation which is ranged from 0.28 to 0.84. The ADS, DQOL, EDBS, IDSRQ, LQD, PAID, QSD-R, and WED have been assessed for test-retest reliability which varies between 0.27 and 0.99. The DQLCTQ-R, DQOL and IDSRQ were not subjected to factor analysis. Responsiveness was assessed in PAID with effect sizes and ranged from 0.32 to 0.65 for interventions. Four domains were responsive to clinical change in metabolic control in DQLCTQ-R. The other instruments were not been formally assessed for responsiveness. This review found evidence that the instruments: ADDQoL, D-39, DDS, DHP1/18, DSQOLS, EDBS and QSD-R had adequate psychometric properties. For future research, responsiveness should be a priority and further study is also required to examine the effect of ethnicity and to determine the validity of these scales in developing countries.

Breast Cancer Screening in Morocco: Performance Indicators During Two Years of an Organized Programme

BACKGROUND Breast cancer is commonly diagnosed at late stages in countries with limited resources. In Morocco, breast cancer is ranked the first female cancer (36.1%) and screening methods could reduce the proportion presenting with a late diagnosis. Morocco is currently adopting a breast cancer screening program based on clinical examination at primary health facilities, diagnosis at secondary level and treatment at tertiary level. So far, there is no systematic information on the performance of the screening program for breast cancer in Morocco. The aim of this study was to analyze early performance indicators. MATERIALS AND METHODS A retrospective evaluative study conducted in Temara city. The target population was the entire female population aged between 45-70 years. The study was based on process and performance indicators collected at the individual level from the various health structures in Tamara between 2009 and 2011. RESULTS A total of 2,350 women participated in the screening program; the participation rate was 35.7%. Of these, 76.8% (1,806) were married and 5.2% (106) of this group had a family history of breast cancer. Of the women who attended screening, 9.3% (190) were found to have an abnormal physical examination findings. A total of 260 (12.7%) were referred for a specialist consultation. The positive predictive value of clinical breast examination versus mammography was 23.0%. Forty four (35.5%) of the lesions found on the mammograms were classified as BI-RADs 3; 4 or 5 category. Cancer was found in 4 (1.95%) of the total number of screened women and benign cases represented 0.58%. CONCLUSIONS These first results of the programme are very encouraging, but there is a need to closely monitor performance and to improve programme procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.

Organization and Evaluation of Performance Indicators of a Breast Cancer Screening Program in Meknes-Tafilalt Region, Morocco

Objective: The benefits of screening and early detection of breast cancer, including reduced morbidity and mortality, have been well-reported in the literature. In 2011, a breast cancer screening program was launched in Meknes-Tafilalt region of Morocco. The aim of this study was to evaluate the early performance indicators of this program. Materials and Methods: This retrospective evaluative study was conducted between April 2012 and December 2014, in Meknes-Tafilalt region of Morocco. Several performance indicators of the breast cancer screening program were calculated: the compliance rate, the positivity rate, the referral rate, the cancer detection rate and the organizational indicators. Results: During 2012-2014, a total of 184,951 women participated in the breast cancer screening program. The compliance rate was 26%, the positive rate was 3.3%, the referral rate was 36.7%, and the cancer detection rate was 1.2 per 1,000 women. The median time between the date of clinical breast examination and the date of biopsy (or cyto-puncture) was 36 days. The median time between the date of positive mammography and the date of biopsy (or cyto-puncture) was 6 days. The median time between the date of clinical breast examination and the date of the first received treatment was 61 days. Conclusions: The program needs better monitoring, as well as implementation of quality assurance tools to improve performance in our country.

Risk factors and prevalence of use of different tobacco products among school adolescents in the North Central region of Morocco: a cross-sectional study

Introduction The rising number of youth smokers is a major concern to public health in Morocco. The implementation of appropriate preventive measures would require information about the prevalence and determinants of tobacco use. Data on tobacco consumption among adolescents in the North Center of Morocco are scarce. Therefore, the current study aims at investigating the risk factors of smoking and the prevalence of the use of different forms of tobacco among school teenagers in the North-Centre region of Morocco. Methods A cross-sectional study was conducted in North Central Region of Morocco among students in public secondary schools selected by stratified cluster random sampling. The statistical unit devised was a school class from the seventh to the twelfth grade of the Moroccan educational system. Results A total of 3020 students (53% were males) and an average age = 16 ± 2.1 years were included in the study. The prevalence of the use of cigarettes was 16.1% (95% CI: 14.8% - 17.4%).For other tobacco types such as hookah, snuff and tobacco chewing, the prevalence was respectively 70.6%, 42.8% and 35.0% for cigarettes smokers. The level of current tobacco use was noticeably higher among boys (15.0% vs. 2.5%, p < 0,001) and high school students in comparison to middle school pupils (21.2% versus 11.9%; p < 0,001). Conclusion Among young people, all types of smoking are growing increasingly in our Moroccan society; this alarming result can contribute to help the decision-makers to make decisions and force us obviously to take preventive measures rapidly.

P093 Analyse des connaissances des patients diabétiques marocains de type 2 sur leur maladie, et l’impact sur la survenue des complications dégénératives ; étude « EpiDiaM » Maroc

Introduction Au Maroc, la plupart des patients diabetiques de type 2 sont suivis par leurs medecins generalistes au niveau des centres de sante de base, aupres desquels l’acquisition de connaissances est souvent rendue difficile par le manque de temps qu’ils peuvent leur consacrer. Patients et methodes Il s’agit des donnees de l’inclusion de la cohorte (EpiDiaM) avec l’inclusion de 300 diabetiques de type 2 suivis au niveau de centre de reference de prise en charge du diabete a Fes – Maroc. Un questionnaire prealablement teste et complete a l’aide du dossier medical. Six axes ont ete explores: connaissances generales sur le diabete, alimentation, complications, traitements, autosurveillance et le suivi. Resultats L’âge moyen etait de 56,49 ± 11,84 ans et 81,0 % des patients etaient de sexe feminin. La duree moyenne du diabete etait de 9,55 ± 6,38 ans. 21,6 % des patients presentaient une ou plusieurs complications. Dans 75,1 % des cas les patients ont deja beneficie d’une education therapeutique. Le respect du traitement etait rapporte chez seulement 38,1 % des patients. 76,4 % etaient en desequi-libre glycemique. Le pourcentage de reponses correctes etait satisfaisant concernant la connaissance de la glycemie preliminaire du diabete (69,2 %), la comprehension des traitements (53,5 %), l’importance de l’exercice physique (57,5 %), le risque d’avoir des complications degeneratives liees au diabete (54,2 %), l’importance de l’autosurveillance glycemique (65,9 %), il etait par contre moyen concernant l’hemoglobine glyquee (48,0 %), les regles d’hygiene alimentaire (48,0 %), la mesure reguliere de la tension arterielle (35,9 %) et la mesure reguliere de poids (24,2 %). La comprehension de l’importance du controle glycemique augmente avec l’anciennete du diabete (p = 0,04) et la regularite du suivi (p = 0,00). Conclusion Les resultats de notre etude ont permis de montrer que les connaissances de la maladie chez les diabetiques de type 2, restent encore trop souvent insuffisantes, ce qui peut contribuer au desequilibre glycemique et aux complications degeneratives du diabete. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.