Imed Harrabi

Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty—a BOLD analysis

Background Chronic obstructive pulmonary disease (COPD) is a commonly reported cause of death and associated with smoking. However, COPD mortality is high in poor countries with low smoking rates. Spirometric restriction predicts mortality better than airflow obstruction, suggesting that the prevalence of restriction could explain mortality rates attributed to COPD. We have studied associations between mortality from COPD and low lung function, and between both lung function and death rates and cigarette consumption and gross national income per capita (GNI). Methods National COPD mortality rates were regressed against the prevalence of airflow obstruction and spirometric restriction in 22 Burden of Obstructive Lung Disease (BOLD) study sites and against GNI, and national smoking prevalence. The prevalence of airflow obstruction and spirometric restriction in the BOLD sites were regressed against GNI and mean pack years smoked. Results National COPD mortality rates were more strongly associated with spirometric restriction in the BOLD sites (<60 years: men rs=0.73, p=0.0001; women rs=0.90, p<0.0001; 60+ years: men rs=0.63, p=0.0022; women rs=0.37, p=0.1) than obstruction (<60 years: men rs=0.28, p=0.20; women rs=0.17, p<0.46; 60+ years: men rs=0.28, p=0.23; women rs=0.22, p=0.33). Obstruction increased with mean pack years smoked, but COPD mortality fell with increased cigarette consumption and rose rapidly as GNI fell below US

Epidemiology of Cardiovascular Risk Factors Among Schoolchildren in Sousse, Tunisia

15 000. Prevalence of restriction was not associated with smoking but also increased rapidly as GNI fell below US

Validation of nomograms to predict the risk of non-sentinels lymph node metastases in North African Tunisian breast cancer patients with sentinel node involvement

15 000. Conclusions Smoking remains the single most important cause of obstruction but a high prevalence of restriction associated with poverty could explain the high ‘COPD’ mortality in poor countries.

Epidemiology of hypertension among a population of school children in Sousse, Tunisia.

Background In Tunisia, where the epidemiological transition phenomenon is well established, there are no data available at the population level on the cardiovascular disease (CVD) risk profile for children, although it is well known that risk factor development takes place in childhood. Methods We report an epidemiological survey based on a representative sample of 1569 urban schoolchildren of Sousse in Tunisia to assess the following CVD risk factors: Hypertension, hypercholesterolaemia and other lipid disorders, obesity and tobacco consumption. Results The main results showed that girls had significantly higher levels of body mass index (BMI), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol than boys, who however had significantly higher levels of systolic blood pressure (SBP). Total cholesterol was significantly correlated to BMI and decreased with age. Obesity (BMI=27) was found in 7.9% of the study population and was significantly higher for girls (9.7%) than for boys (6%): χ 2=9.02, DF=2, P = 0.011. Overweight (BMI = 25) was also significantly higher for girls (16%) than for boys (11.1%): χ 2=8.21, DF=1, P = 0.0041. Smoking habit concerned 7.6% of the study population; it was significantly higher for boys (14.7%) than for girls (1.1%): χ 2=103.4, DF=1, P < 0.00001. Conclusion This study showed to some extent that Tunisias urban population of schoolchildren is exposed early to CVD risk factors and all should be done to avoid the worsening of this profile. These results will serve as a baseline for assessment of future trends in the risk factors studied.

Prevalence of COPD and Tobacco Smoking in Tunisia — Results from the BOLD Study

INTRODUCTION In approximately half of patients with breast cancer and lymph node metastases, the sentinel node (SN) is the only involved axillary node. Scoring systems have been developed to predict probability of non-SN metastases among those with a positive SN. The goal of the present study was to determine whether the five models (Memorial Sloan-Kettering Cancer Center (MSKCC), Stanford, Tenon, Cambridge and the Turkish model) accurately predicted non-SN involvement in a North African Tunisian population. METHODS During a five years period, we identified 87 cases of invasive breast cancer which had a positive SN biopsy and complete axillary lymph node dissection (CALND). The MSKCC, Stanford, Tenon, Cambridge and Turkish models were tested. Results were compared using the area under the curve (AUC) of the receiver operating characteristics for each model. False negative and false positive rates were also calculated. RESULTS The AUC of the MSKCC, Stanford, Tenon, Cambridge and Turkish models was respectively 0.73 (95% CI 0.6-0.86), 0.76 (95% CI 0.65-0.87), 0.75 (95% CI 0.63-0.87), 0.67 (95% CI 0.53-0.82) and 0.75 (95% CI 0.63-0.88). The threshold for a 10% false negative of non-SN involvement was obtained with a cut off value of 10% for MSKCC, 25% for Stanford, a score of 3 for Tenon, 6% for Cambridge and 15% for the Turkish nomogram. CONCLUSIONS Meaningfully applied to our population, although AUC values had overlapping of 95% confidence intervals but combined our data suggest that the Stanford nomogram may be the most accurate. Before prospective trials validate these nomograms, CALND remains the standard for patients who have SN metastases.

Étude de la surcharge pondérale et de l’obésité dans une population d’enfants et d’adolescents scolarisés en milieu urbain à Sousse en Tunisie

BACKGROUND Pediatric hypertension is a field of increasing interest and importance. Early identification of children at risk for hypertension is important to prevent the serious, long-term complications associated with the condition. In Tunisia, there are no data available on the cardiovascular disease risk profile, such as hypertension, in the population of children. OBJECTIVE To establish the prevalence of hypertension, the percentile distribution of blood pressure and the inter-relationships between hypertension and other cardiovascular disease risk factors among school children. METHODS An epidemiological survey was conducted based on a representative sample of 1569 urban school children in Sousse, Tunisia. RESULTS The prevalence of arterial hypertension was 9.6%, with no significant difference between boys (9.2%) and girls (9.9%). The prevalence of systolic and diastolic hypertension was 6.4% and 4.5%, respectively. In both boys and girls, systolic pressure had a highly significant positive correlation with height (boys: r=0.33, P<0.001; girls: r=0.08, P=0.02), weight (boys: r=0.47, P < or = 0.001; girls: r=0.35, P<0.001) and triglyceride concentrations (boys: r=0.13, P<0.001; girls: r=0.10, P=0.006). Among boys, a positive correlation was found between systolic blood pressure and age (r=0.12, P=0.001) and, among girls, a negative correlation was found (r=-0.12, P=0.001). CONCLUSION This information will be used to help launch a regional program of heart health promotion in schools.

School-based intervention to promote healthy lifestyles in Sousse, Tunisia.

In Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD) prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Six hundred and sixty one (661) subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking.

Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia

AIM The aim of this study was to assess the prevalence of obesity and overweight and their relationship with cardiovascular disease risk factors. METHODS Epidemiological survey based on a representative sample of 1569 urban school children of Sousse, Tunisia. RESULTS Overweight (BMI > or = 25) was significantly higher in girls (16.1%) than in boys (11.6%); (chi 2 = 8.2; p = 0.004). Obesity (BMI > or = 30) was slightly higher in girls (3.7%) than in boys (2.7%); (chi 2 = 0.89; p = 0.34). Girls had significantly higher BMI, diastolic blood pressure, cholesterol and HDL cholesterol levels than boys who had however significantly higher levels of systolic blood pressure. Overweight was significantly higher in children who did not practice sport at school: 22 versus 13.1% (p < 0.002), in groups of youngsters who were not affiliated to school sport or city associations. Overweight children had a significantly higher levels of cholesterol, HDL cholesterol and means of systolic and diastolic blood pressures. CONCLUSION These results will serve to set up a regional program of health promotion at schools.

Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high-and low-income sites

Background: Integrated actions against selected risk factors (i.e. smoking, physical inactivity, and unhealthy diet) can lead to the reduction of major chronic diseases. Objective: To implement and evaluate a school-based intervention program to prevent cardiovascular risk factors among children. Materials and Methods: Design: Pre- test post-test quasi experimental design with a control group. Setting: Four secondary schools in Sousse, Tunisia. Intervention: The overall intervention program lasted for a school year and incorporated educative actions concerning tobacco use, physical activity, and healthy diet. Results: Globally, knowledge, behaviors, and intentions concerning smoking improved in both groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline. Conclusions: This pilot study has demonstrated the potential of school as a suitable setting for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group.

Airflow Obstruction and Use of Solid Fuels for Cooking or Heating: BOLD Results

No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in North African countries. We aimed to estimate the prevalence of the metabolic syndrome in Tunisian adolescents. A representative sample of 1569 adolescents was enrolled. The prevalence of the metabolic syndrome was 0.4% with no statistical difference according to sex (p > 0.05). Overweight/obesity was the most common component of the metabolic syndrome (13.7%). This information will be used to develop prevention programs by promoting healthy lifestyles in schools.