M. Soltani

Validation of the Tunisian version of the Roland-Morris questionnaire

Our aim was to validate a culturally adapted, Tunisian-language version of the Roland-Morris Disability Questionnaire (RMDQ), which is a reliable evaluation instrument for low-back-pain disability. A total of 62 patients with low back pain were assessed by the questionnaire. Reliability for the 1-week test/re-test was assessed by a construction of a Bland Altman plot. Internal construct validity was assessed by Cronbach’s αtest. External construct validity was assessed by association with pain, the Schober test and the General Function Score. Sensitivity to change was determined using a t-test for paired data to compare RMDQ scores at inclusion and at completion of the therapeutic sequence of local corticosteroid injections. We also compared the questionnaire score with the General Function Score, both taken after completion of the therapeutic sequence. The constructed Bland Altman plot showed good reliability. Internal consistency of the RMDQ was found to be very good and the Cronbach’s α test was 0.94, indicating a good internal construct validity. The questionnaire is correlated with the pain visual analogue scale (r=33; p=0.0001), with the Schober test (r=0.27; p=0.0001) and the General Function Score (r=56; p=0.0001) indicating an adequate external construct validity. The RMDQ administered after the therapeutic sequence is sensitive to change (r=0.83; p=0.000). Comparison of the questionnaire score to the General Function Score, after completion of the therapeutic sequence, was satisfactory (r=0.75; p=0.000). We conclude that the Tunisian version of the Roland-Morris questionnaire has good reliability and internal consistency. Furthermore, it has a good internal- and external construct validity and high sensitivity to change. It is an adequate and useful tool for assessing low-back-pain disability.

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design

BackgroundRepeat abortion is a public health concern favored by many obstetric and social factors.The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion.MethodsWe carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC).Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women’s demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3–4 weeks following pregnancy termination.ResultsOf the 500 interviewed women, 211 (42.2 %; CI95% [37.88 – 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion.CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %).ConclusionHealth facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

Women’s knowledge, attitudes and practice about breast cancer screening in the region of Monastir (Tunisia)

Breast cancer remains a worldwide public health problem. In Tunisia, it is considered to be the primary womens cancer and causes high morbidity and mortality. This study aimed to investigate female knowledge, attitudes and practice of breast cancer screening in the region of Monastir (Tunisia). We conducted a descriptive cross-sectional design exploring knowledge, attitudes and practices of women in the region of Monastir on breast cancer screening. The study was conducted in health centres of this region from 1 March 2009 to 30 June 2009. Data were collected via a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods and attitudes towards the relevance and effectiveness of breast cancer screening. A scoring scheme was used to score womens responses. A total of 900 women agreed to take part in the study. Their mean age was 41.6±12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 92% of participants had poor knowledge of the specific risk factors for breast cancer and 63.2% had poor knowledge of the screening methods. Proper practice of breast cancer screening was observed in 14.3% of cases. Multiple logistic regression analysis showed that good knowledge of risk factors and screening methods, higher level of education and positive family history of breast cancer were independently correlated with breast cancer screening practice. This study revealed poor knowledge of breast cancer and the screening methods as well as low levels of practice of breast cancer screening among women in the region of Monastir. Results justify educational programs to raise womens adherence to breast cancer screening programs in Tunisia.

Predictors of smoking relapse in a cohort of adolescents and young adults in Monastir (Tunisia)

BackgroundSmoking prevalence in adolescents and young adults is substantially elevated in Tunisia. Moreover, there is a lack of knowledge regarding the effectiveness and associated factors in smoking cessation interventions among adolescents and young adults. This study aims at identifying the major factors leading to smoking relapse among adolescents and young adults in the region of Monastir, Tunisia.MethodsWe carried out a prospective cohort study at the smoking cessation center of the University hospital of Monastir, Tunisia. The population study consisted of all adolescents and young adults (15–30 years) consulted during a period of two years (2009 – 2010). A questionnaire was used to explore the patient’s sociodemographic characteristics, smoking history, nicotine dependence (Fagerstrom test) and anxiety / depression (Hospital Anxiety and Depression Scale). A telephone survey was conducted in July 2011 to assess smoking cessation results. A multivariate Cox regression was used to identify predictors of smoking relapses.ResultsA total of 221 adolescents and young adults were included in this study with a mean age of 25.5 ± 3.9 years. At follow up, 59 study participants (26.7%) were abstinent and the overall median abstinence was 2 months. In the multivariate analysis smoking relapse was associated with being an adolescent patient (HR 2.16; 95% CI: 1.54-3.05), medium or higher nicotine dependence at baseline (HR 2.66, 95% CI: 1.06-7.05 and HR 3.12, 95% CI: 1.20-8.12 respectively), not receiving treatment (HR 1.70, 95% CI: 1.25-2.33) and have friend who is a smoker (HR 1.63; 95% CI: 0.96-2.79).ConclusionThe results of this study provide important information about beneficial effect of smoking cessation support for adolescent and young adults. More efforts must be deployed to deal with contributing factors to smoking relapse.

Rheumatic heart disease in a developing country: Incidence and trend (Monastir; Tunisia: 2000–2013)

BACKGROUND The penicillin therapy of β hemolytic streptococcal pharyngitis has aided in the decrease of rheumatic heart disease (RHD) in developing countries. Tunisia is an endemic area, however, and incidence of RHD is weakly documented. We aimed at establishing the standardized incidence rate (SIR) of RHD in Monastir governorate and at determining RHD prevalence among hospitalized patients in two cardiology departments. METHODS From the regional register of Monastir Hospital morbidity, we have selected newly diagnosed patients with RHD, residents of Monastir, and hospitalized to the 2 cardiology departments between 2000 and 2013 (2001 not included). FINDINGS We studied 676 newly admitted patients. We estimate 1060 to be the number of new annual RHD cases in Tunisia. The SIR per 105 person-years was 10.97, being 9.3 in men and 19.1 in women, respectively. We have notified a negative trend of crude incidence rate/105 Inhabitants (Inh) (CIR) (r=-0.23, p<10-3), and a strong positive correlation between age and CIR/105 Inh (r=0.989, p<10-4). RHD lethality was 1%. We have registered 728 hospitalizations for RHD, representing 2.5% of all cardiology hospitalizations [95% CI: 2.3-2.7%], with a prevalence for 13.3% for women aged 15-29years. The median hospital stay was 9days (IQR: 5-15). CONCLUSION Our results confirm the RHD incidence decrease, consistent with epidemiological transition in Tunisia. We have also emphasized on the close trend of RHD with age and the predominance of RHD among women especially at the procreation age.

Graphic model of birth weight and gestational age in Monastir, Tunisia.

BACKGROUND Birth weight for gestational age curves provide to clinicians available references to assess fetal growth in individual infants and in populations. In Tunisia, until now, only North American based references were used. The objective of this study was to create national reference curves for birth weight and to compare these to those actually used in our maternities. METHODS A retrospective population based study was performed over a period of 11 years (from January 1994 to December 2004) using the register of births database of the region of Monastir. We studied a total of 75,751 births. Gestational age of infants ranged from 28 to 43 weeks. Fifth, tenth, 25th, 50th, 75th, 90th and 95th percentiles for weight were calculated by polynomial linear regression of the following general form to construct the clinical curves (Y=a+bX+cX(2)). RESULTS The database included 38,646 males and 37,105 females (sex ratio: 1.04). The resulting male and female curves provide smoothed percentiles cutoffs for defining small and large for gestational age births. An actual difference does exist between our curves and those routinely used. CONCLUSION These constructed smoothed gestational curves can be used as a useful tool for assessing birth weight and to evaluate clinical or public health interventions to enhance fetal growth.

Hospitalizations for communicable diseases in a developing country: prevalence and trends—Monastir, Tunisia, 2002–2013

BACKGROUND In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013). METHODS All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. CONCLUSION This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.

934 Prevalence and Risk Factors of Paediatric Rotavirus Gastroenteritis in Tunisia

Background and Aims Group A rotaviruses are a major cause of severe acute gastroenteritis (AGE) in children under 5 years of age worldwide. The purpose of this study was to estimate the proportion of rotavirus gastroenteritis and identify its determinants among children admitted to Tunisian hospitals. Methods We set up active rotavirus hospitalization surveillance in 10 Tunisian cities. From May 2009 through October 2010, we enrolled 550 children < 5 years of age who were hospitalized with a diagnosis of AGE. Stool samples were obtained for rotavirus testing and genotype investigation using ELISA and multiplex RT-PCR. Results The prevalence of rotavirus infection was 27.3% (95% CI 23.6–31). Infants < 2 years of age were most frequently affected (91.6%). The most dominant rotavirus genotype was G3P[8], which accounted for 40.4% of cases. On multivariate analysis, rotavirus was significantly associated with the episode occurring in the winter season (aOR 6.73; 95% CI 3.45–3.31), vomiting (aOR 3.05; 95% CI 1.37–6.75), fever (aOR 1.84; 95% CI 1.10–3.07) and dehydration (aOR 8.20; 95% CI 3.45–19.47). Conclusion The determination of rotavirus infection prevalence and its risk factors will help us to better understand the epidemiology of the disease in our country in order to develop effective preventive measures, including vaccines.

Psychometric Examination of an Arabic Version of the State-Trait Anger Expression Inventory

OBJECTIVES This study aimed to examine the psychometric properties of an Arabic version of the trait anger and anger expression scales of the State-Trait Anger Expression Inventory (STAXI). METHODS This study took place between April 2005 and August 2014. Adults in Yemen (n = 334) and Tunisia (n = 200) were recruited from university campuses and a smoking cessation clinic, respectively. The STAXI was translated into Arabic using back-translation methods. An explanatory principal component analysis was conducted to explore the factor structure of the anger expression scale, utilising parallel analyses to determine the number of retained factors. RESULTS Good internal consistency of the trait anger scale was observed among the Yemeni (Cronbachs alpha = 0.76) and Tunisian (Cronbachs alpha = 0.86) samples. The parallel analysis suggested a three-factor solution for the anger expression scale (anger in, anger out and anger control), in accordance with the original STAXI. The internal consistency of anger in, anger out and anger control factors ranged between 0.51-0.79 in the Yemeni sample and 0.66-0.81 in the Tunisian sample. Overall, items loaded on the anger control factor included all items proposed by the original authors and this factor had higher reliability than the other two factors in both samples. CONCLUSION The results of the current study provide initial support for the use of the trait anger and anger expression scales of the STAXI in Arabic-speaking countries.