Nabil Tachfouti

Body mass index, disability, and 13-year mortality in older French adults.

Objective: To investigate the relationship between mortality and BMI in older people, taking into account other established mortality risk factors. Methods: A total of 3,646 French community dwellers aged 65 years and older from PAQUID cohort study were included. Cox proportional-hazards analysis was used to assess association between BMI and mortality. Results: Death occurred in 54.1% of the cohort more than 13 years: 68.99% of the underweight (BMI <19), 52.13% of the obese (BMI > xbd=1204 xhg=1181 ybd=1711 yhg=1685/>30), 51.66% of the overweight (BMI 25-30), and 51.79% of the reference participants (BMI 22-25) died.The relative risk of death as a function of BMI, adjusted for gender and age, formed a U-shaped pattern, with larger risks associated with lower BMI (<22.0) and for BMI of 25.0 to 30.0 and BMI ≥30. (BMI 22.0-24.9 was the reference.) After adjustment for demographic factors, smoking history, and comorbidity, increased mortality risk persisted in underweight older people, BMI <18.5 and BMI 18.5-22 (respectively, HR = 1.45, 95% CI 1.17-1.78; HR = 1.27, 95% CI 1.12-1.43) compared with reference. Overweight (BMI 25-29.9) and obesity (≥30) were not associated with increased mortality compared with the reference category (respectively, HR = 0.98, 95% IC 0.88-1.10; HR = 1.06, 95% IC 0.89-1.27). Similar relationships persisted for disabled participant. For nondisabled participant disability did not alter the associations for BMI of 25.0 and higher but for BMI less than 22.0, the risks become insignificantly different from those for the reference group. Discussion: BMI below 22 kg/ m2 is a risk factor for 13-year mortality in older people, but our findings suggest that overweight and obesity may not be associated to mortality after adjustment for established mortality risk factors.

Prevalence and demographic factors of smoking in Morocco

ObjectivesTo study the prevalence and determinants of cigarette smoking in Morocco.MethodsA sample of 9,195 individuals aged 15–90xa0years, were randomly selected, using a stratified cluster sampling technique. A cross-sectional, household, community-based survey was conducted using a tested questionnaire. The interview covered personal, social and educational characteristics of the respondents and their smoking status. The association between current smoking and sociodemographic variables was estimated.ResultsThe overall prevalence of current smoking was 31.5% for males and 3.1% for females. In men, smoking was associated with lower educational level. In women, it was associated with higher educational level and social class.ConclusionCigarette smoking remains an important public health problem in Morocco. A comprehensive strategy for tobacco control is needed.

First Data On Direct Costs of Lung Cancer Management in Morocco

BACKGROUNDnLung cancer is the leading cause of cancer morbidity and mortality. Its management has a significant economic impact on society. Despite a high incidence of cancer, so far, there is no national register for this disease in Morocco. The main goal of this report was to estimate the medical costs of lung cancer in our country.nnnMETHODSnWe first estimated the number of annual new cases according to stage of the disease on the basis of the Grand-Casablanca-Region Cancer Registry data. For each sub-group, the protocol of treatment was described taking into account the international guidelines, and an evaluation of individual costs during the first year following diagnosis was made. Extrapolation of the results to the whole country was used to calculate the total annual cost of treatments for lung cancer in Morocco.nnnRESULTSnOverall approximately 3,500 new cases of lung cancer occur each year in the country. Stages I and II account for only 4% of cases, while 96% are diagnosed at locally advanced or metastatic stages III and IV. The total medical cost of lung cancer in Morocco is estimated to be around USD 12 million. This cost represents approximately 1% of the global budget of the Health Department. According to AROME Guidelines, about 86% of the newly diagnosed lung cancer cases needed palliative treatment while 14% required curative intent therapy. The total cost of early and advanced stages lung cancer management during the first year were estimated to be 4,600 and 3,420 USD, respectively.nnnCONCLUSIONnThis study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco. A substantial proportion of the burden of lung cancer could be prevented through the application of existing cancer control knowledge and by implementing tobacco control programs.

Determinants of Tuberculosis treatment default in Morocco: Results from a National Cohort Study

Introduction Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default. Methods A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. Results Patients’ mean age was 35.0 ±13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-religious Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2-8.7), being a non-religious Muslim (OR = 2.0; 95% CI: 1.4-2.9) and living in an urban area OR = 3.0; 95% CI: 1.8-4.9). Conclusion The high rate found for default suggests important programs inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.

Emergency Trauma Care for Severe Injuries in a Moroccan Region: Conformance to French and World Health Organization Standards

&NA; In Morocco, injuries account for 11% of total burden of disease. Better organization of emergency care can improve the outcome of trauma patients. In Morocco, these services have been reorganized recently, but were never evaluated. The objective was to assess actual structure and processes of emergency trauma care in a Moroccan region. This comparative qualitative study was carried out in the region of Fez. The process and structure of contacting emergency care and prehospital emergency care were compared with the French 2002 standards. Emergency care at the University Teaching Hospital (UTH) was compared with World Health Organization 2005 Essential Trauma Care guidelines. Predefined care items were categorized as conforming to the standards or not. An emergency call center with a dedicated dial–up number has been established in the region since January 2007. Compared with the standards, this center was not protected by any legislation and was run by interns only. The center was underutilized during triage to help transportation of severe trauma patients. At the prehospital care level, only 3 out of 15 ambulances were equipped with resuscitation equipment and were used rarely. Only one of the ambulance staff out of three was trained in required skills. At the UTH, emergency care equipment and staff was nearly adequate. This study identified several opportunities for improvement in organizing trauma care in Fez particularly at emergency call center and ambulance service. A quality assurance program would be useful to further identifying improvements in this system.

Mortality attributable to tobacco: review of different methods

BackgroundOne of the most important measures for ascertaining the impact of tobacco is the estimation of the mortality attributable to its use. Several indirect methods of quantification are available. The objective of the article is to assess methodologies published and applied in calculating mortality attributable to smoking.MethodsA review of the literature was made for the period 1998 to 2005, in the electronic databases MEDLINE. Twelve articles were selected for analysis.ResultsThe most widely used methods were the prevalence methods, followed by smoking impact ration method. Ezzati and Lopez showed that the general rate of Smoking attributable mortality (SAM) globally was 12% (18% in men). Across countries, attributable fractions of total adult deaths ranged from 8% in Southern Africa, 13.6% in Brazil (18.1% in men) and 25% in Hong Kong (33% in men).ConclusionThe variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses and tobacco prevalence. All methods show limitations of one type or another, yet there is no consensus as to which furnishes the best information.

Knowledge and perceptions of smoking according to income level in Morocco.

Purpose. To determine the association between income level and variations in knowledge and perceptions about tobacco smoking in Morocco. Design. Cross-sectional study. Setting. Random sample of 9195 subjects representative of the Moroccan population. Subjects. Subjects aged > 15 years from households. Measures. Data were collected from selected households using a standardized questionnaire about smoking, educational level, household monthly income, and knowledge of health effects of smoking. Analysis. Stepwise logistic regression was used for multivariate analysis. Adjusted odds ratios with 95% confidence intervals for each variable were calculated as an estimate of the likelihood of having knowledge that smoking causes selected diseases. Results. Among 9195 subjects, 27.8% reported low income (<2000 Moroccan dirhams [MAD]), and 9.9% reported the highest income level (≥ 6000 MAD). Higher income was significantly associated with higher knowledge of health effects of smoking (p < .0001); 55% of low-income respondents compared to 71.5% of respondents with higher income knew about the relationship between cigarette smoking and cancer. Conclusions. Lower income level was associated with lower awareness of the harms of smoking. There is a need to improve knowledge of the dangers of smoking among the disadvantaged segments of the population.

Socioeconomic status and tobacco expenditures among Moroccans: results of the "Maroc Tabagisme" survey.

Purpose. To investigate the relationship of sociodemographic and economic characteristics to tobacco expenses among Moroccan daily smokers. Design. Cross-sectional (“Maroc Tabagisme” Survey) study. Setting. Random sample of 9195 subjects representative of the Moroccan population. Subjects. Household subjects 15 years and older. Measures. Data were collected from selected households using a questionnaire about smoking, educational level, occupation, and household monthly income. Analysis. Associations between sociodemographic and economic characteristics, smoking status, and tobacco expenses were assessed by multivariate analysis in a sample of 5959 respondents who provided details about their family income. Results. Of 5959 participants, 28.5% of men and 2.8% of women were daily smokers. Compared with students, the odds of daily smoking were higher among blue-collar workers (odds ratio, 2.66). Tobacco expenses increased with higher family monthly income (p < .001). Moreover, smokers whose family monthly income was less than 1000 Moroccan dirham (MAD) spent 50.9% on tobacco, while those with family monthly income of 6000 MAD or higher spent 13.0% on tobacco. Conclusions. There was a strong association between tobacco expenses and sociodemographic and economic characteristics. Among households with low monthly income, up to half of the monthly income is spent on tobacco.

Using surveillance data to understand cancer trends: an overview in Morocco.

BackgroundThe aim was to use the existing surveillance data sources of cancer in Morocco that could be used to better describe cancer mortality and incidence trends in Morocco.MethodsNational incidence data were derived from population-based cancer registries. Mortality data were collected from the international GLOBOCAN database.ResultsAn overview of the main results was presented. In general, the most commonly diagnosed cancers in men are lung and prostates whereas in women, breast and cervical cancers are the pre-dominant cancers. Fifty nine percent and of breast and 65.7xa0% of cervical cancers in women are diagnosed at stages II and III. Cancer remains the second highest cause of mortality in Morocco.ConclusionThe data provides a description of the cancer incidence and trends in the Moroccan population. The Moroccan national cancer program should aim for more coherent, consistent and comparable incidence data between different cancer registries in the country, and develop uniform datasets with respect to quality.RésuméIntroductionLobjectif était dutiliser les sources de données existantes de surveillance du cancer qui pourraient être utiles pour décrire les tendances d’incidence et de mortalité du cancer au Maroc.MéthodesLes données de morbidité et mortalité nationales et internationales disponibles ont été explorées. Les registres populationnels de cancer couvrent les données dincidence régionale. Les données de mortalité sont disponibles par les données internationales de Globocan.RésultatsUn aperçu des principaux résultats a été présenté. Globalement, les cancers les plus fréquents sont le poumon et la prostate chez les hommes; le sein et le col utérin chez les femmes; ces deux cancers représentant 56,3xa0% de cancers féminins. Les cancers de sein et du col sont diagnostiqués dans 59xa0% et 65,7xa0% aux stades II et III. Le cancer est la deuxième cause de mortalité au Maroc.ConclusionLes données fournissent une description de lincidence des cancers et leurs tendances dans la population marocaine. Le programme national du cancer marocaine devrait viser pour les données dincidence cohérents et comparables entre les différents registres du cancer dans le pays, et de développer des ensembles de données uniformes par rapport à la qualité.

Health risk behaviours amongst school adolescents: protocol for a mixed methods study

BackgroundDetermining risky behaviours of adolescents provides valuable information for designing appropriate intervention programmes for advancing adolescent’s health. However, these behaviours are not fully addressed by researchers in a comprehensive approach. We report the protocol of a mixed methods study designed to investigate the health risk behaviours of Moroccan adolescents with the goal of identifying suitable strategies to address their health concerns.MethodsWe used a sequential two-phase explanatory mixed method study design. The approach begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. In the first phase, the global school-based student health survey (GSHS) was administered to 800 students who were between 14 and 19xa0years of age. The second phase engaged adolescents, parents and teachers in focus groups and assessed education documents to explore the level of coverage of health education in the programme learnt in the middle school. To obtain opinions about strategies to reduce Moroccan adolescents’ health risk behaviours, a nominal group technique will be used.DiscussionThe findings of this mixed methods sequential explanatory study provide insights into the risk behaviours that need to be considered if intervention programmes and preventive strategies are to be designed to promote adolescent’s health in the Moroccan school.