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Introduction Currently, the Tunisian medical schools are going through a transition period marked by the reform of medical studies. Their curricula must be adapted to globally recognized medical education guidelines. Aware of the importance of teaching scientific research and public health, they are making efforts to integrate this new approach of education within several levels (undergraduate, postgraduate and continuous professional development). In this perspective, the public health research centres (C4EHPs) created under the CONFIDE project provide an opportunity to support such integration. The progress The Faculty of Medicine of Sousse was founded in the 70s to open up to its local and regional community. So, the public health topic was one of the top priorities. With the reform started in 2011, the importance of this topic has been further developed by integrating many modules that cover different aspects of public health throughout the curriculum. In this context, the materials, modules and information developed within the CONFIDE project complement the existing modules and bring a fresh perspective on the teaching methods. The faculty of Medicine of Sousse will integrate this information in the curricula to promote scientific production by allowing students to build up their scientific research knowledge, develop higher research competencies such as critical-thinking, problem-solving and data interpretation and analysis and train public health specialists to be health policy makers in the future. Conclusions Integrating the new approach based on the achievements of the C4EHP is an essential step for our faculty to develop more training in public health, ensure good quality of its teaching process and participate in the development of health policies that will improve the health of the Tunisian population.

Background Experimentation with substance use is common during adolescence. Substance use may result in many health-related problems and contribute to adolescent suicidal behavior. We conducted this study to examine the relationship between substance use and suicidal ideation. Methods This is a cross sectional study conducted among a representative sample of 2020 adolescents enrolled in Tunisian secondary schools using a self-administered questionnaire. Results The prevalence of tobacco, alcohol and cannabis use was respectively 3.7% (95% CI [2.87%-4.52%]), 4.4% (95% CI [3.5%-5.29%]) and 0.8% (95% CI [0.40%-1.18%]) Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months. Tobacco (Odds Ratio = 2.61; 95% CI = 1.59–4.29), alcohol (Odds Ratio = 2.77; 95% CI = 1.76–4.36), and cannabis use (Odds Ratio = 4.98; 95% CI = 1.85–13.96) were significantly associated with suicidal thoughts among adolescents (p < 10-3). Conclusions This cross study has shown a significant association between substance use and suicidal ideation. This relationship can be bidirectional and suicidal ideation and substance use may affect each other. Key messages In his study, the prevalence of substance use was relatively low and was associated with suicidal ideations. The reciprocal link between the two problems and their co-occurrence should be taken into account when planning preventive substance use and suicide programs.

Background Childhood asthma still imposes a substantial burden on the health care system and community. Its management requires a significant direct cost. Several factors can influence the cost of asthma management, particularly severe asthma. There is scant information about the predictors of asthma-related cost. Thus, the purpose of this study was to estimate direct asthma-related cost among children with chronic asthma and to identify factors that have the greatest contribution to change it. Methods This cross-sectional study was carried out in Farhat Hached University Hospital in Sousse (Tunisia, Africa) over a period of three months (April-June 2018) among children with asthma aged 7-17 years. The direct cost was defined as the costs of health resources utilization and medication related to asthma in the past 12 months. Purchasing power parity technique was used to convert TND to USD. Multiple linear regression was performed to examine the association between dependent and independent variables. Results A total of 90 subjects participated in the study. The mean age was 9.81±2.56 and 55.6% were male. The annual mean of the total direct cost was USD 616.71±454. Multivariate analysis showed that the severity of asthma, inhalation technique and emotional domain of QOL predict asthma cost and that the latter was the best predictor (p = 0.005, p = 0.03, p = 0.004, respectively). This data indicates that for one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Conclusions This study showed that higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma. These results are useful for health care providers and community since they provide information about the impact of modifiable risk factors on direct asthma cost. Key messages For one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma.

Background Youth suicidality is a significant public health problem. Understanding the factors leading to suicide is essential to implement effective preventive efforts. In this context, this study was conducted to assess the link between suicidal ideation and adverse life experiences among Tunisian school aged youth. Methods A cross-sectional survey was conducted among a sample of 2020 secondary school adolescents in 2016. An anonymous self-administered questionnaire was used to collect data. The adverse life events measured were: domestic violence, parental divorce, physical aggression, sexual abuse and a familial antecedent of suicide. Results Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months with no gender difference (16.3% among girls and 17.3% among boys, p = 0.62). Among the participants, 26.7% experienced at least one adverse life experience. Those who reported domestic violence (Odds Ratio = 8.93; 95% CI = 6.84–11.66), parental divorce (Odds Ratio = 3.02; 95% CI = 1.57–5.79), physical aggression (Odds Ratio = 6.97; 95% CI =5.14–9.46), sexual abuse (Odds Ratio = 8.69; 95% CI =3.94–19.15), familial antecedent of suicide (Odds Ratio = 8.17; 95% CI = 5.75–11.60) were associated with increased odds of suicide ideation. Conclusions The prevalence of suicidal ideation observed in the survey area was relatively high and associated with all the measured life adverse events. These factors should be included in a suicide screening tool to be integrated in a suicide prevention program. Key messages Suicidal ideation among adolescents was associated with all the measured life adverse events. Identifying adolescents at higher risk of suicide and help them to cope with their adverse experiences could be effective to prevent taking action to attempt suicide.

Background About 800 women die each day worldwide due to complications related to pregnancy, childbirth or in the postpartum period. The objective of this study was to describe the activity of the public maternities in the Governorate of Sousse (Tunisia) and to identify obstetrical complications treated in these facilities. Methods A cross sectional study of all public health facilities, which performed deliveries in Sousse was conducted in 2017 (Five maternities: one University maternity and four peripheral ones). Data were collected by reviewing clinical records and registers of these maternities for the year 2016. Results In total, in the health visited structures, there were 13427 deliveries in 2016, the majority of them (78.8%) took place at the university maternity of Farhat Hached hospital. Of these deliveries, 3397 were performed by caesareans (25.3%). In 2016, there were three maternal deaths and 69 very early neonatal deaths. There were 2036 direct obstetric complications treated in the five maternities visited. The most frequently encountered direct complications were: ’obstructed/prolonged labor’ (41.21%), ’severe pre-eclampsia/eclampsia’ (19.5%) and ’ante and postpartum haemorrhage’ (15.18%). The most encountered indirect obstetrical complications were: gestational diabetes and anaemia. Conclusions The reduction of maternal and neonatal mortality requires the existence of a functioning basic health care system that provides all pregnant women and their newborns with timely access to skilled care, particularly when a complication occurs. The provision of this qualified care requires also the presence of qualified personnel working in a suitable professional environment. Key messages The majority of obstetrical complications occur in university maternity and this is due to excessive references from peripheral maternities. Peripheral maternities need to be strengthened with material and human resources.

Introduction An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.

This study aimed to determine the frequency and the nature of maternal near miss (NM) events in a population of women attending a tertiary level maternity hospital in Tunisia and to evaluate the care level of this institution according to indicators proposed by the World Health Organization (WHO). We opted for a retrospective medical chart review of cases of NM and maternal mortality that occurred in the year 2010 at the Farhat Hached Maternity University Hospital. NM cases were defined based on the WHO criteria 2009. There were 9957 deliveries, 58 NM events and one case of maternal death. Haemorrhagic (74.1%) and hypertensive disorders (20.7%) were the leading causes of NM. The study showed a low Maternal NM Ratio of 5.86/1000 live births, a relatively low mortality index of 1.7 % and Severe Maternal Outcome Ratio of 5.96/1000 live births. This was the first study to document NM in a Tunisian public maternity. The WHO approach allowed a systematic monitoring of quality of maternal health care. There is a low frequency of maternal morbidity and mortality at the level of this facility. But, more efforts are still needed to document NM events in other types of care facilities in Tunisia. (Afr J Reprod Health 2016; 20[4]: 44-50) Resume Cette etude a pour objectif de determiner la frequence et la nature des cas maternels presque rates (PR) au sein d'une population de femmes dans une maternite de niveau tertiaire en Tunisie et d'evaluer le niveau de soins de cette institution selon les indicateurs proposes par l'Organisation mondiale de la sante (OMS). Nous avons prefere faire un examen medical retrospectif des cas de PR et de mortalite maternelle qui ont eu lieu en 2010 a la Maternite Universitaire Farhat Hached. Les cas de PR ont ete definis selon les criteres de l'OMS de 2009. Il y a eu 9957 accouchements, 58 cas de PR et un cas de deces maternel. Les maladies hemorragiques (74,1%) et hypertensives (20,7%) ont ete les causes principales de PR. L'etude a indique un faible taux de PR maternel de 5,86 / 1000 naissances vivantes, un indice de mortalite relativement faible de 1,7% et un rapport de resultat maternel severe de 5,96 / 1000 naissances vivantes. C'etait la premiere etude a documenter le PR dans une maternite publique tunisienne. L'approche de l'OMS a permis un suivi systematique de la qualite des soins de sante maternelle. Il existe une faible frequence de morbidite et de mortalite maternelles au niveau de cet etablissement. Mais il reste encore beaucoup a faire pour documenter les cas de PR dans d'autres types d'etablissements de soins en Tunisie. (Afr J Reprod Health 2016; 20[4]: 44-50).

The results of this study will help guide public hospital human resource managers in the choice of measures designed to increase the motivation of their employees in order to ensure staff satisfaction as well as quality health care services. .

Objectifs : Etudier les delais de la premiere prise en charge therapeutique des patientes operees et suivies pour cancer du sein au service de gynecologie du CHU Farhat Hached de Sousse en 2013 et de determiner les facteurs associes a ces delais. Methodes : Il s’agit d’une etude descriptive retrospective, effectuee sur les dossiers de patientes diagnostiquees, operees et suivies pour un cancer du sein au Service de Gynecologie du CHU Farhat Hached de Sousse en 2013. Les delais etudies sont : le delai global de premiere prise en charge therapeutique (chirurgie ou chimiotherapie neo-adjuvante), le premier delai intermediaire (le delai d’acces au diagnostic), le deuxieme delai intermediaire (le delai d’acces au premier traitement). Les delais sont presentes sous formes de mediane avec l’intervalle interquartile (IIQ). Resultats : L’echantillon etait constitue de 213 femmes. Le delai median d’acces au diagnostic etait de 13 jours avec un IIQ de [4-34]. Si le premier traitement est chirurgical, le delai median d’acces a l’acte chirurgical etait de 35 jours avec un IIQ de [27-45,7]. S’il s’agit d’une chimiotherapie neo-adjuvante, le delai median etait de 62,5 jours avec un IIQ de [31-122]. Independamment de la nature du premier traitement, le delai median d’acces au traitement etait de 35 jours avec IIQ de [27-50]. Conclusion : Il est capital de maitriser les temps d’attente lors du parcours de soins, a la fois pour le succes du traitement et pour repondre aux besoins des malades.

Introduction:emergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia). Methods:a cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated. Results:only the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%. Conclusion:raising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction.

Fetal macrosomia is associated with an increased risk of adverse outcomes to both the mother and the infant.To determine maternal and neonatal outcomes associated to fetal macrosomia in diabetic and non- diabetic mothers.It is a descriptive retrospective study conducted in Tunisia. We included in this study all patients who delivered newborns having a birth weight above 4kg during 2013. Multivariate analysis was performed using binary logistic regression to identify the complications associated to macrosomic pregnancies with diabetes.Among the 10186 deliveries registered during the study period, 821 mothers gave birth to macrosomic newborns. The prevalence of macrosomia was 8.1%, and macrosomic newborns who had a birth weight of 4500 g or greater were 1.06%. Macrosomia was significantly higher in males (p10-3). The rate of cesarean delivery was 47.9%. The most frequent adverse maternal and neonatal outcomes were perineal tears (3.6%), post-partum hemorrhage (0.6%), shoulder dystocia (4.9%) and neonatal intensive care unit admission (7.6%).The proportion of maternal diabetes was 9.3%. Macrosomic pregnancies with diabetes appear to be significantly associated with cesarean delivery (OR=2.22), postpartum hemorrhage (OR=6.69) and neonatal intensive care unit admission (OR=4.18).Macrosomia increases the risk of maternal and perinatal morbidity particularly when it was associated to maternal diabetes.

To assess safety culture in primary healthcare centres and to explore its associated factors.This multicentre cross-sectional descriptive study was conducted in the 30 primary healthcare centres in central Tunisia and used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire' (HSOPSC).A total of 214 professionals participated, corresponding to a response rate of 85%. The ?Teamwork within centres? dimension had the highest score (71.5%). However, two safety dimensions had very low scores: ?Frequency of event reporting?, ?Non-punitive response to errors? with percentages of 31.4% and 35.4%, respectively. Among the associated factors, the ?Frequency of reported events? dimension was significantly higher among professionals involved in risk management committees (p = 0.01).This study demonstrates that the level of safety culture needs to be improved in primary healthcare centres in Tunisia and also highlights the need to implement a quality management system in primary healthcare centres.

Background The plant species Rosmarinus officinalis (RO), Thymus algeriensis (TA) and Thymus capitatus (TC) are widely used in traditional medicine in Tunisia. Their bioactivities have been reported before and particularly referred to their essential oils. The main objective of this work was to assess the phytochemical composition, the antioxidant activity, the antibacterial, antifungal, and cytotoxic potential of these 3 plants. Method The High Performance Liquid Chromatography (HPLC), chemical tests and spectrophotometric methods were used for screening, quantification of phytochemicals and for antioxidant activities. Extracts were evaluated for antibacterial potential by the microdilution method. Antifungal activities were tested using the Poisoned food method against: Aspergillus niger and Aspergillus flavus. The cytotoxic potential of the plant extracts was checked using HCT 116 cultures. Results Results revealed that aqueous extracts are not toxic compared to the methanolic extracts. Phenolic compounds were detected and these extracts showed excellent antioxidant activity presenting dose-dependent relationship. For antibacterial potential, all tested strains are more sensitive to Thymus extracts than Rosmarinus extracts. However, for antifungal activities, only Rosmarinus extracts inhibited mycelial growth. HPLC analysis allowed the identification of ten compounds with the abundance of gallic acid. Conclusion This study showed important bioactivities (antioxidant, antimicrobial, and safety potential) of the plant species RO, TA and TC used in traditional medicine.

Bullying is a serious public health concern remarkably common among youth. Involvement in bullying can lead to deleterious effect on the emotional well-being of pupils. The aim of this study was to assess the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior.A cross-sectional study.We conducted this study in 2015 among a representative multistage sample of 1584 students enrolled in middle schools in the Region of Sousse using the revised Olweus Bully/Victim Questionnaire. It assesses the prevalence of bullying and covers qualitative details of bullying including psychosocial factors and perceived efforts of others to counteract bullying.11.7% of respondents were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy and liking school. They were more likely to be afraid of being bullied, aggressive and to have fewer friends in the class. Only 30.3% of the victims indicated that they told someone about being bullied. The majority of the middle school students perceived that classmates (54.1%) and teachers (39.5%) did nothing to counteract bullying.Information about bullying is critical and must be gathered before effective intervention is planned. Parents, teachers and students should learn effective ways to handle the bullying problem since the most effective programs are comprehensive targeting students, schools, families and the community.

Internet represents a revolution in the world of technology and communication all over the world including Tunisia. However, this technology has also introduced problematic use, especially among students. The current study aimed to determine the prevalence of Internet addiction among college students and its predictors in the region of Sousse, Tunisia.A cross-sectional study.The current study was conducted in the colleges of Sousse, Tunisia in 2012-2013. A self-administrated questionnaire was used to collect data from 556 students in 5 randomly selected colleges from the region. Collected data concerned socio-demographic characteristics, substances use and internet addiction using the Young Internet Addiction Test.The response rate was 96%. The mean age of participants was 21.8±2.2 yr. Females represented 51.8% of them. Poor control of internet use was found among 280 (54.0%; CI95%: 49.7, 58.3%) participants. Low education levels among parents, the young age, lifetime tobacco use and lifetime illicit drugs use were significantly associated with poor control of internet use among students (P0.001). While, the most influential factor on internet use among them was under-graduation with an adjusted odds ratio of 2.4 (CI95%: 1.7, 3.6).Poor control of internet use is highly prevalent among the college students of Sousse especially those under graduate. A national intervention program is required to reduce this problem among youth. A national study among both in-school and out-of-school adolescents and young people would identify at-risk groups and determine the most efficient time to intervene and prevent internet addiction.

Objective: This study was designed to assess the quality of the Gabès (Tunisia) mobile emergency care medical records and propose corrective actions.Materials and methods: A clinical audit was performed at the Gabès mobile emergency care unit (SMUR). Records of day, night and weekend primary and secondary interventions during the first half of 2014 were analysed according to a data collection grid comprising 56 criteria based on the SMUR guidelines and the 2013 French Society of Emergency Medicine evaluation guide. A non-conformance score was calculated for each section.Results: 415 medical records were analysed. The highest non-conformance rates (48.5%) concerned the “specificities of the emergency medical record” section. The lowest non-conformance rates concerned the surveillance data section (23.4%). The non-conformance score for the medical data audit was 24%.Conclusion: This audit identified minor dysfunctions that could be due to the absence of local guidelines concerning medical records in general and more specifically SMUR. Corrective measures were set up in the context of a short-term and intermediate-term action plan.

Aim: This study was designed to assess the prevalence of alcohol consumption and factors associated with alcohol consumption among students of the Sousse region of Tunisia. Methods: This was a cross-sectional study conducted among 556 students of Sousse universities during the 2012-2013 academic year, using an anonymous self-report questionnaire. Data capture and statistical analysis were performed with SPSS software 18.0. Results: Our study population was composed of 268 males (48.2%) with a mean age of 21.8 ± 2.1 years. Eighty-four students (15.1%) had consumed alcohol at least once. On multivariate analysis, male gender (OR = 6.94; 95%CI = [2.32-20.72]), smoking (OR = 13.21; 95%CI = [6.20-27.78]), drug use (OR = 32.22; 95%CI = [6.73-154.26]) and parental alcohol consumption (OR = 4.31; 95%CI = [1.70-10.91]) were the factors significantly associated with alcohol consumption among students. Conclusion: This study was designed to determine the characteristics of alcohol consumption among Tunisian students. Alcohol consumption levels were comparable to those reported in the general population and were significantly related to smoking and drug use. The next step of this study will consist of developing strategies to prevent risk behaviours in the student population.

Rosemary (Rosmarinus officinalis L.) is an aromatic plant common in Tunisia and it is widely consumed as a tea in traditional cuisine and in folk medicine to treat various illnesses. Currently, most research efforts have been focused on rosemary essential oil, alcoholic and aqueous extracts, however, little is reported on rosemary infusion composition.To investigate compounds present in rosemary tea obtained from Rosmarinus officinalis L. collected in a sub-humid area of Tunisia in order to assess whether the traditional rosemary tea preparation method could be considered as a reference method for rosemary's compounds extraction.Qualitative characterisation of Rosmarinus officinalis tea obtained after rosemary infusion in boiled water was determined by high performance liquid chromatography coupled with electrospray ionisation quadrupole time-of-flight mass spectrometry (HPLC-ESI-QTOF-MS). Quantitative analysis relies on high performance liquid chromatography with diode array detector (HPLC-DAD).Forty-nine compounds belonging to six families, namely flavonoids, phenolic acids, phenolic terpenes, jasmonate, phenolic glycosides, and lignans were identified. To the best of the authors' knowledge eucommin A is characterised for the first time in rosemary. Rosmarinic acid (158.13 μg/g dried rosemary) was the main compound followed then by feruloylnepitrin (100.87 μg/g) and luteolin-3'-O-(2″-O-acetyl)-β-d-glucuronide (44.04 μg/g). Among quantified compounds, luteolin-7-O-rutinoside was the compound with the lowest concentration.The infusion method allows several polyphenols present in rosemary tea to be extracted, therefore it could be a reference method for rosemary's compounds extraction. Moreover, traditional Tunisian Rosmarinus officinalis tea consumption is of interest for its rich phenolic content. Copyright © 2017 John WileySons, Ltd.

The results of this study will help guide public hospital human resource managers in the choice of measures designed to increase the motivation of their employees in order to ensure staff satisfaction as well as quality health care services./ce:para.

Contexte : Le style d’apprentissage semble jouer un role dans le choix de l’approche d’apprentissage prometteuse de succes. Ainsi, il pourrait etre opportun que les educateurs cherchent a identifier les styles d’apprentissages des etudiants et a y adapter leurs dispositifs pedagogiques. But : Decrire les styles d’apprentissage des etudiants de la faculte de medecine de Sousse (Tunisie). Sujets et methodes : Une etude descriptive de nature transversale a ete menee aupres de cinq promotions d’etudiants de la Faculte de medecine de Sousse au cours de l’annee universitaire 2009-2010. L’instrument de mesure utilise etait l’Inventaires des Styles d’Apprentissage du Laboratoire d’Enseignement Multimedia –ISALEM 97, developpe par l’Universite de Liege, qui suggere l’existence de quatre styles d’apprentissage. Resultats : Huit cent cinquante six etudiants ont participe a l’etude pour un total de 1043 (taux de reponse : 82 %). Le style predominant etait le style intuitif-pragmatique dans 40 % des cas, suivi du style methodique- pragmatique dans 28 % des cas. La dimension de transformation de l’experience differait significativement selon le sexe. L’analyse en composantes principales confirme la structure bidimensionnelle de l’ISALEM 97. Les coefficients de Cronbach etaient ≥ 0,72. Conclusion : Les etudiants de la faculte de medecine de Sousse ont plutot un style intuitif-pragmatique ; ils recourent a l’intuition pour la saisie des concepts et ont tendance a les appliquer dans de nouvelles experiences pour resoudre les problemes. Ce profil ne change pas tout au long des annees d’etudes medicales mais different legerement en fonction du sexe.

Background Overweight in schools is a worrisome public health problem because they increase medium and long term risks of morbidity and mortality especially with an increased risk of persistence of obesity in adulthood. Aim To estimate the prevalence of overweight among school children and to identify its associated risk factors. Methods this is a descriptive cross-sectional study conducted among school students aged less than 18 years in the area of "Hazoua" (Tozeur). The references of BMI used for overweight and obesity are those of IOTF. The French BMI references are used to establish the prevalence of underweight. Data entry and analysis was performed using SPSS 20. Results Our sample included 445 students. The average BMI was 18.73±3.4 kg/m2. The prevalence of Underweight was 9.7%, while overweight and obesity have been reported among 6.7% of students. Overweight was significantly associated to gender and the practice of sport outside school. Conclusion Obesity in schools in the community of Hazoua is now lower than that reported in other studies. In contrast, we detected a problem of underweight, which deserves as much attention. Intervention programs should be established and whose objectives are to improve students' skills in terms of eating behavior and physical activity, these actions require collaboration at all levels.

Introduction: Parmi les événements indésirables, ceux liés au circuit des médicaments occupent une place importante et risquent de causer un préjudice grave aux patients. Dans ce contexte, nous avons mené cette étude dans l'optique de décrire et d'évaluer le circuit des médicaments anticancéreux dans un hôpital régional tunisien. Méthodes: Il s'agit d'une étude évaluative du risque lié aux médicaments anticancéreux, type « visite de risque » menée sur une période de 15 jours au cours de l'année 2014 au service de cancérologie de l'hôpital régional de Gafsa (Tunisie). Cette méthode d'évaluation est inspirée de celle conduite par le projet « SECURIMED » développé par le Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA), en France. Résultats: Dans notre étude, l'observation du circuit des médicaments anticancéreux a révélé certaines insuffisances. On a noté que la répartition des missions des différents acteurs est sujette parfois à des glissements de tâches. Un manque important ainsi que une inadéquation aux normes au niveau des équipements nécessaires pour la préparation et la protection des professionnels manipulant ces médicaments ont été également décelés. Conclusion: La sécurisation du circuit des médicaments devrait être une priorité inscrite dans l'ensemble des démarches nationales et partagée par tous les intervenants et ce dans l'optique d'atteindre un objectif prémium : la qualité de la prise en charge globale et la sécurité des patients.Key words: Risk management, anticancer drugs, patient safety

Introduction : La mortalite maternelle est un probleme majeur de sante mondiale. Une grande proportion de ces deces serait evitable par des soins adequats, une aide a l'accouchement, la disponibilite des soins d'urgence et l'utilisation des outils d'aide a la decision tels que le partogramme. L'objectif etait d'evaluer l'ecart entre ce qui est cense etre fait et ce qui est fait reellement pour les differents parametres situes dans le partogramme au sein d'une maternite de 3 eme niveau et elaborer des recommandations pour la mise en place d'un plan d'action. Methodes : Il s'agit d'une etude descriptive retrospective par audit clinique, effectuee sur un echantillon de 400 dossiers obstetricaux des parturientes ayant accouchees dans la maternite du CHU Farhat Hached durant l'annee 2011. Le referentiel utilise est celui realise par l'Agence Nationale d'Accreditation et d'Evaluation en Sante en l'an 2000, concernant la qualite de la tenue du partogramme. Resultats : La majorite des criteres d'evaluation portant sur la presentation du partogramme etait conforme. Deux criteres concernant la variete de la presentation et le rythme cardiaque foetal etaient non conformes parmi ceux portant sur la surveillance du foetus. Plusieurs criteres en rapport avec la surveillance de la mere etaient non conformes. Aucun des criteres portant sur les traitements administres et les marqueurs d'evenements n'est conforme. Les criteres portant sur la naissance et la surveillance immediate qui etaient non conformes sont : le debut des efforts expulsifs, le mode d'accouchement, l'etat du perinee, la delivrance et la revision uterine. Conclusion : La veritable demarche de l'audit clinique se doit d'aller au-dela du recueil et de l'analyse des donnees, le but final etant l'amelioration des pratiques.

Objective To assess the patient safety culture (PSC) in operating rooms (ORs) and to determine influencing factors. Design A cross-sectional descriptive multicenter study which was conducted over a period of 7 months (October 2014–April 2015) using the French validated version of the Hospital Survey On Patient Safety Culture questionnaire. Setting Of the note, 15 ORs of public and private healthcare institutions. Participants In total, there were 368 participants including surgeons, anesthesiologists, surgical and anesthesia technicians, nurses and caregivers, divided into 316 professionals exercising in public sector and 52 working in private one. Main Outcome Measure(s) A self-administrated questionnaire investigating 10 dimensions of PSC (including 45 items), two items examining the staff perception of patient safety quality and reporting events, and five items regarding demographic characteristics of respondents. Results The participation rate in the study was 70.8%. All 10 dimensions were to be improved. The overall perception of patient safety had a score of 34.9%. The dimension that had the lowest score (20.5%) was the non-punitive response to error, and the one that had the highest score (41.67%) was teamwork in the ORs. Three dimensions were developed in private sector, and none in public hospitals. Conclusion This study showed that the level of the PSC needs to be improved not only in public hospitals but also in private ones. The obtained results highlight the importance of implementing quality management systems and developing PSC.

We determined the profile of respiratory morbidity in family practice in the region a cross-sectional study in 86 primary health care centres in Souse over 1 year (2002-03). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data. Respiratory diseases ranked first both for reason for consultation (8397/24 882, 33.7%) and for diagnosis made (7788/18 097, 43.0%). Of the 7715 respiratory complaints, cough was the most common complaint (54.8%). Of respiratory diagnoses, 37.1% were acute tonsillitis, 26.5% acute bronchitis and 21.6% were acute respiratory tract infection. Children under 5 years were most affected by acute upper respiratory tract infections (44.5%). Acute bronchitis was the primary diagnosis for patients aged over 45 years.

Background Throughout recent years, Workplace violence in hospital emergency departments has become common problem. Thus, rate of emergency departments workers who are experiencing it is increasing significantly especially since Tunisian revolution. Closely related to reduced job satisfaction and performance. The objective of this study was to have an overview the characteristics of Workplace violence against workers in emergency departments in a secondary healthcare center in Tunisia. Methods We conducted a cross-sectional study in the emergency department in Sidi Bouzid Hospital. The study investigated all types of violence against Emergency department workers including physicians, nurses, admission/registration personnel and security officers. Assaults that occurred during the year of study were included. Data were collected from registers, medical certificate files and interviews with aggressor and aggrieved from October 2014 till October 2015. Socio-demographic characteristics of both of them as well as types of violence were recorded. Data were verified and analyzed using Statistical Package for Social Science (SPSS), software version 18.0. Results A total of 110 participants were enrolled: 27 (25%) physicians, 45 nurses (41%), 16 security officer (14%), 18 workmen (16%) and 4 administrative personnel (4%). The majority (56%) experienced at least one type of work place violence in the past 12 months: 29% exposed to physical violence, 41% to non-physical assaults or verbal abuses and 30% experienced both types of violence. Males were more prone to violence than females (61% vs. 31%). Same results were reported regarding type of violence (physical/verbal). In fact, in either types men were more concerned but insignificant statistically (P = 0.86). Regarding aggressors profile, our results showed that they are mostly males (77%) with a mean age of 36 years (± 12). They were dunk/intoxicated and suffering from mental disorders in 47% and 12% among all cases, respectively. Conclusion Violence against workers in emergency departments is highly common. All categories are affected. Neither men nor women are exempted even if our results concluded a male predominance. All stakeholders should collaborate in order to prevent and tackle this problem.

Resume Les objectifs de notre etude consistaient a identifier la morbidite diagnostiquee chez les enfants âges de moins de dix-neuf ans dans les structures de sante de premiere ligne, et a relever les pathologies pediatriques qui avaient necessite d’etre adressees a un specialiste pour avis specialise. Il s’agissait d’une etude descriptive effectuee dans 92,5 % des structures de sante de base. Nous avons procede par un sondage a deux degres. Le premier a porte sur trois semaines par saison et par district. Le second sondage a porte sur les fiches medicales. L’unite statistique est la consultation medicale. Le codage des diagnostics et des references a ete fait selon la Classification Internationale des Soins Primaires (CISP2). Les consultations des enfants âges de moins de dix-neuf ans ont represente 6 629 consultations, soit 42,5 % du total des consultations tous âges et sexes confondus. La pathologie respiratoire etait predominante avec 62,5 %, suivie des pathologies digestive et cutanee dans respectivement 10,4 % et 9,1 % des cas. Parmi les 6 629 consultations, 270 d’entre elles, soit 4,1 % ont necessite d’etre adressees a un specialiste pour avis. Les references interessaient plus les garcons (57,4 %) que les filles (42,6 %) (p = 0,015). Dans 83 % des cas, les references etaient reparties selon les chapitres de la CISP2, en 21,9 % pour le respiratoire, 16,7 % pour le digestif, 12,6 % pour aussi bien les chapitres œil que cutane, 10,4 % pour l’osteo-articulaire, 4,8 % pour le chapitre urinaire et 4,1 % concernait le chapitre oreille. L’interet de cette etude est non seulement epidemiologique mais aussi pedagogique puisqu’il oriente le choix des themes pour la formation des medecins et permet une comparaison entre regions et pays.

Introduction Parmi les événements indésirables, ceux liés au circuit des médicaments occupent une place importante et risquent de causer un préjudice grave aux patients. Dans ce contexte, nous avons mené cette étude dans l'optique de décrire et d’évaluer le circuit des médicaments anticancéreux dans un hôpital régional tunisien. Méthodes Il s'agit d'une étude évaluative du risque lié aux médicaments anticancéreux, type « visite de risque » menée sur une période de 15 jours au cours de l'année 2014 au service de cancérologie de l'hôpital régional de Gafsa (Tunisie). Cette méthode d’évaluation est inspirée de celle conduite par le projet « SECURIMED » développé par le Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA), en France. Résultats Dans notre étude, l'observation du circuit des médicaments anticancéreux a révélé certaines insuffisances. On a noté que la répartition des missions des différents acteurs est sujette parfois à des glissements de tâches. Un manque important ainsi que une inadéquation aux normes au niveau des équipements nécessaires pour la préparation et la protection des professionnels manipulant ces médicaments ont été également décelés. Conclusion La sécurisation du circuit des médicaments devrait être une priorité inscrite dans l'ensemble des démarches nationales et partagée par tous les intervenants et ce dans l'optique d'atteindre un objectif prémium: la qualité de la prise en charge globale et la sécurité des patients.

La nouvelle morbidite chronique et multifactorielle, les limites de l’efficacite de la medecine classique et la place preponderante qu’occupe actuellement la personne dans la vie sociale ont impose une approche centree sur le patient comme modele ideal de pratique medicale. L’objectif de ce travail est d’evaluer les habiletes d’ecoute, d’empathie et de participation des medecins de la region sanitaire de Sousse. Il s’agit d’une etude descriptive et transversale portant sur un collectif de 133 praticiens exercant dans la region de Sousse dans les deux secteurs de soins liberal et public. Les donnees ont ete collectees a travers un questionnaire auto-administre au cours de l’annee 1999. Parmi les principaux resultats : 28 % des medecins declarent avoir des difficultes lors de la communication avec leurs patients et 31 % d’entre eux n’accordent pas d’importance aux aspects psychosociaux du patient. Seulement 31 % des praticiens sont favorables a la participation du patient a la prise de decision. Il ressort de cette etude que la domination du modele des soins bio-medical aussi bien dans l’enseignement que dans la pratique medicale, a affaibli les competences elementaires necessaires a une pratique medicale humaine basee sur le respect et l’implication du patient. Une transformation du curriculum de l’enseignement medical vers une centralisation sur la personne souffrante et l’orientation vers la communaute, est indispensable a concilier entre les besoins des patients et l’offre des soins.

Aim: This study was designed to assess the prevalence of alcohol consumption and factors associated with alcohol consumption among students of the Sousse region of Tunisia. Methods: This was a cross-sectional study conducted among 556 students of Sousse universities during the 2012-2013 academic year, using an anonymous self-report questionnaire. Data capture and statistical analysis were performed with SPSS software 18.0. Results: Our study population was composed of 268 males (48.2%) with a mean age of 21.8 ± 2.1 years. Eighty-four students (15.1%) had consumed alcohol at least once. On multivariate analysis, male gender (OR = 6.94; 95%CI = [2.32-20.72]), smoking (OR = 13.21; 95%CI = [6.20-27.78]), drug use (OR = 32.22; 95%CI = [6.73-154.26]) and parental alcohol consumption (OR = 4.31; 95%CI = [1.70-10.91]) were the factors significantly associated with alcohol consumption among students. Conclusion: This study was designed to determine the characteristics of alcohol consumption among Tunisian students. Alcohol consumption levels were comparable to those reported in the general population and were significantly related to smoking and drug use. The next step of this study will consist of developing strategies to prevent risk behaviours in the student population.

Introduction Les étudiants en début du cursus suivent la même formation hospitalo-universitaire, cependant, ils sont peu nombreux à choisir délibérément la médecine générale comme discipline d'exercice médical. Notre objectif est de préciser auprès des étudiants en médecine, les facteurs qui déterminent le choix de la médecine générale comme carrière et leur vision de cette discipline. Méthodes Etude descriptive transversale menée auprès d'un échantillon d’étudiants inscrits à la faculté de médecine de Sousse (Tunisie) pour l'année universitaire 2012-2013. Le recueil des données a été pratiqué par l'intermédiaire d'un questionnaire conçu pour les fins de ce travail. La saisie et l'analyse des données ont été effectuées par le logiciel SPSS 18.0. Résultats Notre étude a porté sur 388 étudiants dont 69,5% étaient du genre féminin. L’âge moyen était de 22,1 ± 2,8 ans. Cent étudiants (25,8%) avaient un parent cadre de santé sans que cela n'ait une influence sur le choix de carrière. A l'entrée à la faculté, seulement 7,1% (n = 27) voulaient faire de la médecine générale leur carrière. Le changement de choix vers la médecine générale est statistiquement différent à l'entrée et à la sortie de la faculté chez les internes finissants. Conclusion Afin d'attirer davantage les étudiants vers la médecine générale, il serait judicieux d'adopter des changements majeurs touchant l'enseignement théorique et pratique et de modifier les conditions de travail en fonction des attentes des générations futures.

Nowadays, the ageing of the population became a societal frequent problem throughout the world. In Tunisia, the part of the elderly of 60 years old and over is estimated at 17,7 % in 2029. This ageing is at the origin of important health problems, in particular the increase of the frequency of the chronic diseases.To identify the Sociodemographic characteristics of the consultants of 65 years old and over, and to describe the morbidity diagnosed in this age group in the primary health care centers of the sanitary region of Sousse.We conducted a cross-sectional descriptive study in 86 primary health care centers in Sousse over 1 year (2002-2003). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data.2198 consultations were collected, elderly person presents on average 1,22 (± 0,55) morbid states by consultation. The main diseases identified in order were cardiovascular (26,2%), breathing (20,8%), osteo-articular (14,8%). Psychological and social disorders accounted for only 0,4% of cases. The major health problems were uncomplicated hypertension (22,4%), acute bronchitis / bronchiolitis (9,2%), diabetes mellitus type 2 (7,9%) and osteoarthritis of knee (4,7%).These results are important both to meet the needs of consultants and especially to better adapt the training to practice field.

Introduction: Les étudiants en début du cursus suivent la même formation hospitalo-universitaire, cependant, ils sont peu nombreux à choisir délibérément la médecine générale comme discipline d'exercice médical. Notre objectif est de préciser auprès des étudiants en médecine, les facteurs qui déterminent le choix de la médecine générale comme carrière et leur vision de cette discipline. Méthodes: Etude descriptive transversale menée auprès d'un échantillon d'étudiants inscrits à la faculté de médecine de Sousse (Tunisie) pour l'année universitaire 2012-2013. Le recueil des données a été pratiqué par l'intermédiaire d'un questionnaire conçu pour les fins de ce travail. La saisie et l'analyse des données ont été effectuées par le logiciel SPSS 18.0.Résultats: Notre étude a porté sur 388 étudiants dont 69,5% étaient du genre féminin. L'âge moyen était de 22,1 ± 2,8 ans. Cent étudiants (25,8%) avaient un parent cadre de santé sans que cela n'ait une influence sur le choix de carrière. A l'entrée à la faculté, seulement 7,1% (n=27) voulaient faire de la médecine générale leur carrière. Le changement de choix vers la médecine générale est statistiquement différent à l'entrée et à la sortie de la faculté chez les internes finissants. Conclusion: Afin d'attirer davantage les étudiants vers la médecine générale, il serait judicieux d'adopter des changements majeurs touchant l'enseignement théorique et pratique et de modifier les conditions de travail en fonction des attentes des générations futures.Key words: Médecine générale, enseignement médical, choix de spécialité

A contraceptive prevalence survey was conducted among 1277 women of reproductive age, to explore knowledge of and attitudes to contraceptive use and study factors influencing contraceptive use. We found that family planning methods were generally well known. The prevalence of modern contraceptive use was 53.6%, IUDs being the most commonly used followed by sterilization and pills. The public sector was the main source for obtaining contraceptives although pills and condoms tended to be obtained from the private sector. There was a significant correlation between contraceptive use and urban residence.

Introduction L’anxiete et la depression sont des symptomes frequemment identifies chez les femmes atteintes de cancer du sein. En effet, face a cet evenement stressant, la femme adoptera des strategies de coping variees qui peuvent influencer positivement ou negativement ces symptomes psychologiques. Objectif Etudier la relation entre les strategies de coping et les niveaux d’anxiete et de depression chez les femmes suivies pour cancer du sein. Materiels et methodes Une etude descriptive transversale a ete menee aupres des femmes suivies pour cancer du sein a la consultation externe du service de gynecologie et obstetrique a l’hopital Farhat Hached de Sousse. Un questionnaire en trois parties a ete administre : la premiere partie concernait les variables sociodemographiques et cliniques ; la deuxieme et la troisieme partie correspondaient respectivement aux versions arabes du « Hospital Anxiety and Depression Scale » et du « Brief COPE Scale ». Des analyses de correlations ont ete effectuees afin d’explorer les liens entre les niveaux d’anxiete et de depression et les strategies de coping. Resultats Au total, notre population d’etude etait composee de 200 femmes de moyenne d’âge de 50,8 ± 11,7 ans. Les prevalences de l’anxiete et de depression etaient respectivement de 65 %, IC95 % = [58–71] et 51,5 %, IC95 % = [44–58]. La religion etait la strategie de coping la plus frequemment adoptee. L’acceptation, la reinterpretation positive et l’humour etaient correles negativement et d’une maniere significative a l’anxiete et a la depression. Les strategies de coping dysfonctionnelles etaient associees a une augmentation du niveau d’anxiete et de depression. Conclusion Les professionnels de sante doivent non seulement depister precocement les symptomes anxieux et depressifs chez les femmes suivies pour cancer de sein, mais aussi encourager les femmes a adopter les strategies de coping efficaces pour reduire ces desordres psychologiques.

Introduction Parallelement a l’augmentation de l’incidence du cancer du sein et a la complexification grandissante des trajectoires de prise en charge, s’est developpee une augmentation de la conscience des possibles longs delais pour l’acces aux soins. Notre etude a pour objectif d’etudier les delais de la premiere prise en charge therapeutique des patientes operees et suivies pour cancer du sein au service de gynecologie du CHU Farhat Hached de Sousse en 2013 et de determiner les facteurs associes. Methodes Il s’agit d’une etude descriptive retrospective, effectuee sur les dossiers de patientes operees et suivies pour un cancer du sein au service de gynecologie du CHU Farhat Hached de Sousse en 2013. Les delais etudies sont : le delai global de premiere prise en charge therapeutique (chirurgie ou chimiotherapie neoadjuvante) qui regroupe le premier delai intermediaire (le delai d’acces au diagnostic : entre le diagnostic radiologique et le diagnostic anatomopathologique) et le deuxieme delai intermediaire (le delai d’acces au premier traitement : entre le diagnostic anatomopathologique et le debut du premier traitement). Les delais sont presentes sous forme de mediane avec l’intervalle interquartile. Resultats L’echantillon etait constitue de 213 femmes. Le delai median d’acces au diagnostic etait de 13 jours avec un intervalle interquartile de [4 j–34 j]. Si le premier traitement est chirurgical, le delai median d’acces a l’acte chirurgical etait de 35 jours avec un intervalle interquartile de [27 j–45,7 j]. S’il s’agit d’une chimiotherapie neoadjuvante, le delai median etait de 62,5 jours avec un intervalle interquartile de [31 j–122 j]. Le delai median global de premiere prise en charge therapeutique etait de 52 jours avec un intervalle interquartile de [37 j–89 j]. Conclusion Il est capital de maitriser les delais d’acces aux soins lors du parcours de soins pour garantir le succes du traitement et repondre aux besoins des malades de plus en plus exigeants.

Introduction Malgre les benefices de l’allaitement au sein aussi bien pour l’enfant que pour la mere, ni la duree recommandee ni l’exclusivite ne sont respectees par la majorite des meres. Plusieurs etudes se sont focalisees sur l’identification des facteurs pouvant influencer l’allaitement au sein. Parmi les facteurs modifiables susceptibles de favoriser cette pratique, on rapporte le sentiment d’efficacite personnelle. L’objectif de notre etude etait d’etudier l’effet de ce sentiment sur la duree et le degre d’exclusivite de l’allaitement au sein. Methodes Nous avons mene une etude descriptive longitudinale avec un suivi allant de la naissance jusqu’a 8 semaines, aupres d’un echantillon de femmes ayant accouche au CHU de Farhat Hached de Sousse durant la periode allant du 15 mai 2015 au 15 juin 2015. Une fiche de collecte de donnees a ete concue pour les fins de ce travail incluant le « Breastfeeding Self-efficacy Scale-Short Form ». Resultats L’echantillon etait constitue de 150 femmes. Un peu plus de la moitie (54 %) etaient âgees entre 20 et 30 ans et seulement 2,7 % etaient celibataires. Ces femmes etaient primipares dans 48 % des cas et l’accouchement etait par voie basse dans 73 % des cas. Le score d’efficacite personnelle etait eleve chez 67 % des parturientes. Seulement 114 nourrissons (76 %) continuaient a etre allaites au sein a 8 semaines et seulement 11 (7,3 %) l’etaient exclusivement. La raison la plus rapportee par les meres etait l’apport insuffisant de lait. Le score d’efficacite personnelle etait significativement associe a la duree de l’allaitement au sein et au degre de ce dernier (exclusivite). Conclusion Cette etude met l’accent sur un nouvel axe pour la promotion de l’allaitement maternel. En effet, le sentiment d’efficacite personnelle maternel est un facteur modifiable sur lequel on peut agir.

Introduction La dependance fonctionnelle chez la personne âgee constitue une preoccupation en sante publique surtout dans un contexte de vieillissement de la population l’objectif etait de determiner le taux de la dependance fonctionnelle chez les personnes âgees de 65 ans et plus consultant les centres de sante de base de la ville de Sousse. Methodes Une etude descriptive transversale a ete realisee pendant le deuxieme trimestre de l’annee 2014. Un echantillon representatif de consultants âges de 65 ans et plus a ete constitue. Deux echelles de l’autonomie fonctionnelle ont ete utilisees : echelle de Katz des activites de la vie quotidienne (soins corporels, habillement, toilette, transfert, continence, alimentation) et l’echelle de Lawton pour mesurer les activites instrumentales de la vie quotidienne. Les donnees de l’enquete ont ete traitees a l’aide du logiciel SPSS. Resultats Au total, 200 patients ont ete retenus. L’âge moyen etait de 76,1 ± 6,9 ans. Les femmes representaient 67,5 % des cas. Selon l’echelle de Katz 37,5 % (n = 75) des patients etaient tres dependants dans les activites de la vie quotidienne. Ils recoivent de l’aide pour les soins corporels dans 38,5 % des cas (n = 77), pour l’habillement dans 52 % des cas (n = 104) et pour la toilette dans 13,5 % des cas (n = 27). Selon l’echelle de Lawton, 68,1 % (n = 92) des femmes presentaient une dependance severe dans les activites instrumentales versus 55,4 % (n = 36) des hommes. Cette difference n’etait pas statistiquement significative. Les activites instrumentales les plus atteintes etaient l’utilisation du telephone dans 46 % des cas, suivie par faire les courses dans 41,5 % des cas. Discussion/conclusion Le taux eleve (37 %) de la dependance fonctionnelle dans les activites de la vie quotidienne chez les sujets âges de 65 ans et plus, incite les professionnels de sante a evaluer la dependance a fin de prevenir l’apparition de plusieurs complications et de proposer aux autorites des axes d’aide sociale.

Introduction: Il est admis que la satisfaction des patients est un indicateur de la qualité des soins. L’objectif de ce travail était de mesurer la satisfaction des patientes du service de gynécologie obstétrique du CHU Farhat Hached de Sousse. Méthodes: Une étude transversale a été menée entre mai et octobre 2005. La collecte des données a été faite par trois internes grâce à des entrevues structurées avec des patientes et à partir d’un questionnaire validé. Résultats: 600 patientes ont été interviewées. L’âge médian était de 30 ans. Prés de quatre vingt cinq pour cent des femmes étaient instruites. Les patientes analphabètes ont exprimé une meilleure satisfaction (score de 56,6 %) par rapport aux autres (p < 10-3). Par ailleurs, nous avons noté : un niveau de satisfaction globale moyen (score de 51%) ; un faible niveau de satisfaction pour la restauration et les conditions de séjour ; un bon niveau de satisfaction pour les soins médicaux et paramédicaux. Les patientes les plus satisfaites étaient celles qui avaient l’impression que leur état de santé s’est amélioré, celles qui s’attendaient à des services de qualité moindre ou de qualité similaire, et celles qui avaient l’intention de recommander l’hôpital à leurs proches. Conclusion: Il est difficile de transposer les résultats de travaux étrangers au contexte tunisien, en raison des différences entre les systèmes de santé d’une part et les caractéristiques socio-démographiques des patientes, d’autre part. En revanche, certains domaines devraient être examinés par des professionnels de la santé afin d'assurer la qualité requise.Key words: Qualité des soins, satisfaction des patients, gynécologie, Tunisie

Compliance with medical treatment is a public health problem. It denotes the patient's perception of the disease and the treatment prescribed by doctors. It concerns one out of two patients. It may happen to any patient at one or another. It is secondary for reasons that are numerous and modifiable in time. It results from problems related to the patient as much as to the doctor. It represents an obstacle to paying for chronic diseases such as chronic open-angle glaucoma, hence the importance given to it in the recent years.To evaluate the compliance of adult patients suffering from early open-angle glaucoma and to determine the influential factors.We conducted a survey at the ophthalmology department of Ibn El Jazzar Hospital among 132 adults being treated for early open-angle glaucoma. The evaluation was done on the basis of patient's medical files and a questionnaire from January 2007 to June of the same year. It ranges between good, average or bad depending on the frequency of the patient's visits to doctors, regularity of treatment and compliance with the doctor's prescription.40.15% of the patients have positively complied with the prescriptions. This improvement has mainly been due to the following factors: The patient's good knowledge of the disease and its treatment; use of antiseptic eye lotion with the utmost effectiveness for the least instillation and side effects; patient's mastery of drop usage; doctor's intensive care required for some particular cases.Our results need to be confirmed by other studies. It's very important to consider all the determining factors in order to improve patient's compliance.

Background: Primary health care is one of the most important pillars of the Tunisian health care system. However, very little information is available regarding the specificities of general practice and the patterns of morbidity encountered. Methods: We conducted a descriptive study from June 2002 to May 2003 in 85 primary health centres in Sousse during 12 randomly selected weeks in order to describe the variability of the morbidity in all seasons;(3 weeks were randomly selected in each season). Each working day of selected weeks, a systematic sample of patients was identified in each health centre by taking every fifth registered patient. There were 16,271 consultations. The International Classification of Primary Care (ICPC-2) was used to code recorded data of the consultation. Results: There were 24,882 reasons for encounter, a total of 18,097 problems managed by general practitioners (GPs), and 40,190 interventions. There was a predominance of females (62%) and a relatively young population attending the primary health care settings as 50% was aged less than 25 years. According to ICPC-2 chapters, we found that respiratory diseases were the main problems managed in primary health care (43%), followed by digestive (10.1%), locomotive (8.9%), cardiovascular affections (8.7%) and skin diseases (8.4%). These five conditions alone constituted about 80% of the total cases. However, genital conditions for both males and females (1%) as well as psychological and social problems (0.85%) were rarely managed in primary care. Conclusion: The findings will be useful in helping to revise the educational curriculum of medical studies as required in general practice and to plan relevant vocational training for GPs. They will also be important for health policy makers in Tunisia.

It has been demonstrated that the prognosis of the end-stage renal diseases have been changed after the introduction of dialysis modalities (haemodialysis and peritoneal dialysis). Technical progress, have increased life duration of these patients; however, some health concerns persist to be frequent, such as physical alteration and psychological disturbances.This study aimed to evaluate the patients' quality of life of those who are treated by haemodialysis and peritoneal dialysis in Kairouan Gouvernorate.It is a descriptive study that included the whole 134 dialysed patients who are taken care of in the four dialysis unites using the KQQOL-SF questionnaire for quality of life assessment.Demographic characteristics showed that 71% of the study population were illetrate, and 50% were jobless. The mean distance of home-dialysis unit was 47 km and the mean duration of dialysis care was 27 months. Therefore, 36.2% of patients have been dialysed twice a week and 87.1% were aneamic. The mean quality of life score was 55.1. With reference to Lean standard value of 66.7 on the SF-36 scale, a deterioration of the quality of life was found in 75.2% of cases. Disorders were noted more deeply in the physical component (49.2 +/- 16.4) than on mental component (60.9 +/- 10.3). The mean of renal component score was 62.7 +/- 12.9. Statistical analysis found that quality of life alteration was correlated to the following: female patients, elderly people, low socioeconomic status, presence of comorbidity, aneamia, and low rate of albuminemia.The results could be used as a needs assessment study in order to improve the quality of life of dialysed patients. This needs the implementation of a quality improvement programme that should include the biological and psychosocial aspects in dialysis care.

The aim of this study is to evaluate the quality of medical records throughout a sample of 380 records at the medicine ward of three regional hospitals in Monastir. The medical audit was performed using a reference standard previously developed by foreign teams and adapted to the health care features of our country. The results showed that the quality of medical records should be improved. It depends on the hospital and in 2/3 of cases there was a lack of information or sheets important for the coordination and the continuity of medical care. The quality improvement of medical records could be reached by the professional education, which should emphasise the importance of medical and administrative data in the health care management. This could be included in a continuous quality improvement program.