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Introduction: Sexual violence (SV) against women represents a public health problem. Despite, the promulgation of the new Act of 2017-58, SV remains frequent in Tunisia. In this paper, we propose to determine the socio-demographic characteristics of women victims of SV and to identify risk factors related to serious SV., Material and Methods: This is a retrospective, descriptive and analytical study including all women victims of SV, examined at the Forensic Department of Sfax Hospital, between 1st March 2018 and February 29th, 2020. We defined serious SV as any sexual violence associated with genital or anal lesions., Results: We collected 269 cases of women victims of SV. This sexual violence was associated with extra-genital physical violence in 18.86 % of the cases. The average age of the victims was 21.23 years (+/-10.67 years). The consultation delay was relatively long. Only 11.52 % of victims consulted within 24 h. It was mainly an extra-family abuse. Vaginal examination revealed recent defloration in 9.29 % of the cases. The proctological examination was normal in most cases (61.63 %).Seven victims were pregnant. In the analytical study, we studied the risk factors of serious SV against women. A total of 150 cases were considered serious (55.8 %). Serious SV was statistically related to the age (over 18),the profession (housewives),the origin (urban),and the relationship with the aggressor (friend, neighbor, or family member).The risk of serious SV was greater when the victim didn't have any traumatic extra-genital injury., Conclusion: Sexual violence is a serious problem worldwide and in Tunisia. The Tunisian legislation repressing SV has been strengthened by the promulgation of the 2017-58 Act. However, much effort remains to be deployed to fight against this form of violence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Violence against women is a widespread offense worldwide. It causes serious physical, psychological, and medico-legal repercussions. We aim to specify the socio-demographic characteristics of female victims of physical violence well as the medical consequences and risk factors related to serious physical violence against women in Tunisia., Materials: This is a retrospective study including all women victims of physical violence, examined on judicial requisition at the Forensic Department of Habib Bourguiba University Hospital in Sfax, over two years (March 1st, 2018 to February 29th, 2020). Physical violence is considered serious whena forensic specialist predicts long term effects at the lesional stage (determining partial permanent disability: PPD)., Results: In our study, 2909 women were victims of physical violence. The average age of the victims was 34 ± 13 years (extremes:2 and94 years). The majority of victims were married (83.3%), jobless (52.5%), and of an urban origin (72.7%). Physical violence predominated in summer and autumn with a peak in frequency in July and at weekends. The consultation delay ranged between 1 and 30 days in two-thirds of the cases. The perpetrator was an intimate partner in 38.2% of cases, a stranger in 11.1% of cases, and a family member in 5.9% of cases. The weapon used was a blunt object in 82.8% of cases. Injuries were preferentially located in the upper limbs (52.6%) followed by the head and face (42.7%), consisting essentially of bruising and abrasions. The median duration of the total temporary disability (TTD) was 5 days (extremes: 0-60 days). The duration of TTD was statistically correlated to the type and the site of the most serious injuries. Moreover, there was a statistically significant correlation between the duration of TTD and the PPD prediction (p < 0.001). A 9-day TTD represented the threshold to expect PPD. A total of 198 cases (6.8%) were considered serious. Serious physical violence was statistically correlated to the origin of the victim (urban), the relationship with the aggressor (stranger, or thief), the type of weapon used (sharp or thermal force), the type of injury (contused wound, sharp wound, penetrating wound, fracture-dislocation, or head trauma) and thesite of the injury (head and face)., Conclusion: Violence against women is a very widespread practice in our society. Despite legislative advances, Tunisian women remain victims of discrimination in several areas. A change in mentalities and an awareness of the need to respect women's rights are necessary and require collaboration between the various social, legal and medical stakeholders., (Copyright © 2023 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objectives/background: Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip., Patients/methods: A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9., Results: Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality., Conclusion: Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia. This survey was designed as a cross-sectional study. It concerned women victims of violence over 18 years old, consulting the emergency department of the University Hospital of Kairouan during 3 months in 2017. We defined violence against women according to the Tunisian protection of gender discrimination law. This survey included 100 Tunisian victims of violence; their median age was 35 (ranging from 18 to 59 years old). This study showed that 58% of victims, CI95% [48.3%, 67.6%], were illiterate or had only a primary level education and that 90%, CI95% [84.1%, 95.8%], had a low or middle socioeconomic level. The Intimate Partner Violence was about 70% among all cases, CI 95% [61.0%, 78.9%]. Most aggressive partners were young (aged between 39 and 51 years old). The most affected part of the body was the face (76%, CI 95% [67.6%, 84.3%]). Alcohol consumption was the primary risk factor of violence in 29.6% of cases, CI95% [20.0%, 37.9%]. Other risk factors were the occupational instability, conflicts with the family in-laws and infidelity. Violence against women remains widespread. Even strict legislations in Tunisia didn't protect women sufficiently from different types of violence. It mostly happens within intimate relationships. Therefore, surveillance and early intervention controlling risk factors are extremely important.

Background: Health-care associated infections (HAI) are considered a public health problem and have substantial effect on mortality and morbidity. This study aimed to determine the prevalence of HAI in South Tunisian University Hospitals (UH) and to identify their risk factors., Methods: We performed a point prevalence study, in the UH of Southern Tunisia in February 2019, including all hospitalized patients for at least 48 hours., Results: Overall, 898 patients were included in this survey, among whom 480 participants (53.5%) were males. There were 81 HAIs, accounting for a prevalence of HAI of 9.02%. Urinary tract infections (28.4%) were the most common HAI, followed by respiratory tract infections (22.2%). The main identified microorganisms among HAI patients were Klebsiella pneumonia (22.7%) and Escherichia coli (20.7%). Independent intrinsic risk factors of high prevalence of HAI were diabetes (Adjusted Odds Ratio (AOR)=3.5;p=0.016) having a rapidly fatal disease (AOR=4;p=0.024) and an ASA scores ≥2 (AOR=2.8;p=0.045). As for extrinsic risk factors, admission in ICU (AOR=11.1;p= 0.04), a length of hospital stay ≥ 7 days (AOR=4.1;p=0.04), previous hospitalization within 90 days prior to the admission (AOR=4.2;p=0.01) and having a peripheral vascular catheter (AOR=6.7; p=0.039) were independently associated with higher prevalence of HAI. Lower prevalence of HAI was independently associated with prescription of antimicrobial preoperative prophylaxis (AOR= 0.1; p=0.02)., Conclusion: Our findings illustrated high prevalence of HAI in South Tunisian Hospitals, affecting principally fragilized patients who may require special needs. Therefore, promoting hygiene programs for health professionals to establish patient safety's culture is urgently needed., (Copyright © 2021 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Objectives: This study aimed to estimate the extent of smoking experience among high and middle school adolescents in Southern Tunisia and to delineate its potential associated factors., Methods: We conducted a cross-sectional study among middle and high school-adolescents in the governorate of Sfax, South of Tunisia in the 2017-2018 school-years. A questionnaire was anonymously administered to a representative sample of 1,210 school-adolescents randomly drawn., Results: The mean age of the school-adolescents was 15.6 ± 4.2 years. The prevalence of lifetime smoking was 16.7% (95% CI=[14.7-18.8%]) (boys 32.6%; girls 5.9%;p<0.001). Among the respondents, 13.9% (95% CI=[11.9-15.8%]) were current smokers. In multivariate logistic regression analysis, independent associated factors of current smoking were male gender (Adjusted (AOR)=10.2; p<0.001), 16-17 and 18-19-year age-groups (AOR=2; p=0.005 and AOR=2.6; p=0.001, respectively), below average academic performance (AOR=5.2; p=0.012), divorced parents (AOR=3.9; p=0.007), family monthly income ≥800 dollars (AOR=2.1; p=0.001), having a part time job (AOR=3.9; p<0.001) and a perceived high stress level (AOR=1.98; p=0.008). Secondhand smoke (AOR=1.8; p=0.011) and concomitant alcohol drink (AOR=14.56; p<0.001) were independent predictors of current smoking, while high education level of the father was independently associated with lower prevalence of current smoking (AOR=0.17; p<0.001)., Conclusion: The prevalence of lifetime and current smoking were relatively high in Southern Tunisian middle and high schools. Multilevel influences on youth smoking behavior had been identified, which reflected the need to conceive appropriate school interventions and effective antismoking education program., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background: The aim of this study was to determine the prevalence of health care-associated infections (HAI) in our university hospitals (UH) and to delineate the risk factors associated with HAI., Methods: We conducted a cross-sectional study in the 2 UH of Sfax, Tunisia on July 2017, including all patients hospitalized for at least 48 hours. It was a 1-day pass per department and a 1-week prevalence survey per UH., Results: Of 752 patients eligible for the study, the total number of HAI was 82, representing an overall prevalence of HAI of 10.9%. Respiratory tract infections were the most prevalent HAI (36.6%). In multivariate analysis, intrinsic risk factors independently associated with HAI were immune-suppression (adjusted odds ratio (AOR) = 2.8; P < .001), diabetes (AOR = 2.2; P = .008), and malnutrition (AOR = 2.2; P = .019). Extrinsic risk factors were endotracheal intubation (AOR = 17; P = .01), transfer to another department (AOR = 9; P = .019), parental feeding (AOR = 7.2; P = .014), tobacco use (AOR = 6.3; P = .004), as well as surgical wound class contaminated or dirty (AOR = 6.3; P = .002), and peripheral venous catheter (AOR = 4.7; P = .006)., Conclusions: Our study highlighted the magnitude of the HAI problem threatening the quality of care in Southern Tunisia. A wise identification of HAI risk factors may help health care workers to ascertain the avoidability of these infections., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Body image is considered as central to many aspects of human functioning including emotions, thoughts, behaviors and relationships. Our study aimed to investigate the prevalence of body image distortion and dissatisfaction among adolescents and to assess their main determinants., Methods: This was a cross-sectional school-based study conducted among school-adolescents in the south of Tunisia, between October 2017 and February 2018., Results: Among 1210 school-adolescents, body image distortion and dissatisfaction prevalence were 44.8% and 42.4%, respectively. Multivariate analysis showed that being in the 16-18 years age group [adjusted odds ratio (AOR) = 1.28, p = 0.046], low family financial situation (AOR = 1.88, p = 0.014), as well as high frequency of eating pasta (AOR = 1.3, p = 0.04) and fast-food consumption (AOR = 1.7, p = 0.042) were independently associated with under-estimated body image. Skipping breakfast (AOR = 1.9, p = 0.017) and having one obese parent (AOR = 1.9, p = 0.01) were independently associated with higher frequency of over-estimated body image. Regarding body image dissatisfaction, independent factors associated with desire to lose weight were: female gender (AOR = 1.53, p = 0.007), high income family financial situation (AOR = 2.1, p = 0.008) and having one parent who is obese (AOR = 2.21, p < 0.001). However, frequent fast-food consumption (AOR = 1.9, p = 0.038) and eating between meals (AOR = 1.57, p = 0.01) were independently associated with a higher desire to gain weight., Conclusions: Our study highlighted that the prevalence of body image distortion and dissatisfaction were substantially high among adolescents. Their determinants included socio-demographic factors and lifestyle behaviors. Increased awareness among parents, educators and public health planners may help adolescents improve accuracy of body image attitudes., (©2019 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: Cardiovascular diseases (CVD) are a major cause of morbidity and mortality, driven by the epidemiological transition world-wide., Aim: We aimed to describe the epidemiological profile of CVD hospitalizations, to assess their chronological trends and to estimate their future projected trends., Methods: We retrospectively collected data from the regional morbidity registry of the University Hospital of Sfax, Tunisia, between 2003 and 2016. We included patients with ischemic heart disease (IHD), heart failure (HF) and rhythm and conduction disorder (RCD)., Results: The mean age-standardized hospital incidence rate (ASHIR) was 94.8, 20.6 and 14/100000 inhabitants/year for IHD, HF and RCD, respectively. Trends analysis of CVD showed a significant increase in the ASHIR of IHD from 54.3/100000 inhabitants in 2003 to 123/100000 inhabitants in 2016, with an Annual Percentage Change (APC) of 3.59% (95%CI:0.4-6.7%;p<0.001). An upward trend was observed for HF, with ASHIR rising from 8.6/100000 inhabitants in 2003 to 22.6/100000 inhabitants in 2016, with an APC of 8.29% (95%CI:4.1-12;p<0.001). For RCD, no significant change in ASHIR was found. Projections showed that the estimated ASHIR would attend 131 and 36.5/100000 inhabitants for IHD and HF, respectively, while RCD would decline to 19.6/100000 inhabitant in 2026., Conclusions: IHD and HF were rising at an alarming rate and were expected to continue up to the next 10 years. Therefore, there is an urgent need to emphasize on primordial, primary, and secondary prevention in order to reduce the massive burden of CVD.

Objectives: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period&#160;2010-2015., Methods: We retrospectively collected data of hospitalized&#160;patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015., Results: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005)., Conclusion: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these&#160;patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.

Background: Musculoskeletal pain (MSP) is a public health problem among school-adolescents. This study aimed to identify the prevalence, risk factors and consequences of neck, shoulders and low-back pain among school-adolescents., Study Design: A cross-sectional study., Methods: School-adolescents aged from 12 to 18 years between October 2017 and February 2018 in South of Tunisia were recruited. Eligible participants were randomly selected and were asked to respond a four-section questionnaire. Factors independently associated with MSP were determined through multivariate logistic regression analysis., Results: Among 1221 enrolled subjects, shoulders, low-back and neck pain were reported in 43%, 35.8% and 32%, respectively. Multivariate analysis showed that independent risk factors of neck pain were female gender (Adjusted odds ratio AOR=1.55; P=0.002), using computer ≥4 hours/week (AOR=1.50; P=0.010), too low desk (AOR=2.30; P<0.001) and carrying schoolbag ≥60 minutes (AOR=1.58; P=0.008). Female gender (AOR=3.30; P<0.001), BMI ≥25 Kg/m2 (AOR=1.6; P=0.018), playing videogames ≥2 hours/day (AOR=2.37; P<0.001) and schoolbag weight to body weight ≥10% (AOR=1.46; P=0.026) were independently associated with shoulders pain. For low back-pain, independent risk factors were high-school grade (AOR=2.70; P<0.001), playing videogames ≥2 hours/day (AOR=1.83; P<0.001), watching TV≥12 hours/week (AOR=1.5; P=0.016), too low seat backrest (AOR=1.4; P=0.005) and too far seat-to-black (board) distance (AOR=1.5; P=0.041). School-adolescents consumed drugs for MSP in 19.5%, had sleep disturbance in 34% and aggressive behaviors in 22.8%., Conclusions: The prevalence of MSP was substantially high among school-adolescents and their associated risk factors included sociodemographic factors, leisure activities and classroom furniture. An ergonomic specific and behavior-based school program is urgently needed.

Introduction: Tobacco is the main preventable cause of death worldwide. Our study aimed to determine the role of tobacco in the occurrence of non-communicable diseases (NCDs)., Methods: We conducted a retrospective study including all NCDs patients during 2015-2016. NCDs include cardiovascular diseases (CVD), chronic respiratory diseases (CRD), cancers (CS) and diabetes mellitus (DM)., Results: We identified 3643 cases of NCDs (43%) among 8478 hospitalizations, all diseases combined. Active smoking was found in 1076 cases (29.5%). Among the NCDs groups, CVD was the most common (65%). Tobacco was significantly associated with CVD (P<0.001), CRD (P=0.002), bronchopulmonary CS (P<0.001), haematological malignancy (P=0.023), and DM (P<0.001). Multivariate analysis performing binary logistic regression revealed that tobacco was an independent factor associated with CVD (OR=2.6, P<0.001), CRD (OR=1.5, P<0.001), bronchopulmonary CS (OR=1.8, P=0.013) and DM (OR=3.6, P<0.001)., Conclusion: Active smoking was a major risk factor in the occurrence of NCDs. Thus, smoking cessation represents the cornerstone for preventing the spread of these diseases, especially in countries with limited resources., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: The aim of this study was to describe the epidemiological profile of childhood respiratory tract diseases (RTD) in the region of Sfax, Tunisia, and to evaluate their trends over a 13 year period., Methods: We conducted a retrospective study of all children hospitalized with RTD aged under 14 years. We collected data from the regional morbidity register of the university hospital of Sfax from 2003 to 2015., Results: A total of 10 797 RTD patients were enrolled from 49 880 pediatric hospitalizations (21.7%). A male predominance was noted (60%). The median age was 8 months (IQR, 2-36 months). Acute bronchitis (AB) accounted for 53.8%, followed by asthma (15%), pneumonia (14%) and acute upper respiratory infection (AURI; 7.2%). The hospital incidence rate (HIR) of RTD was 34/10 000 inhabitants/year. It was 18.2; 5.07; 4.7 and 2.4/10 000 inhabitants for AB, asthma, pneumonia and AURI, respectively. We noted a significant increase in the HIR of RTD with an annual percentage change (APC) of 10.94% (P < 0.001); in the HIR of AB (APC, 5.27%; P < 0.001); and in asthma HIR (APC, 11.2%; P < 0.001). Otherwise, a significant decrease in AURI HIR was observed (APC, -8.8%; P < 0.001). AB lethality rate increased significantly, with an APC of 7.4% (P < 0.001). Projected trends analysis up to 2024 showed a significant rise in AB and in asthma, while AURI would significantly decrease., Conclusions: RTD continues to be a serious health problem over time in terms of morbidity and mortality. Preventive and curative strategies are needed urgently., (© 2017 Japan Pediatric Society.)

Aneurinibacillus migulanus has biocontrol activities against fungal, fungus-like, and bacterial plant pathogens with different levels of efficacy depending on the target pathogens. Here, we report the high-quality draft genome sequence of A. migulanus NCTC 7096., (Copyright © 2015 Alenezi et al.)

A bioreactor cascade with a submerged biofilm is proposed to treat young landfill leachate of jbel chakir landfill site south west from capital Tunis, Tunisia. The prototype was run under different organic loading charges varying from 0.6 to 16.3 kg TOC m(-3)day(-1). Without initial pH adjustment total organic carbon (TOC) removal rate varied between 65% and 97%. The total reduction of COD reached 92% at a hydraulic retention time of 36 h. However, the removal of total kjeldahl nitrogen for loading charges of 0.5 kg Nm(-3)day(-1) reached 75%. The adjustment of pH to 7.5 improved nitrogen removal to a rate of 85% for loading charge of 1 kg Nm(-3)day(-1). The main bacterial groups responsible for a simultaneous removal of organic carbon and nitrogen belonged to Bacillus, Actinomyces, Pseudomonas and Burkholderia genera. These selected isolates showed a great capacity of degradation at different leachate concentrations of total organic carbon., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In the title compound, {[Cu(C2O4)(C6H16N2)].4H2O}n, the Cu atom is six-coordinate in a distorted octahedral geometry, and N,N,N',N'-tetramethylethylenediamine acts as a chelating ligand. The oxalate anion, which lies about an inversion centre, bridges the metal cations and forms infinite chains. The structure cohesion is ensured by hydrogen-bonding interactions, which form a three-dimensional framework.