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Biomedical subjects

N Achour

Publications and source records attributed to N Achour.

At least 19 recordsLinked to original sources
PubMed2005

[Epidemiological transition and health impact of cardiovascular disease in Tunisia].

OBJECTIVE: We aim at analysing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. METHODS: Data are recorded through the Tunisian National Morbidity and Mortality Survey (TNMMS). In order to assess the CVDs (CHDs vs RHDs) trend, two representative samples of Cardiology Departements patients were compared one is selected from the TNMMS and the second from the hospitalisations recorded in 1992. Causes, stay duration, status at the end of the hospitalisation, transfer to another hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. RESULTS: CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectivly 58.8% and 38.2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. CONCLUSION: This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological, social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities.

Adult↗
PubMed2004

[The first Tunisian cardiovascular diseases register: processes and results].

BACKGROUND: In Tunisia, cardiovascular diseases are the leading causes of death (30%) and a few studies conducted in the population have demonstrated that the level of their risk factors is increasing. For policy makers, the health system impact of these diseases is currently a crucial issue. The National Public Health Institute has identified the implementation of a morbidity register as a priority. METHODS: A CVD morbidity register is implemented since 2001, in 3 different geographical populations having contrasted levels of health status (Tunis, Ariana and Ben Arous). The 3 regions are covering about 2 millions inhabitants which is the fifth of the overall Tunisian population. All coronary heart events occurring among adults 25 years old and above in the 3 populations are recorded. The diagnosis of events, case fatality and classification are defined according to MONICA criteria. The data are recorded from public and private hospitals, death certificates and autopsies. RESULTS: During the year 2001, the total number of myocardial infarction events was estimated at 942: in men, the age-standardized rates were 163.8/100000 in Tunis population vs. 161.9 in Ariana and 170.5 in Ben Arous. In women, the rates were respectively 43.4, 61.1 and 44.6. Medical causes of death registration was the most crucial problem in spite of the implementation of the death certificate designed according to WHO model. Specific surveys for clinical assessment and surveillance of risk factors were conducted in the register populations. CONCLUSION: It is the first time that data on coronary heart disease incidence and fatality are available in Tunisia through this experience which highlights the practical difficulties experienced in registering and coding coronary events in a developing country. The data source quality should be improved and the register should be integrated in the local health system.

Adult↗
PubMed2003

[Life years lost and epidemiological transition in the Sfax region (Tunisia)].

OBJECTIVE: To assess the burden of disease in the Sfax region and identify the main diseases that are the cause of lost life years due to premature death. METHODOLOGY: The calculation of lost life years due to premature death was conducted using the demographic mortality data for the region obtained from the National Institute of Statistics combined with data on the classification of the causes of death collected through a survey on these causes conducted through a random sample taken from half of the deaths in the region. As described by Murray and Lopez, years of life lost as a result of premature death represent the difference between the age of death and an age corresponding to life expectancy falling between 65 and 85 years. RESULTS: Out of a total of 52,316 life years lost that were recorded 27,902 were in the male population and 24,414 in the female. The main diseases found in males which cause lost life years are accidents (24.9%), cardiovascular diseases (17.3%), communicable diseases (17%), respiratory diseases (10.8%), prenatal problems (59.5%), and cancer (7.5%). For women the main causes were cardiovascular diseases (26.5%), respiratory illness (15.5%), accidents (11.5%), communicable diseases (10.3%) and cancer (9.5%). RECOMMENDATIONS: These results marking the epidemiological transition in the region should serve to steer decision-makers to better rationalize and plan for health care costs and expenditure.

Adolescent↗
PubMed2003

[Smoking dependence and symptoms of anxiety and depression among Tunisian smokers].

INTRODUCTION: The aim of this study was to describe the incidence of depression and anxiety, and their relationship with smoking dependence, in patients attending a Tunisian smoking cessation clinic. METHODS: We studied 72 Tunisian smokers attending the smoking-cessation clinic at the Charle Nicolle Hospital in Tunis. Nicotine dependence was assessed by the Fageström Test for Nicotine Dependence. Anxiety and depression symptoms were measured using the HAD (Hospital Anxiety Depression) Scale. RESULTS: The prevalence of anxiety and depression was 22.9% (16 patients) and 20% (14 patients) respectively with four patients (7.1%) exhibiting symptoms of both. Overall, 50% of the group had emotional morbidity with high HAD scores for depression or anxiety, or both. Smokers with symptoms of anxiety and/or depression had higher physical and psychological dependence, smoked more at times of stress, had a reduced quitting rate and endured more withdrawal symptoms than those smokers without anxiety or depression. CONCLUSIONS: The data of this survey from Tunisia, a country that has just put in place a tobacco control strategy, underline the high rates of anxiety and depression that exist in patients attending a smoking cessation clinic. It confirms the association between anxio-depressive disorders and a high level of smoking dependence.

Adult↗
PubMed2003

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers].

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians. The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice.

Breast Neoplasms↗
PubMed2001

[Medical studies in Tunisia].

In this report, the author analyses the Tunisian medical studies following their main stages of evolution, since the creation of the first medical university (1963), and focus on the major reforms. A great interest was designed to evaluate the comity findings reforms, held during the 1990, which has lead to undertake many measures for the medical studies. The author expose the measures applied, since 1990 in his report.

Curriculum↗
PubMed2001

[Epidemiology and prevention of smoking in Tunisia: current situation and perspectives].

This paper describes the trends in tobacco sales and smoking prevalence in the Tunisian population, estimates the consequences of smoking on mortality of this population, and discusses anti-tobacco actions: educational actions, legislative measures and price increases. Sales Data were collected from the Tunisia tobacco company. Smoking prevalence data from surveys, conducted by several institutes, and numbers of deaths by causes have been estimated from WHO for the year 1998. Tobacco sales increased from 4.96 g per adult per day in 1981, to 6.3 g, in 1993, then decreased widely. The proportion of smokers was 30% in 1996. 55% among men versus 5.6% among women. Among 17 to 24 years old young adults, the proportion of smokers was 29.2% in 1994 (50% among men versus 3.9%, among women). Mortality attributable to tobacco in Tunisia has been estimated to 6430 deaths in 1997 (5580 among men versus 850 among women). These deaths represent 22% of the total male deaths and 4% of the female ones. Anti-tobacco measures have been reinforced by the enactment of anti-tobacco law. Proportion of young smokers remaining elevated, it is expected that consequences of the tobacco addiction in Tunisia, in term of mortality, will be even heavier in the next two decades, if efficient anti-tobacco actions are not implemented.

Adolescent↗
PubMed2000

[Cost effectiveness of cervical cancer screening strategies in Tunisia].

Cervical cancer is a public health problem in developing countries and is the first cancer among women in several of these countries. Screening using the Pap test is the principle control strategy for this cancer. The aim of this study is to identify the highest cost-effectiveness strategy of Pap test screening, according to age group (20-64 years, 35-64 years and 40-64 years) and the frequency of this test (every 3 years or every 5 years). Number of cases avoid by screening and mean cost to prevent one case were used to compare these screening strategies. The principles results showed that the number of cervical cancer cases avoid increase with the coverage level of the screening and age group size, and decrease with the frequency of the Pap tests. The screening strategy interesting age group "40-64 years" every 5 years observed the highest cost-effectiveness ratio (19 MD); however cost is 23 MD for age grovy 35-64 years. These results lead to choice a frequency of Pap tests every 5 years. However, for determination of age group, other factors, as psycho-social ones, should be taken into account besides economic criterias.

Age Distribution↗
PubMed2000

[Trends in tobacco consumption in Tunisia].

Because tobacco-related diseases are a growing health problem, we assessed tobacco smoking in Tunisia since 1970 using different sources. The average consumption of tobacco calculated over the period of 10 years (1981-90) was 1493 g per person and per year; equivalent of 75 packets of cigarettes. Cigarettes are the most popular form of tobacco smoking. Cigarette smoking increased from 1981 to 1993 but since has decreased slightly. According to a national study of respiratory diseases conducted in 1996, the current prevalence of tobacco smoking is 30.4% for both sexes: around 52% for males and 6% for females. Average consumption is 17.7 cigarettes/day, irrespective of sex. For young people, the prevalence is 29.21%: 50% for males and 3.9% for females. Young people who attend school smoke less than those who do not (18.1% versus 38.4%). Most started smoking between 14 years and 18 years.

Adolescent↗
PubMed1990

[Incidence of male urethritis in Tunisia: estimate done with a survey by general practitioners (1985)].

In order to evaluate the yearly incidence of male urethritis in Tunis, a survey was carried out among general practitioners, dermatologists and dispensing chemists. During a 6-week period, the mean incidence was 3.16 +/- 1.2 for general practitioners, 4.65 +/- 2.0 for dermatologists and 3.76 +/- 1.0 for dispensing chemists. Taking into account the number of general practitioners in the Tunis district, the mean yearly incidence would be about 1,200 cases per 100,000 inhabitants, or 300 cases per 10,000 men aged 15 years and more. This rate is intermediate between estimations obtained by two mathematical hypotheses, taking non-responses into account: an optimistic hypothesis with an estimated incidence of about 1,700 cases, and a pessimistic hypothesis of about 800 cases per 100,000 inhabitants, a figure which agrees with an estimate based on the sale of specific drugs used for gonorrhoea. This study emphasizes the fact that more than two-thirds of the patients are treated by private dispensing chemists, and only 7% of the cases are notified to the primary health care centres.

Adolescent↗