IntroductionAn 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.MethodsA 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.ResultsReferrals 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.ConclusionThe current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.

Background Illicit substance use among college students represents one of the most complicated social problems. Studying its predictors could help deal with this problem more efficiently. Aims To determine the prevalence of life time illicit substance use and its predictors among Tunisian college students. Methods A cross-sectional study was conducted in five colleges in the region of Sousse, Tunisia in the 2012-2013 school year. A sample of 556 college students responded to an anonymous self-administrated questionnaire. Collected data concerned socio-demographic characteristics and substances use. Results The mean age of students was 21.8 ± 2.2 years. Females represented 51.8% of participants. Among respondents: 31 (5.6%) had used illicit substance at least once. Cannabis was the main substance used by 26 (4.7%) students. The average age of the illicit substance use initiation was 19 (±2.5) years while it was almost 17 (±3) years for both tobacco and alcohol use initiations. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, tobacco use and low socioeconomic level. Conclusion This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Background Bullying is a serious public health concern affecting the emotional well-being of pupils. We conducted this study to examine the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior. Methods This is a cross-sectional study conducted in 2015 among a representative sample of pupils enrolled in 14 colleges in Sousse using the revised Olweus Bully/Victim Questionnaire. Results We included 1584 students aged between 11 and 15 years. The prevalence of bullying and victimization was 16.0% [95% CI: 14.2%, 17.8%] and 11.3% [95% CI: 9.7%, 12.9%] respectively. Four groups of students were identified, 11.7% 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 (38.3%, p < 10-3) and liking school (30.0%, p < 10-3). They were more likely to be aggressive (56.2%, p < 10-3) and disintegrated in the class (30.6%, p = 0.002). Among the victims, 11.1% reported that their parents contacted the school several times to stop their victimization. The majority of the middle school students perceived that their classmates (54.1%) and teachers (39.5%) did nothing to counteract the bullying behavior. Conclusions The school institution is expected to be for pupils a highly meaningful space for social, emotional and academic development. Parents, teachers and students should learn effective ways to handle the bullying problem since it has been emphasized that the most effective programs are comprehensive targeting students, schools, families, and the community. Key messages This is the first study conducted in Tunisia to highlight the extent of school bullying. Our findings can help to raise awareness of parents, school staff and policy makers about bullying.

No abstract

IntroductionLa mortalité maternelle est un problème majeur de santé mondiale. Une grande proportion de ces décès serait évitable par des soins adéquats, une aide à l'accouchement, la disponibilité des soins d'urgence et l'utilisation des outils d'aide à la décision tels que le partogramme. L'objectif était d’évaluer l’écart entre ce qui est censé être fait et ce qui est fait réellement pour les différents paramètres situés dans le partogramme au sein d'une maternité de 3ème niveau et élaborer des recommandations pour la mise en place d'un plan d'action.MéthodesIl s'agit d'une étude descriptive rétrospective par audit clinique, effectuée sur un échantillon de 400 dossiers obstétricaux des parturientes ayant accouchées dans la maternité du CHU Farhat Hached durant l'année 2011. Le référentiel utilisé est celui réalisé par l'Agence Nationale d'Accréditation et d'Evaluation en Santé en l'an 2000, concernant la qualité de la tenue du partogramme.RésultatsLa majorité des critères d’évaluation portant sur la présentation du partogramme était conforme. Deux critères concernant la variété de la présentation et le rythme cardiaque fœtal étaient non conformes parmi ceux portant sur la surveillance du fœtus. Plusieurs critères en rapport avec la surveillance de la mère étaient non conformes. Aucun des critères portant sur les traitements administrés et les marqueurs d’évènements n'est conforme. Les critères portant sur la naissance et la surveillance immédiate qui étaient non conformes sont: le début des efforts expulsifs, le mode d'accouchement, l’état du périnée, la délivrance et la révision utérine.ConclusionLa véritable démarche de l'audit clinique se doit d'aller au-delà du recueil et de l'analyse des données, le but final étant l'amélioration des pratiques.

Introduction: Malignant pleural mesothelioma is a rare tumour with a bad prognosis. The only consensual prognostic factors are represented by the stage and the histologic type. Concerning the histologic type, epithelioid mesothelioma is known to have better prognosis in comparison with the sarcomatoid and biphasic types. Epithelioid mesotheliomas have been reported to be a heterogeneous prognostic group. Our aim was to assess the impact on the survival of different characteristics of epithelioid mesothelioma, including nuclear atypia, mitotic count, MIB-1 index, inflammatory host response, stromal desmoplasia, necrosis, vascular emboli and invasion depth. Material and methods: We performed a study of survival of 30 malignant pleural mesotheliomas according to the different parameters studied. Results: The study included 26 women and 4 men. The mean age of the patients was 61 years. The microscopic exam concluded to an epithelioid mesothelioma in 17 cases, sarcomatoid mesothelioma in 4 cases and biphasic mesothelioma in 9 cases. The 17 cases of epithelioid mesothelioma developed severe nuclear atypia in 6 cases and mild nuclear atypia in 11 cases. The mitotic count and the MIB-1 score were respectively inferior to 5 mitoses/50 HPF and inferior to 10% in 11 cases and were superior to 5 mitoses/50 HPF and superior to 10% in 6 cases. No vascular emboli were recorded. Tumour necrosis was reported in 1 case. The inflammatory host response was severe in 4 cases and mild in 13 cases. The tumoral stroma was desmoplastic in 4 cases. The invasion depth was superior to 0.5mm in 16 cases. The median overall survival amounted to 180 days. Nuclear atypia was the only feature that had impact on survival in the group of epithelioid mesothelioma. Conclusion:Our results highlight the correlation of nuclear atypia with survival.

Introduction. Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim. To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods. This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results. The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference ( p = 0.08 ). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion. Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.

No abstract