344 research outputs found
Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.
Background. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. Methods. We developed and validated a Markov model for the Tunisian population aged 35â94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). Results. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (â30240 [â30580 to â29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. Conclusions. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations
Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop
Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases.
However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers
that hinder integrated work between researchers and policy-makers. This paper describes a âpolicy effectivenessâfeasibility loopâ (PEFL) that
brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and
policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying
them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key
stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological
modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate
how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern
Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to
generate evidence-based policy, and they encourage further evaluation of this approach
Trends in Secondary Prevention of Coronary Heart Disease in Tunisia: Prevention of Recurrences of MI and Stroke
ObjectivesThe survival benefits achieved by prescription of antiplatelet agents, B-adrenoreceptor antagonists (beta-blockers), angiotensin II receptor blockers (ARB), and lipid lowering agents in patients surviving the myocardial infarction (MI) have been well documented in large clinical trial. Despite well-established benefits, these pharmacological agents continue to be underutilized. The main objective of this study was to evaluate the progress of cardiovascular secondary prevention practices in Tunisia.MethodsThe PREMISE (Prevention of Recurrence of Myocardial Infarction and Stroke) is a descriptive, cross-sectional study conducted in Tunisia in two phases (2002 and 2009). Seven hundred eighty two patients were recruited. The recruitment criteria were: previous MI, stable angina, unstable angina, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), stroke, transient ischemic attack (TIA) or carotid endarterectomy. This analysis is limited to coronary heart disease (CHD) patients. Five hundred hospital patients were interviewed and their medical records were reviewed: 250 in 2002 and 250 in 2009. Patients were included if they had confirmed diagnosis of MI, angina, CABG or PTCA, and if their first cardiovascular event had occurred more than one month but not later than 3 years ago. We compared the total of both patient groups, using the prevalence of Cardio-Vascular Risk Factors (CVRF) and the treatment prescribed at hospital discharge.ResultsThe proportion of patients with reported hypertension, diabetes, hypercholesterolemia and current smoker patients had decreased. Concerning pharmacological prescriptions, a significant increase was observed in prescribing statins (38.9% vs. 70.3%) and ACE inhibitors (49.3% vs. 69.9%), non pharmacological prescriptions as healthy diet or tobacco cessation had opposite trends. Adherence to treatment did not change substantially.ConclusionAlthough the use of cardioprotective drugs had increased in CHD patients, there are still gaps in secondary prevention in Tunisia. The recommended strategies of secondary prevention need to be applied more intensively in clinical practice
On d-symmetric classical d-orthogonal polynomials
AbstractThe d-symmetric classical d-orthogonal polynomials are an extension of the standard symmetric classical polynomials according to the Hahn property. In this work, we give some characteristic properties for these polynomials related to generating functions and recurrence-differential equations. As applications, we characterize the d-symmetric classical d-orthogonal polynomials of Boas-Buck type, we construct a (d+1)-order linear differential equation with polynomial coefficients satisfied by each polynomial of a d-symmetric classical d-orthogonal set and we show that the d-symmetric classical d-orthogonal property is preserved by the derivative operator. Some of the obtained properties appear to be new, even for the case d=1
La mucormycose nasosinusienne: Diagnostic et modalites therapeutiques
La mucormycose est une infection fongique rare qui touche essentiellement les sujets immunodĂ©primĂ©s et notamment diabĂ©tiques. La localisation de cette maladie est surtout nasosinusienne. Son pronostic reste mauvais malgrĂ© le dĂ©veloppement des moyens de prise en charge. Nous rapportons deux cas de mucormycose nasosinusienne Ă travers lesquels nous discutons les aspects cliniques et radiologiques, ainsi que les moyens thĂ©rapeutiques de cette maladie. Il sâagit dâun homme et dâune femme ĂągĂ©s respectivement de 56 et 52 ans. Le premier Ă©tait diabĂ©tique et la deuxiĂšme insuffisante rĂ©nale. LâĂ©volution Ă©tait lente dans le premier cas et trĂšs rapide dans le deuxiĂšme. Le diagnostic Ă©tait dans les deux cas histologique. LâĂ©volution Ă©tait, dans le premier cas, favorable aprĂšs traitement associant dĂ©bridement chirurgical et amphotĂ©ricine B, et dans le second rapidement fatale. Conclusion : La mucormycose nasosinusienne est une affection grave dont le pronostic peut ĂȘtre mauvais malgrĂ© le traitement.Mots clĂ©s : Infection fongique, mucormycose rhinocĂ©rĂ©brale, zygomycĂštes
The LPS O-antigen in photosynthetic Bradyrhizobium strains is dispensable for the establishment of a successful symbiosis with Aeschynomene legumes
The photosynthetic bradyrhizobia are able to use a Nod-factor independent process to induce nitrogen-fixing nodules on some semi-aquatic Aeschynomene species. These bacteria display a unique LPS O-antigen composed of a new sugar, the bradyrhizose that is regarded as a key symbiotic factor due to its non-immunogenic character. In this study, to check this hypothesis, we isolated mutants affected in the O-antigen synthesis by screening a transposon mutant library of the ORS285 strain for clones altered in colony morphology. Over the 10,000 mutants screened, five were selected and found to be mutated in two genes, rfaL, encoding for a putative O-antigen ligase and gdh encoding for a putative dTDP-glucose 4,6-dehydratase. Biochemical analysis confirmed that the LPS of these mutants completely lack the O-antigen region. However, no effect of the mutations could be detected on the symbiotic properties of the mutants indicating that the O-antigen region of photosynthetic Bradyrhizobium strains is not required for the establishment of symbiosis with Aeschynomene
Premature mortality attributable to smoking among Tunisian men in 2009
INTRODUCTION: Tobacco smoking is a significant public health threat in the world, a risk factor for many diseases, and has been increasing in prevalence in many developing countries. In this study, we aimed to estimate the burden of premature deaths attributable to smoking among Tunisian men aged 35-69 years in 2009. METHODS: The number of deaths attributable to smoking was estimated using the population attributable risk fraction method. Smoking prevalence was obtained from a nationally representative survey. Causes of death were obtained from the registry of the National Public Health Institute. Relative risks were taken from the American Cancer Society Prevention Study (CPS-II). RESULTS: Total estimated premature deaths attributable to smoking among men in Tunisia were 2601 (95% CI: 2268-2877), accounting for 25% (95% CI: 23.3-26.6) of total male adult mortality. Cancer, cardiovascular and respiratory diseases were the major causes of premature deaths attributable to smoking with 1272 (95% CI: 1188-1329), 966 (95% CI: 779-1133) and 364 (300-415) deaths, respectively. CONCLUSIONS: Tobacco smoking is highly relevant and is related to substantial premature mortality in Tunisia, around double that estimated for the region as a whole. This also has not decreased over the past 20 years. Urgent actions are needed to reduce this pandemic
Otospongiose : a propos de 149 cas
Introduction : Lâotospongiose est une ostĂ©odystrophie de la capsule otique se traduisant par une surditĂ© de transmission ou plus rarement une surditĂ© mixte dâapparition progressive. Le but de notre travail est dâanalyser les caractĂ©ristiques épidĂ©miologiques, cliniques, paracliniques et comparer les rĂ©sultats en fonction de lâĂąge, du stade de lâostĂ©odystrophie, de la technique chirurgicale et de la prothĂšse.Patients et mĂ©thodes : notre Ă©tude est rĂ©trospective portant sur 124 patients (149 oreilles) colligĂ©s sur une pĂ©riode de 9 ans (2000-2008).RĂ©sultats : notre population a comportĂ© 86 femmes et 38 hommes. La moyenne dâĂąge Ă lâintervention Ă©tait de 39,82 ans. La surditĂ© Ă©tait bilatĂ©rale dans 61,3% des cas et unilatĂ©rale dans 38,3%. Les seuils moyens prĂ©opĂ©ratoires de la conduction osseuse et aĂ©rienne Ă©taient respectivement de 17,33 dB et 52,52 dB, le rinne moyen Ă©tait de 35,19 dB. La tomodensitomĂ©trie a Ă©tĂ© rĂ©alisĂ©e chez 63 patients. On a rĂ©alisĂ© 21 platinectomie totale, 24 platinectomie partielle et 101 platinotomie calibrĂ©e. Selon la classification de Portmann, on a trouvĂ© une rĂ©partition sensiblement Ă©gale entre les stades II, III et IV. On a utilisĂ© un piston tĂ©flon 6/10 mm dans 119 cas et 4/10 mm dans 27 cas. Le rinne moyen postopĂ©ratoire était de 15,95 dB. a 1 an, le rinne Ă©tait de 14,81 dB avec un rĂ©sultat satisfaisant de 94,2%.Conclusion : Il ressort de notre travail que certains facteurs semblent prĂ©dictifs de bons rĂ©sultats et qui sont : le sexe fĂ©minin, lâĂąge <50 ans, le stade chirurgical< stade IV, la platinotomie, et le piston 0,4 mm.Mots clĂ©s : otospongiose, conduction osseuse, conduction aĂ©rienne, platinotomie, platinectomie.Objective : Otosclerosis is a common disorder of the otic capsule characterized by the presence of a progressive conductive or rarely mixed hearing loss. The aims of this study were to analyses the epidemiologic, clinical, paraclinical characteristic and compare our results according to age, stage, surgical technique and prosthesis. Patients et mĂ©thodes : Our study is retrospective about 124 patients (149 ears) in the period of 9 years (2000-2008).Results: Our population included 86 female and 38 male patients. mean age at intervention time was 39,82 years. The hearing loss was bilateral in 61,3% of cases and unilateral in 38,3%. The bone and air conduction threshold was 17.33 dB and 52,52 dB, the air-bone gap was 35,19 dB. The CT scan was realized in 63 patients. We have realized 21stapedectomy, 24 partial stapedectomy and 101 stapedotomy. In accordance with Portmann classification, the distribution between II, III and IV stages was almost equal. We used 6/10 mm Teflon piston prosthesis in 119 cases and 4/10 mm in 27 cases. The postoperative air-bone gap was 15,95 dB. after 1 year, the air-bone gap was 14,81 dB with a satisfying results in 94,2%.Conclusion: it seems that some factors are predictive for good results like a female sex, age<50 years, stage< stage IV, platinotomy and piston 4/10 mm.Keyswords : otosclerosis, bone conduction, air conduction, stapedectomy, stapedotom
Menopause and metabolic syndrome in Tunisian women
Objectives. This study aimed to evaluate the effect of menopausal status on the risk of metabolic syndrome (MetS) in Tunisian women. Methods. We analyzed a total of 2680 women aged between 35 and 70 years. Blood pressure, anthropometric indices, fasting glucose, and lipid profile were measured. The MetS was assessed by the modified NCEP-ATPIII definition. Results. The mean values of waist circumference, blood pressure, plasma lipids, and fasting glucose were significantly higher in postmenopausal than in premenopausal women, a difference that was no longer present when adjusting for age. Except for hypertriglyceridaemia, the frequency of central obesity, hyperglycemia, high blood pressure, and high total cholesterol was significantly higher in postmenopausal than in premenopausal women. After adjusting for age, the significance persisted only for hyperglycemia. The overall prevalence of MetS was 35.9%, higher in postmenopausal (45.7% versus 25.6%) than in premenopausal women. A binary logistic regression analysis showed that menopause was independently associated with MetS (OR = 1.41, 95% CI 1.10-1.82) after adjusting for age, residence area, marital status, family history of cardiovascular disease, education level, and occupation. Conclusions. The present study provides evidence that the MetS is highly prevalent in this group of women. Menopause can be a predictor of MetS independent of age in Tunisian women
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