Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: contributions from risk factor changes and treatments

Background Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. Methods Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model. Results Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2 kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. Discussion CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically

Factors impacting the height of the interproximal papilla: A cross‐sectional study

Abstract Objectives To determine the relationship between different parameters (age, periodontal phenotype, contact point height, and crown shape) and the height of the interproximal papilla around the teeth of/in the maxillary anterior sector. Material and Methods A total of 45 subjects were involved in this study, with 315 interproximal papillae of the maxillary anterior sector. The interproximal papillae were clinically classified according to the Norland and Tarnow classification. The periodontal phenotype was assessed by periodontal probe transparency through the marginal gingiva. The height of the papilla, the height of the contact points, and the width/length ratio of the crown were also measured using the periodontal probe. The relationship between the variables was studied using Pearson's correlation. Statistical significance was set at a value of p < .05. Results A positive correlation was found between age and the papilla score. However, a negative correlation was noted between age and papilla height, with statistically significant values. A negative correlation was found between the papilla score and the rest of the studied clinical parameters. However, this correlation was not found with regard to the height of the papilla with the same parameters, except for the height of the contact points. Conclusions A statistically significant relationship was noted between the appearance of the interproximal papillae and all the parameters studied

Health system challenges of NCDs in Tunisia

Objectives The objective of this study was to present a qualitative ‘situation analysis’ of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Methods Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson’s framework (1994) for policy analysis was used: content, actors, context, and process. Results Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. Conclusion This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.</p

Sterol, aliphatic alcohol and tocopherol contents of Quercus ilex and Quercus suber from different regions

2 Figuras.-- 3 TablasQuercus ilex and Quercus suber are grown typically in the Mediterranean area. The aim of the present work was to study the content of sterols, aliphatic alcohols and tocopherols in acorn oil of Q. ilex and Q. suber from different locations in Tunisia. The level of total sterols ranged from 4632.71 to 10985.10 mg/kg (Q. ilex) and from 6563.40 to 11576.09 mg/kg (Q. suber), and β-sitosterol was the predominant form (ca. 90%). The total content of aliphatic alcohols was between 1650.39 and 2969.99 mg/kg for Q. ilex and from 1532.81 to 3575.39 mg/kg for Q. suber, and tetracosanol was the most abundant (ca. 50%). The average tocopherol content was slightly higher in Q. ilex (ca. 190 mg/kg) than Q. suber acorn oil (ca. 140 mg/kg). Two isoform (α and γ) were detected and γ- tocopherol was the major compound (more than 90%). All these results highlight the possibility of using Q. ilex and Q. suber as a potential resource of biomolecules for the development of functional foods.The authors are grateful to the Higher Education and Scientific Research Ministry from Republic of Tunisia. This study was supported by the project P09-AGR-04789

Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment

Objectives The growing prevalence of non-communicable diseases across the Middle East and North Africa poses major challenges for underfunded health services. This article presents data on the perspectives of ordinary Tunisians who are coping with two of these diseases—diabetes and hypertension—and who are obtaining treatment through Tunisian public health clinics. Little has been written to date on patient experiences of biomedical treatment in Maghreb countries.<p></p> Methods Based on qualitative methods and semi-structured interviews with 24 patients attending two clinics, one urban and one rural.<p></p> Results We examine popular aetiological beliefs, ideas about biomedical treatment and its implications, and comparative views on the benefits and drawbacks of treatment in both public and private clinics.<p></p> Conclusions We highlight two main themes. One was nostalgia for a recent past when ‘pure’ and ‘natural’ food, ‘proper’ meals and less stressful lives meant less chronic illness, with demanding and costly treatment. The other concerned communication in the clinic, and the recurrent dismay patients felt at what they saw as the cursory attention and guidance they received from clinic staff in public facilities.<p></p

Social determinants of corpulence: a case of reverse causality ? Example among urban Tunisian women

<p>Poster presented at the "International Symposium on Social Determinants of NCDs in Mediterranean Countries", Istanbul, Turkey, 6-7 May 2013</p

Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries

This paper presents evidence from research into health system challenges of cardiovascular disease (CVD) and diabetes in four Eastern Mediterranean countries: the occupied Palestinian territory, Syria, Tunisia and Turkey. We address two questions. How has the health system in each country been conceptualised and organised to manage the provision of care for those with CVD or diabetes? And what were key concerns about the institutional ability to address this challenge? Research took place from 2009 to 2010, shortly before the political upheavals in the region, and notably in Syria and Tunisia. Data collection involved a review of key documents, interviews with key informants and brief data collection in clinics. In analysing the data, we adopted the analytical schema proposed by Walt and Gilson, distinguishing content, actors, context and process. Key findings from each country highlighted concerns about fragmented provision and a lack of coordination. Specific concerns included: the lack of patient referral pathways, functioning health information systems and investment in staff. Regarding issues underlying these ‘visible’ problems in managing these diseases, we highlight implications of the wider systemic pressure for reform of health-sector finance in each country, based on neoliberal models