Abstract Introduction Therapeutic education is a patient-centered, approach aimed at addressing the patient’s needs and resources. It is intended not only to help the patient understand their illness and treatment but also to empower them to become autonomous. So far, in Tunisia, we lack structures for therapeutic education specifically tailored for coronary patients. In this context, we implemented a Therapeutic Education Program (TEP) for coronary patients visiting the cardiology department at Sahloul University Hospital with the aim of assessing the impact of this program in the short, medium (3 months), and long term (12 months). Methods We conducted a quasi-experimental study on TEP for patients with coronary artery disease over one year at Sahloul University Hospital. Patients were divided into two groups, intervention, and control. Outcome measures included major cardiovascular events, improvement in knowledge, and biological indicators, with statistical analysis performed using SPSS in accordance with ethical considerations. Results The study included 129 patients, of whom 38 underwent a therapeutic education program. TEP demonstrated a significant improvement in knowledge about coronary artery disease, with program satisfaction rated ≥8 on a scale of 0 to 10.Our program also showed improvement in biological parameters, particularly lipid profiles, within the educated group before and after 3 months, such as LDL cholesterol levels (2.53 vs 1.88, P < 0.001), and compared to the control group (1.88 vs 2.9, P = 0.001).Moreover, it led to a significant reduction in long-term cardiovascular events compared to the control group (21.1% vs 59.3%, p < 0.001). Conclusions this study underscores the crucial importance of therapeutic education in enhancing the care and quality of life of coronary patients, highlighting its central role in a proactive, personalized approach to medical management. Key messages • The significance of therapeutic education in empowering patients to understand their condition and become self-reliant. • Need for Structured Programs specifically for coronary patients in Tunisia.

Aim of the study. - To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics Population and methods. - We undertook an analytical cross-sectional study. The questionnaire was adminis-tered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Know-ledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life.Results. - We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabe-tes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D.Conclusion. - Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations. (c) 2022 Elsevier Masson SAS. All rights reserved.

De nombreuses recherches ont été menées afin d'évaluer les troubles mentaux notamment chez les adolescents. Ces troubles sont la première cause d'invalidité dans le monde et peuvent même conduire au suicide. Dans notre pays, les recherches portant sur cette problématique sont encore rares. L'objectif de notre étude était de déterminer la prévalence de la dépression, de l'anxiété et de mesurer le score d'estime de soi chez les adolescents. Nous avons réalisé une étude transversale dans la délégation d'Enfidha du gouvernorat de Sousse en Tunisie chez les collégiens et les lycéens. La collecte des données a été effectuée au cours de l'année scolaire 2019/2020. Un questionnaire structuré auto-administré a été utilisé dans ce but. Il comprenait les caractéristiques sociodémographiques, les comportements de style de vie et le dépistage des troubles mentaux suivants : la dépression (échelle « Beck Depression Inventory-II »), l'anxiété (le » Screen for Child Anxiety Related Disorders » (SCARED-C)) et la mesure du score d'estime de soi (« Rosenberg Self-esteem Scale »). Nous avons recruté les participants à l'étude par échantillonnage proportionnel avec une stratégie de sélection en grappes pour obtenir un échantillon représentatif. Un total de 1352 participants a été inclu dans l'étude avec un âge moyen de 16,07 ans (SD : 1,97). Les femmes représentaient 56 % de l'échantillon. Près de 40 % des participants ont redoublé au moins une fois (39,3 %). La dépression, tous stades confondus, a été signalée chez 79,1 % des adolescents. Les filles étaient plus enclines à être sévèrement déprimées (73,3 % contre 26,7 %) ; p<0,005. Concernant l'anxiété, plus de la moitié des élèves souffraient d'une anxiété certaine (51,3 %) avec une prédominance féminine (68,5 %). Nos résultats soulignent que 49,7 % des participants ont un faible score d'estime de soi. Il est crucial de répondre aux besoins des adolescents souffrant de troubles mentaux. La priorité doit être donnée dans la politique de santé publique à ce fléau via la promotion et le dépistage précoce. Adolescent, Santé mentale Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Le diabète type 2 pose le problème crucial de l’observance thérapeutique ; concept large associé à plusieurs facteurs. On a mené cette étude descriptive auprès des patients suivis pour diabète type 2 dans un hôpital de circonscription du centre tunisien pour déterminer leur niveau d’observance thérapeutique et les facteurs qui lui sont associés. Nous avons mené une étude transversale à visée analytique en utilisant un questionnaire élaboré pour les fins de cette étude et ayant inclus le questionnaire de Morisky à 8 items. L’observance ou l’adhésion thérapeutique ont été définies par un score ≥ 6 au questionnaire Morisky et l’équilibre glycémique a été défini par une HbA1c < 7 %. Nous avons inclus dans notre étude 50 patients diabétiques type 2 suivis à la consultation des chroniques de l’hôpital Mahdia. Un âge moyen était de 63,10 ± 10,72 ans. L’ancienneté du diabète était de 10,4 ± 7,12 ans. Dans notre population, seulement 54 % des patients étaient retrouvés observants pour leur traitement antidiabétique. Parmi les facteurs étudiés, seule la prise de traitements à type sulfamide était associée significativement à l’observance thérapeutique (p = 0,01). Optimiser l’observance dans le diabète contribue en effet à diminuer les complications de la maladie et les hospitalisations, améliore la qualité de vie des patients, et permet de diminuer les dépenses de santé. Nous étions limités par la taille faible de l’échantillon vu les circonstances de COVID-19. Des programmes multidisciplinaires pour l’éducation thérapeutique à l’échelle nationale et régionale seraient utiles pour améliorer l’observance thérapeutique chez les patients diabétiques.

To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life.We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D.Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations.

Le cyber-harcèlement scolaire constitue un grave problème de santé publique et d'éducation. Les adolescents ont un risque plus élevé de subir la cyber-harcèlement en tant que victime étant donné la fréquence de leur utilisation d'Internet via des sites de réseaux sociaux tels que Facebook et des appareils mobiles tels que les téléphones portables et les tablettes. La victimisation par cyber-harcèlement est répandue dans le monde atteignant des taux de prévalence allant jusqu'à 15 %. La connaissance des facteurs de risque de ce cyber-harcèlement chez les collégiens est cruciale pour la mise en œuvre les mesures préventives adéquats. Cette étude vise à déterminer la prévalence du cyber-harcèlement chez les collégiens de la région d'El Kef (Tunisie) et d'identifier ses facteurs associés. Une étude transversale à visée analytique a été conduite auprès d'un échantillon en grappe de collégiens de la région d'El Kef. Un questionnaire auto-administré a été utilisé pour recueillir les caractéristiques sociodémographiques et éducatives des participants. L'échelle d'Olweus Bully/Victim révisée (OBVQ-R) a été utilisée pour évaluer la prévalence et les formes de victimisation par harcèlement. Un modèle de régression logistique binaire a été utilisé pour identifier les facteurs associés au fait d'être victimes de cyber-harcèlement. Au total, 1111 collégiens âgés de 11 à 17 ans (moyenne d'âge 13 ans (SD=1,03)), ont participé à l'étude. Cet échantillon était composé de 472 garçons (42 %) et de 639 filles (58 %). La prévalence de la victimisation par cyber-harcèlement était de 14,3 %. Au terme de l'analyse multivariée, deux facteurs ont été retenus comme associés à la victimisation par cyber-harcèlement (tableau 1). En fait, les filles étaient plus à risque de cyber-harcèlement que les garçons (OR=1,67 ; CI 95%=[1,14-2,37]). Alors que les non redoublants semblent être protégés contre le cyber-harcèlement (OR=0,29 ; CI 95%=[0,20-0,43]). (tableau 2). Le cyber-harcèlement est une expérience fréquente chez les collégiens tunisiens. Ces résultats s'ajoutent aux données empiriques sur la victimisation par cyber-harcèlement et renforcent le besoin urgent de prévention du cyber-harcèlement en Tunisie. En outre, du point de vue de la pratique, il est important d'accroître notre sensibilisation au cyber harcèlement et de réduire ses facteurs de risque. Cyber-harcélement , Victimisation , Adolescents , Milieu scolaire Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

L'épuisement académique ou « burnout » (BO) chez les étudiants en médecine sollicite de plus en plus de l'intérêt en recherche en éducation médicale. Il a un impact négatif important sur les étudiants en médecine et sur la qualité de leurs services. Cela pourrait nuire à leur développement professionnel, affaiblir leurs qualités personnelles et professionnelles, et engendrer des problèmes tels que l'accroissement des erreurs médicales et la réduction de la qualité et de la satisfaction des patients. Cette étude vise à étudier les effets du stress perçu, des caractéristiques socio démographiques et académiques et des habitudes de vie des étudiants en médecine sur l'épuisement académique. Une étude transversale à visée analytique a été menée à la Faculté de médecine de Sousse (Tunisie), auprès des étudiants de 1ère, 2ème, 4ème et 5ème années. Un questionnaire auto-administré a été utilisé pour recueillir les caractéristiques sociodémographiques et académiques, ainsi que les habitudes de vie des participants. L'échelle de « Maslach Burnout Inventory » (MBI-SS) à 15 items dans sa version pour les étudiants a été utilisée pour évaluer le niveau d'épuisement académique. De plus l'échelle de stress perçu (« Perceived Stress Scale », PSS) à 10 items a été utilisée pour évaluer le niveau de stress perçu. Une régression linéaire hiérarchique a été effectuée pour explorer les effets du stress perçu, des caractéristiques socio démographiques, les caractéristiques académiques et les habitudes de vie sur l'épuisement académique Au total, 703 étudiants âgés de 18 à 31 ans (moyenne d'âge 21 ans±1,84), ont participé à l'étude. Cet échantillon était composé de 499 filles (70,98 %) et de 204 garçons (29,01 %). Au terme de l'analyse multivariée, le stress perçu était positivement associé à l'épuisement académique (épuisement émotionnel (EE) : ß=0,36, p<0,001 ; cynisme : ß=0,41, p<0,001 ; efficacité professionnelle : ß= -0,34, p<0,001). Alors que, le niveau d'étude avait un effet positif sur l'épuisement émotionnel et le cynisme : plus le niveau d'étude augmente, plus les niveaux d'EE (ß=0,16, p<0,001) et cynisme (ß=0,07, p<0,001) augmentent. Par ailleurs, la consommation d'alcool semble accroitre le niveau de cynisme (ß=0,069, p=0,05), mais réduire le niveau d'efficacité académique (ß=-0,09, p=0,01). Quand au niveau d'éducation du père, il avait principalement un effet positif sur l'épuisement émotionnel. En effet, plus le père est éduqué, plus le score d'EE est important (ß=0,12, p=0,001). Au final, les étudiants redoublants avaient un score d'efficacité académique plus faible que les non redoublants (ß=-0,1, p=0,004). Le stress perçu était un fort indicateur d'épuisement académique. De plus, les étudiants en médecine ont un risque accru de développer un BO durant leurs années d'études, ce qui pourra se répercuter négativement sur leur carrière et leur relation avec leurs patients. De nombreuses interventions doivent être instaurées visant à améliorer notamment l'environnement éducatif et de pratique des étudiants en médecine. Stress perçu, Epuisement académique, Etudiants, Médecine Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Déterminer les facteurs de risque de détérioration de la qualité de vie des diabétiques tunisiens. Nous avons mené une étude analytique transversale qui a colligé des diabétiques de type 1 et de type 2, sélectionnés par un échantillonnage non probabiliste, de convenance. Un questionnaire auto-administré rédigé en langue arabe comportant les données générales et spécifiques au diabète et la version arabe validée du « Diabetes Health Profile-18 » a été remis aux diabétiques. Trois cent trente-trois diabétiques de type 1 et de type 2, âgés en moyenne de 51,11 (16,21) ans, avec un sexe-ratio de 0,94, ont été colligés. Les réponses au questionnaire ont mis en évidence une qualité de vie globalement altérée, dans les domaines de la psychologie, des activités et de l’alimentation chez les diabétiques de l’étude. Après analyse multivariée, le sexe féminin (p = 0,005), un niveau socioéconomique bas (p = 0,007) et l’irrégularité du suivi médical (p = 0,04) étaient des facteurs de risque de l’altération de la qualité de vie des diabétiques. Cette étude souligne le rôle majeur d’une prise en charge globale et de la gestion des facteurs de risque de détérioration de la qualité de vie des diabétiques.

Déterminer les facteurs associés aux bonnes attitudes des diabétiques sur leur maladie. Nous avons mené une étude descriptive corrélationnelle. Un échantillon de convenance de diabétiques a été recruté. L’instrument de mesure utilisé était auto-administré en langue arabe et comportait les données démographiques et cliniques du patient et le « Diabetes Attitude Scale -3 » dans sa version arabe valide pour mesurer les attitudes des diabétiques sur leur maladie. Au total, nous avons colligé 333 diabétiques d’âge moyen de 51,11 (16,21) ans. Leur attitude sur le diabète était positive. L’étude des facteurs associées aux attitudes sur le diabète a montré que le niveau d’éducation était significativement associé à l’amélioration de la dimension de la « gravité du diabète de type 2 » ( p < 10 −3 ), à la valeur de la dimension du « contrôle glycémique serré » ( p < 10 −3 ) et à la dimension de « l’attitude vers l’autonomie du patient » ( p < 10 −3 ). La durée du diabète était significativement corrélée à la dimension de « l’attitude envers l’autonomie du patient » ( r = 0,146 ; p = 0,008). Le contrôle glycémique était significativement associé à l’amélioration de la dimension de « la gravité du diabète de type 2 » ( p = 0,022). En nous basant sur les résultats de notre étude, nous pouvons suggérer qu’afin d’améliorer les attitudes des diabétiques, il faut agir efficacement sur les facteurs qui y sont associés.

Abstract Background Participation in a humanitarian mission can be considered as a heroic work especially for health professionals. In 2011, a refugee camp was set up in southern Tunisia. The objective of this study was to describe and better understand the experience of Tunisian nurses in the Choucha refugee campbased on the Meleis transition theory. Methods We conducted a qualitative, phenomenological study among 14 nurses using an interview guide. Data analysis was carried out according to the method of Giorgi, from which 5 core themes and 28 sub-themes had emerged. Results This studydescribed the experience of nurses as a passage between 4 different phases: before, during, after the passage to the refugee camp and the memory.Five core themes emerged from our research:1) Trigger events: 3 sub-themes were evoked for the reason of participation: motivation, commitment and expectations; 2) Professional and interpersonal relationships marked the integration of the interviewees despite some misunderstandings, 3) Coping, 4) The impacts are mostly positive, and 5) Feelings that expressed emotions and nostalgia. For the transition, the last stage, which is the appreciation of the past moments, indicated the passage from an unbalanced state to stability. Conclusions Looking at the lived experience of the nurses and the transition experience described by the participants, this study found that the lack of training of the nurses previous to the humanitarian mission was the major barrier to making a healthy transition. These findings can contribute to raise the awareness, preparation and education of nurses to improve the experiences of future caregivers who will participate in humanitarian missions. Key messages It seems essential to set up training program focusing on preparation and debriefing of nurses to support them in achieving a healthy transition in their humanitarian mission in refugee camps. Training health care professionals before their participation to humanitarian mission in refugee camps can be among the factors that enhance the quality of care provided to refugee populations.

Over the past years, Tunisia has experienced important reforms in the field of public health. The Tunisian medical faculties (Universities of Sfax, Tunis el Manar, Sousse and Monastir) play a key role in this endeavor by training public health professionals who can contribute to the modernization of the health system. Funded by the EC through Erasmus+ programme, the CONFIDE project (coordinated by Babes-Bolyai University, having as EU partners the Universities of Southern Denmark and Trnava, and the above mentioned Tunisian universities) has established the Research into Policy training programme by strengthening their capacity to provide public health training. The Research into Policy training programme has been delivered by the Centres for Evidence into Health Policy (C4EHPs) established within the Tunisian partner universities for the needs of CONFIDE. The training programme was implemented in four steps: (1) train the trainer sessions - the European experts trained 18 Tunisian trainers; (2) shadowing sessions - the trainers participated in shadowing sessions in the European partner institutions; (3) training delivery - the CONFIDE trainers, assisted by the European experts, delivered the training to an interdisciplinary group of 25 students and professionals; (4) internships - the students participated in internships in local health institutions. Three modules have been built within the Research into Policy training programme: Public health research, Health promotion policies and Evidence based public health policy. They contributed to increasing the public health knowledge and skills of the professionals trained. The training programme was well received by the Tunisian universities and the material developed so far during the project was adapted to the Tunisian context in the third step of implementation. On the long term, the project is expected to have an impact at the national level and produce updates at curricula level in the Tunisian medical faculties. Research into Policy training programme developed by the EC partners and culturally adapted by the Tunisian partners to the Tunisian public health context. Research into Policy training is a well-received tool for the high quality learning process in the public health field in Tunisian medical faculties.

Abstract Introduction Smoking cessation is the most important step to limit the complications of chronic obstructive pulmonary disease (COPD). Outcomes from studies that assessed the association between health-related quality of life (HRQL) and smoking cessation have been controversial. This study aimed to assess the relationship between HRQL and smoking cessation in patients with COPD in Tunisia. Methods A cross-sectional study was carried out in the two main primary care centers in the center of Tunisia over a period of three months (April-June 2016). Clinic and socio-demographic data were collected from patients' records. HRQL was assessed by the Medical Outcomes Study Short-form 36 (SF-36). This instrument is composed of two dimensions: physical and mental components. The questionnaire outcomes were described as means and standard deviation. T-test was performed to assess the statistical difference between the dependent and categorical variables. Results A total of 249 COPD patients participated in the study with a mean age of 67.77±11.13. Of this sample, 169 (67.9%) ceased smoking. The average period of smoking cessation was 10 years. The mean of total HRQL score in patients who ceased smoking was lower in comparison to patients who did not quit smoking (40.65±24.49, 43.37±24.49; respectively). The T-test reported a significant difference between the physical component of HRQL and smoking status. Patients with current smoking status had a better physical component score in comparison with patients who quit smoking (43.76±22.62, 37,86±18.21, p = 0.04, respectively). No significant differences were found between smoking cessation, mental component, and HRQL total score (p = 0.89, p = 0.39; respectively). Conclusions This study revealed that smoking cessation was associated with the physical component of HRQL. The smoking dependence in patients with COPD could explain this finding. Health care professionals should work harder on effective smoking cessation strategies. Key messages These findings suggested that HRQL was better among patients who did not quit smoking. Patients who did not cease smoking reported better physical status and poorer mental status in comparison with patients who quit smoking.

Abstract Background In recent years, patient safety has become a priority and a major target for improvement especially in the emergency rooms. According to the French National Authority for Health, 1/3 of serious adverse events could be avoided thanks to better coordination and better communication between the teams. Thus, this study aimed to describe the perceptions of healthcare professionals in the emergency rooms of Sousse-Tunisia regarding teamwork, and to determine the factors influencing it. Methods It is a descriptive cross-sectional study, conducted between December 2018 and April 2019. It included all the caregivers working in all the emergency rooms of Sousse-Tunisia. The measurement tool used in this study was “Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)” Teamwork Perception Questionnaire. Data were coded and analyzed by The Statistical Package for Social Sciences (SPSS 20.0). Results A total of 110 participants were recruited with a participation rate of 72.36%. Nurses represent more than half of the respondents (56.4%). Average work experience was 7.27 years. The Teamwork overall score was 2.5±0.5. The most developed dimension was leadership (2.7±0.8) and the less developed dimension was communication (2.3±0.7). Women had a significantly higher overall score than men (2.6±0.5, 2.4±0.3, p = 0.017). Results also showed that emergency technicians have significantly higher overall score than doctors and nurses (p = 1 × 10-5). The overall score also varied significantly across the hospitals (p = 0.016). Conclusions Our results showed that the level of teamwork still needs to be improved. Furthermore, various factors are associated with teamwork, and that should be taken into consideration to guide the future interventions. Key messages There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to focus on the affecting factors of teamwork, in order to prevent adverse events.

Abstract Background Patients use medicinal plants as the first-line treatment for many chronic and acute medical conditions. The lack of access to conventional health care, historical, cultural and economic considerations contributes to the important use of these plants. The purpose was to identify medicinal plants used by primary Health Care Centers' visitors in the region of Sousse (Tunisia) and to assess its associated factors. Methods A cross-sectional descriptive study was conducted among Primary health care centers' visitors of the region of Sousse (Tunisia) in 2018. We randomly selected 18 primary health centers and 50 participants were chosen from each center. Data were collected using a pre-tested questionnaire, filled through a direct interview with participants which explores: socio-demographic variables and medicinal plants' use (name of plants, symptoms, methods of preparation, routes of administration, plant source, tolerance and side effects). Results 900 persons were included with a female predominance (72.4%). The median age of participants was 48 years ranging from 18 to 93. 65.2% (n = 587) of them report using medicinal plants to heal. The most common sources of information were family (90.5%), beliefs and traditions (56.4%). Fifty-three (53) plants were used to treat different disorders. The most used plants are: verbena (81.6%), rosemary (53.3%), mint (52%) and thyme (45.1%). The most reported treated symptoms were: flu and gastro-intestinal disorders. Plants utilization was associated to: lower age, female gender, marital status, high level of education and social existence of protection coverage. Conclusions Plants use should be based on well-conducted scientific results specifying the mechanism of action of plants, the therapeutic and toxic dose through researches on local plants samples and extracts. Key messages It seems essential to train health professionals on herbal therapy during their studies and practice. The further step after this picture of the herbal medicine use in the Region of Sousse, is to evaluate the safety and the efficacy of their use.

M Limam, J Sahli, I Khalfallah, M Mellouli, M Ghardallou, A Mtiraoui, C Zedini, T Ajmi Department of Family and Community Medicine, Université de Sousse, Faculty of Medicine of Sousse, Research Laboratory ‘‘LR12ES03’’, Sousse, Tunisia Contact: dr-jihene19@hotmail.com Background: Patients use medicinal plants as the first-line treatment for many chronic and acute medical conditions. The lack of access to conventional health care, historical, cultural and economic considerations contributes to the important use of these plants. The purpose was to identify medicinal plants used by primary Health Care Centers’ visitors in the region of Sousse (Tunisia) and to assess its associated factors. Methods: A cross-sectional descriptive study was conducted among Primary health care centers’ visitors of the region of Sousse (Tunisia) in 2018. We randomly selected 18 primary health centers and 50 participants were chosen from each center. Data were collected using a pre-tested questionnaire, filled through a direct interview with participants which explores: sociodemographic variables and medicinal plants’ use (name of plants, symptoms, methods of preparation, routes of administration, plant source, tolerance and side effects). Results: 900 persons were included with a female predominance (72.4%). The median age of participants was 48 years ranging from 18 to 93. 65.2% (n = 587) of them report using medicinal plants to heal. The most common sources of information were family (90.5%), beliefs and traditions (56.4%). Fifty-three (53) plants were used to treat different disorders. The most used plants are: verbena (81.6%), rosemary (53.3%), mint (52%) and thyme (45.1%). The most reported treated symptoms were: flu and gastro-intestinal disorders. Plants utilization was associated to: lower age, female gender, marital status, high level of education and social existence of protection coverage. Conclusions: Plants use should be based on well-conducted scientific results specifying the mechanism of action of plants, the therapeutic and toxic dose through researches on local plants samples and extracts. Key messages: It seems essential to train health professionals on herbal therapy during their studies and practice. The further step after this picture of the herbal medicine use in the Region of Sousse, is to evaluate the safety and the efficacy of their use.

Abstract Background Adolescence is one of the main growth periods of life during which dietary needs are specific and where diet quality is important for healthy development. Nonetheless, unhealthy eating behaviours are common among adolescents including over consumption of unhealthy fast food, sugar and fat and skipping meals. Exposure to unhealthy eating can lead to chronic conditions such as obesity and diabetes. In this context, we conducted this study to describe the quality of the diet of middle school students in the Region of Kairouan in Tunisia. Methods This is a cross-sectional study conducted in 2017 among middle school students in the Region of Kairouan. Data collection was carried out using a self-administered questionnaire. Results In this study, 494 students were included. In terms of food type, fast food meals (sandwiches) were the most preferred type of food (52.6%). Daily consumption of vegetables and fruit was reported by 48.8% of students. Among the participants, 46.8% reported daily consumption of olive oil. Daily water consumption was less than one liter for 32% of the college students. Daily coffee and/or tea consumption concerned 53.8% of respondents. In the current study, 39.3% of the students reported that they consume more than three meals per day and 26.7% declared that they often skip the breakfast. In our study, 62.8% of the participants had reported their dissatisfaction with their nutrition education, 54.9% sought to know the food composition and 57.9% reported that they have a willingness to adopt a healthy eating. Conclusions A quality and diversified diet can cover the specific nutritional needs of adolescents. A diet inspired by the Mediterranean food is to be encouraged. Further studies should be conducted among adolescents to evaluate the impact of a healthy and balanced diet on health and school achievement. Key messages The quality of diet of Tunisian adolescents is to be improved. Effective comprehensive programs for healthy lifestyle promotion are needed to improve the eating behaviour among Tunisian adolescents.

Abstract Background Teamwork is fundamental to ensuring the quality of care and patient safety in operating rooms. It has been shown that the occurrence of adverse events is closely linked to a poor quality of teamwork in these settings. Thus, this study aimed to assess teamwork in different operating rooms of the university hospital of Sahloul Sousse (Tunisia). Methods It is a descriptive cross-sectional study with convenience sampling, conducted in operating rooms of the university hospital of Sahloul Sousse (Tunisia) between February and April 2018. The measuring instrument was the validated observation grid 'Communication and Teamwork Skills Assessment Tool (CATS) '. Teamwork is assessed through 4 domains (Situation awareness, Coordination, Communication, Cooperation). Behaviors are marked in rows each time they occur and are rated for quality in columns labeled “Observed and Good,” “Variation in Quality” (meaning incomplete or of variable quality), and “Expected but not Observed.” Results A total of 51 interventions were observed. Good coordination between the team members was noted, as well as good cooperation within the teams. A variation of quality level of communication with the patient was noted in 31.4% of cases, also communication about the context, the situation and recommendation among caregivers is not quite good with a percentage of 39.2%. Moreover, the work environment was rated as good in 84.3% of cases. Conclusions Some failures in teamwork were noted, hence it is important to take corrective measures for better practice and better patient management in such a complex environment, the operating rooms, where there is a strong need for team coordination. Key messages There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to eliminate the barriers to communication, in order to prevent adverse events.