Sihem Ben Fredj

Background: Chronic fatigue constitutes a critical occupational health challenge among healthcare workers with substantial implications for individual well-being and patient safety. Empirical evidence regarding chronic fatigue among healthcare professionals in North Africa remains limited, particularly in contexts where healthcare systems contend with resource constraints and elevated workload demands. Objective: This study aimed to determine the prevalence of chronic fatigue and chronic fatigue syndrome (myalgic encephalomyelitis (CFS/ME)) among healthcare professionals without severe chronic diseases at a university hospital in Tunisia and identify independent associations of chronic fatigue. Methods: We conducted a cross-sectional analysis of 205 healthcare professionals at University Hospital Farhat Hached, Sousse, Tunisia, from October to December 2021. Data were collected using a pre-test questionnaire to collect data about sociodemographic characteristics, chronic fatigue, quality of life, and lifestyle habits. A vitamin D3 test was also performed, as it is identified as an associated factor and potential biological modulator of chronic fatigue. Results: Chronic fatigue prevalence was 37.1%, with chronic fatigue syndrome (myalgic encephalomyelitis (CFS/ME)) prevalence of 11.2%. Multivariate analysis revealed good physical health-related quality of life (adjusted Odds Ratio (OR) = 0.08, p < 0.001) and good mental health-related quality of life (adjusted OR = 0.10, p < 0.001) as protective factors. Moderate-to-severe depression (adjusted OR = 5.84, p < 0.001) and obesity (adjusted OR = 2.50, p = 0.021) independently increased chronic fatigue risk. No independent association was detected between vitamin D levels and chronic fatigue. Conclusions: Chronic fatigue affects more than one-third of healthcare professionals in this resource-limited setting. Comprehensive occupational health interventions addressing psychological and metabolic health factors are needed to protect healthcare workers’ well-being and maintain the quality of care delivery.

To assess the effectiveness of health promotion programs among Arabic-speaking patients, it is essential to have valid and reliable assessment tools in Arabic. The objectives of this study were: to translate the “Healthy Lifestyle and Personal Control Questionnaire (HLPCQ)” into Arabic; and to study the psychometric properties of this version in a sample of Tunisian patients with diabetes. A cross-sectional study was conducted among consecutive patients followed for diabetes in an Endocrinology clinic in Tunisia. The HLPCQ was translated into Arabic by two bilingual translators and back-translated by two other bilingual translators. The translated version was then administered by a medical doctor to participants via phone interviews. Statistical analyses included reliability testing using Cronbach’s alpha, content validity and exploratory factor analysis. A total of 300 responses were obtained. The median age of participants was 57.5 years (IQR: 45.2–66.0). Females represented 55%. Cronbach’s alpha coefficients exceeded 0.7 for almost all subscales. Exploratory factor analysis revealed nine factors explaining 65.9% of the total variance. Overall, the Arabic version of the HLPCQ has satisfactory validity and reliability indices. It could be used to assess adherence to a healthy lifestyle among Tunisian patients and in other Arab-speaking countries.

Background: According to the WHO, COVID-19 pandemic has had a negative impact on the health, well- being of people worldwide. Healthcare workers (HCWs) represent a particularly vulnerable group due to increasing work stress. Our study aimed to describe the prevalence of job strain among...

Introduction: Children are susceptible to unhealthy lifestyle and have been shown to have various risk factors that may predispose them to development of non-communicable diseases (NCDs). The objective of our study was to assess NCDs risk factors among pre-school children in Sousse, Tunisia....

In Tunisia, despite the implementation of national strategies to prevent some of cardiovascular risk factors, these diseases still represent the leading cause of death. The current study aimed to determine the prevalence of cardiovascular risk factors and assess the screening and health education practices related to these factors among the adults of Sousse (Tunisia). A cross-sectional study was conducted in 1000 households in Sousse, Tunisia. To collect data, a team of trained medical doctors administered by interview a pre-tested questionnaire and performed blood pressure and anthropometric measures at the participants’ homes. In total, 1977 adults participated in the study. Their mean age was 39.8 (± 13.8) years. The Females/Males sex ratio was 1.5. Weight excess and lack of physical activity were found in 65.4% and 60.7% of participants. Screening for obesity and android obesity were reported by 36.6% and 5.7% of health services users. Advices from a healthcare professional to practice the recommended physical activity and eat healthily were reported by less than a third of these latter. Screening and health education practices related to cardiovascular risk factors should be reinforced in the Tunisian healthcare facilities. The implementation of multisectoral actions is necessary at the national level in order to obtain an environment that promotes a healthy lifestyle.

In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation. Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms. Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]). Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Background: People's lives were seriously affected by the emergence and the spread of the COVID-19 disease. Several vaccines were developed in record time to overcome this pandemic. However, putting an end to this public health problem requires substantial vaccination coverage rate. This latter depends on the acceptance of these vaccines especially by health professionals; the leaders of the current war against COVID-19. In fact, they have a central role in promoting vaccination against the SARS-CoV-2. In the developed countries, hesitancy rates towards these vaccines among health professionals vary from 4.3% to 72%. In the developing countries, few studies focused on this issue. Objective: To estimate the prevalence and the predictors of SARS-CoV-2 vaccine hesitancy among the Tunisian health professionals. Methods: A cross-sectional study was led online between the 7th and the 21th of January 2021 among Tunisian health professionals. At least 460 participants were required. Snowball sampling method served to recruit participants. Data were collected using a pre-established and pre-tested questionnaire recorded in a free Google form. The link of the questionnaire was disseminated online to be self-administered anonymously to the participants. The generated online Google Sheet was uploaded and exported to SPSS software for analysis. Results: Of the 546 responses, 493 were retained. The mean age of participants was 37.4 (± 9.5) years. Females represented 70.2% of participants. Social media represented the most frequently used source of information about COVID-19. The prevalence of SARS-CoV-2 vaccine hesitancy among participants was 51.9% (95% CI_: 47.5–56.3)). Female sex, working far from the capital and having concerns about the vaccines components predicted more hesitancy among participants. In contrast, the use of the national COVID-19 information website predicted less hesitancy among them. Conclusions: The current Tunisian communication plan about COVID-19 vaccines must be reinforced. Social media represent a cost effective communication channel that can serve to reassure Tunisian health professionals regarding the safety of COVID-19 vaccines. Special interest should be paid to females, paramedical professionals and those working far from the capital.

Background: Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs). Methods: We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers’ workplace. Results: Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038). Conclusion: This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.