Imen Mlouki

Background: Right‐sided colon cancer (RSCC) exhibits distinct characteristics, yet specific prognostic determinants remain insufficiently defined. This multicentre retrospective study evaluated clinicopathological and surgical factors influencing survival in a real‐world cohort undergoing curative resection for non‐metastatic RSCC. Methods: We analysed 800 adults undergoing curative‐intent resection for non‐metastatic RSCC across 28 centres (2018–2024). The primary outcome was 3‐year overall survival (OS). Multivariate Cox model identified prognostic factors. An exploratory, post hoc subgroup analysis evaluated the impact of complete mesocolic excision (CME) on OS, stratified by tumour anatomical subsite. Results: The mean age was 62.8 years, and 24% required emergency surgery. CME was performed in 57.1% of patients, with baseline characteristics reflecting significant real‐world selection bias against CME in complex clinical presentations. At 3 years (OS: 86%), multivariate analysis identified age (HR 1.071, 95% CI: 1.023–1.122, p = 0.004) and adjacent organ invasion (HR 3.642, 95% CI: 1.360–9.750, p = 0.010) as independent mortality predictors. Unadjusted post hoc analysis suggested CME was associated with improved OS for ascending colon and hepatic flexure tumours ( p = 0.003). Conclusion: Although CME showed an exploratory site‐specific survival advantage, the critical lack of molecular profiling (MSI, RAS, BRAF) prevents adjustment for major biological confounders. Consequently, these findings are strictly hypothesis‐generating, highlighting real‐world surgical bias and require prospective multi‐institutional validation before altering standard practice.

Background: Non-adherence to proper Healthcare Waste Management (HCWM) has the capacity to trigger healthcare-associated infections, posing a threat to the well-being of both patients and medical staff. Thus, the aim of this research is to compare healthcare worker knowledge and practices related to waste management during and after the Covid-pandemic in a Tunisian university hospital. Methods: We performed two cross-sectional surveys in September of 2021 and October of 2023. We used a standardized grid to assess the availability of resources and the compliance with practices. A self-administered questionnaire, validated by the Regional Office for Nosocomial Infection Control in France, was used to assess HCWM knowledge. Results: We recruited 160 healthcare workers in 2021 and 114 in 2023. A decline was observed in the proper on-site sorting from 2021 to 2023 (84.4% vs 71.9%; p = 0.01). The availability of resources and materials improved from 2021 to 2023. However, there was a significant decrease in adherence to proper waste management practices between 2021 and 2023 (61% vs 39.1%; p = 0.01). Conclusion: This study sheds light on HCWM knowledge and practices gap. Addressing this through multidimensional strategies is needed for safer healthcare environments for the community.

We sought to investigate the impact of recent violence exposure on the relationship between extrafamilial adverse childhood experiences (ACEs) and self-inflicted violence in male Tunisian prisoners. We performed a cross-sectional study among adult male prisoners during April 2023. We used the validated Arabic versions of the World Health Organization ACE questionnaire and the Hospital Anxiety and Depression Scale. We assessed exposure to violence during the incarceration. Self-directed violence was subdivided into suicidal behaviors and self-harm. The participation was anonymous and voluntary, and the questionnaire was self-administered. A total of 540 prisoners were recruited with a response rate of 74.6%. Exposure to at least one extrafamilial ACE was reported by 96.8% of them. Anxiety and depression were screened in 83.2% and 79.6% of cases, respectively. Approximately the half (51.5%) reported recent violence exposure mainly psychological (45.8%). About 35% of prisoners had suicidal thoughts and 45.9% reported self-harming. We found that the risk of self-directed violence was significantly higher when the number of extrafamilial ACEs increased. After adjusting for anxiety and depression, our study revealed that childhood collective and peer violence predict self-directed violence through recent exposure to violence (%mediated = 41.6 and %mediated = 30.8, respectively). This survey underscores the urgent need for targeted interventions to break the vicious cycle of violence in jails. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Given that resilience is the ability to cope with adversities, and impulsivity is characterized with rapid reactions without foresight, we aimed to explore the pathways between intra-familial childhood adversities, resilience, impulsivity and suicidal behaviors among adolescents in Mahdia and Gafsa cities (Tunisia). We conducted a cross-sectional study in secondary schools from January to February 2020. Exposure to intra-familial early life experiences was evaluated by the Adverse Childhood Experiences (ACEs)-International Questionnaire. Resilience and impulsivity were assessed via the Adolescent Psychological Resilience and the Barratt Impulsivity Scale. A total of 3170 students were recruited with a response rate of 74%. About 81.1% of them reported being emotionally abused. The resilience mean score was 86.10 ± 9.85. Impulsivity was screened among 42.2% of them. About 38% of students presented suicidal thoughts, 16.4% had a suicide plan, and 10.8% have made a suicide attempt. We found that exposure to intra-familial ACEs predicts suicidal behaviors through impulsiveness (% mediated = 18% for emotional violence) and interpersonal resilience (% mediated = 24% for emotional violence; % mediated = 20.4% for physical violence). Our results emphasize the need to prevent ACEs, and to seek out a way to promote ACE protective factors among adolescents such as resilience.

Background: Several studies revealed that medical students have low performance levels of hand hygiene (HH) and biomedical waste management (BMWM). However, there have been limited interventions directed at young students targeting HH and BMWM enhancement. Given these data, we aimed at assessing HH and BMWM among medical students after two training methods.Methods: We performed a quasi-experimental study from September 2021 to May 2022, which included fifth-year medical students enrolled in the faculty of Medicine of Monastir (Tunisia). We relied on a conventional training based on presentations and simulations guided by the teacher and a student-centred training method based on courses and simulated exercises prepared by students. We used the WHO HH Knowledge Questionnaire and the “BMWM audit” validated by The Nosocomial Infection Control Committee in France.Results: A total of 203 medical students were included (105 in the control group and 98 in the experimental group) with a mean age of 23 ± 0.7 years. Regarding HH, we found a statistically significant increase in post-test scores for both training methods. A higher post-test mean score was noted for student-centred method (14.1 ± 1.9 vs. 13.9 ± 2.3). The overall improvement in good HH knowledge rates was greater after student-centred method compared to conventional training (40.5% vs. 25%). Concerning infectious waste, mean scores were higher after student-centred learning in all hazardous waste management steps (25 ± 3.3 vs. 23.6 ± 5.5).Results: Coupling student-centred teaching and continuous supervision could improve HH and BMWM knowledge and practices among medical students.

Background and Aim: The COVID‐19 is a stigmatizing infectious disease even after healing. Until now, no COVID‐19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID‐19 stigma and reduce it effectively. Indeed, stigmatization of COVID‐19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12‐item HIV stigma scale among Tunisian COVID‐19 patients.Methods: A cross‐sectional study was conducted between November and December 2020 among a representative sample of COVID‐19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12‐item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self‐image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA).Results: The responses of 346 COVID‐19 patients were obtained. Their median age was 40 years (interquartile range: 30‐54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14‐item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self‐image, and disclosure concerns, respectively.Conclusion: This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID‐19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

Background: Assessing stigma related to COVID-19 is crucial to better understand the pandemic's impacts and establish effective stigma-reducing interventions. The aim of this study was to screen for stigma and evaluate its associated factors among adults with COVID-19 living in the governorate of Sousse (Tunisia). Methods: A cross sectional study was conducted among a representative sample of patients with COVID-19 between the 6th of November and the 12th of December 2020 in the governorate of Sousse. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context.Three pre-trained medical doctors administrated the pre-tested Arabic questionnaire to each participant by phone calls. Higher scores reflect a higher level of perceived Covid-19-related stigma. Results: Responses of 346 participants with COVID-19 infection were obtained. The majority of participants were females (60.4%) with a median age of 40 years (interquartile range, 30 to 54.5 years). Among them, 12.7% were health professionals and 12.5% had at least secondary educational level. Because of COVID-19 illness, 17.1% reported financial deterioration. We found mean scores of 14.6 ±4.07, 6.8±2.39 and 6.2±1.95 for social stigma, disclosure concerns and negative self-image dimensions respectively. Social stigma score was significantly higher among adults (14.9±3.9 versus 13.05±4.4 among elderly; p = 0.01) and people with low socioeconomic level (15.8±4.8 versus 14.3±3.8; p = 0.02). Lower scores of social stigma were found among health caregivers (13.3±2.6 versus 14.8±4.2; p = 0.002). Those factors remained as predictors of social stigma after linear regression analysis. Conclusions: Screening for stigma is required in order to identify the most vulnerable patients and could prevent among them social repercussions. Psychological assistance of patients with social stigma would help them to overcome this crisis. Key messages: Being adult with low socioeconomic level and not being health worker were determinants of social stigma. Psychological assistance for COVID-19 patients is crucial to prevent social stigma repercussion during this outbreak.

Background: Although, there is a rapidly accumulating body of studies on the various aspects of COVID-19, little interest was given to develop valid specific scales measuring COVID-19-related stigma. The current study aims to testvalidity and reliability ofa modified version of the 12-item HIV Stigma Scale, adapted for adults with COVID-19 infection living in the region of Sousse (Tunisia). Methods: A cross sectional study was conducted among patients with COVID-19 infection between November and December 2020. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context. A preliminary version with twenty items covering the four dimensions of COVID-19 stigma was tested (Personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The psychometric evaluation included internal consistency as well as principal component analysis (PCA). Results: Responses of 346 COVID-19 patients were obtained.Among participants, 60.4% were women with a median age of 40 years (interquartile range, 30 to 54.5 years). Evidence for internal validity was supported by a PCA, suggesting a three factor solution with fourteen items. The 14-item scale demonstrated good internal consistency. The global Cronbach'sα was 0.91, with values of 0.94, 0.93 and 0.98 for social stigma, negative self-image and disclosure concerns respectively. Conclusions: The results suggest construct validity and reliability of the 14-item stigma scale measuring three aspects related to COVID-19 infection in Tunisia. Key messages: The 14-item stigma scale is a good psychometric tool to be used in assessing COVID-19 related stigma in Tunisia. Monitoring COVID-19 stigma with a valid and reliable would guide its prevention actions.