T Nacef

University of Tunis El Manar, Tunis-Ville, Tūnis, Tunisia

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Publications (81)14.67 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Health human resources management is one of the important determinants of health care access equity. To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. Current medical density was calculated using Bar Council of Physicians of Tunisia database. Medical density was calculated and analysed for the period 2000-2009 then modelled by 2024 (estimate of needs and supply). The active medical density raised by 36% during the period 2000-2009 with a higher increase for specialists. The proportion of non-active physicians rose from 4.6% to 15.2% in 2009. Increasing feminization of medical density and persistence of its regional disparities. By the year 2024, 217 physicians for 100,000 inhabitants would be required while the supply would correspond to 212/100 000 inhabitants. medical human resources have indeed globally improved. However, some lacks remain and adequate measures are required, based on a rational planning directed to satisfy the population needs and to allow health equity.
    La Tunisie médicale 02/2012; 90(2):166-71.
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    ABSTRACT: The image of the Tunisian doctor seems to have lost some of its aura and social value. Aim: To evaluate the medical profession's social image and to identify the reasons of a possible dissatisfaction by interviewing a sample of 200 adults in the District of Tunis. Population was selected according to the method of quotas depending of sex, age and instruction degree. One hundred and ninety nine persons aged 20 years and above were included. Collection of data was made by an interview and included 4 items: identification of respondent, expected qualities of medical doctor, satisfaction level regarding health services, comparison between general medicine and specialists. Chi-2 test was done for comparison of proportions. In order to classify professions according to income and prestige a score was calculated. It ranged from 10% (10th rank) to 100% (1st rank). Patience and availability were quoted as particularly essential requirements in a doctor. Yet only 35.7% of the interviewees reported being satisfied by their doctor's qualities. A general dissatisfaction regarding health services was also noted. Our sample's perception of professional prestige rated industrials over doctors by placing them in first position. With regards to the perception of best-paid jobs, doctors were classed third after industrials and important traders. In order to counter these deficiencies and to preserve doctors' social image and their place in society, it is imperative to change our understanding of their training and recycling and also to improve their purchasing power as it is the unquestionable guarantee of the preservation and durability of their public image.
    La Tunisie médicale 03/2011; 89(3):236-42.
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    ABSTRACT: In order to analyse the methods of curative prescription of antibiotics in four units of hospitalization of the hospital Charles Nicolle of Tunis, a descriptive study of prescriptions was carried out during the first five months of year 2001. On the whole, 165 prescriptions delivered to patients were included in the study. The average age of the patients was 44 years, the sex ratio of 1.45 and the average duration of 15.1 days. Approximately two thirds of the initially probabilist prescriptions were not documented secondarily. Those secondarily documented (n = 51) were essentially related to nosocomial pneumonias and septicaemias (29 and 10 prescriptions). The two germs most frequently isolated during nosocomial pneumonias were Acinetobacter baumannii and, Pseudomonas aeruginosa (17 and 8 strains). Only imipenem, netilmicin and colistin remain active on A. baumannii. The bitherapy was the most used treatment (87.5%). It was generally an association beta-lactamin-aminosid (52.9%). The average cost of a documented prescription varied from 943,6 to 1184,9 TD (Tunisian Dinars) according as the prescription were secondarily documented or not.
    La Tunisie médicale 10/2006; 84(9):556-62.
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    ABSTRACT: We aim at analysing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey (TNMMS). In order to assess the CVDs (CHDs vs RHDs) trend, two representative samples of Cardiology Departements patients were compared one is selected from the TNMMS and the second from the hospitalisations recorded in 1992. Causes, stay duration, status at the end of the hospitalisation, transfer to another hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectivly 58.8% and 38.2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological, social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities.
    La Tunisie médicale 06/2005; 83 Suppl 5:1-7.
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    ABSTRACT: We describe the dramatic demographic, socioeconomic and health changes witnessed in Tunisia over the past 50 years. Demographically, the gross mortality rate and the infant mortality rate have gone from 19 per 1000 and 150 per 1000 respectively in 1956 to 5.7 per 1000 and 26.2 per 1000 now, and life expectancy at birth going from 50 to 72 years for the same period. Socioeconomically, the urban population has risen from 25% to 62%, the literacy rate from 15% to 73%, and the per capita income has increased 5-fold in real terms. Epidemiologically, the infectious and perinatal diseases prevailing in the 1960s have decreased whereas chronic and degenerative diseases have risen. The proportion of the GNP related to health expenditure has risen from 3.8% to 6.2%. The implication of these changes on the Tunisian health system and the need to adapt in terms of curative care and prevention of risks are discussed.
    Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 01/2005; 11(1-2):181-91.
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    ABSTRACT: The objective of this study is to estimate in Tunisia on a national scale the incidence of the main cancerous localizations for the period 1993-1997 while taking results of registers of the cancer of the region of the North, Sousse and Sfax as a basis. After having verified the relation of exponential type between the incidence of cancers and the life expectancy at the birth (Evo) in a certain number of country we extrapolated levels of governorates incidence included in registers of the North, Sousse and Sfax to the other governorates while taking the similarity of the Evo level as a basis. The incidence rate of in all localizations are 100.11/100.000 for male and 86.4/100.000 for female. The main cancerous localizations for male are the lung (20.8/100.000) the bladder (10.7/100.000), the cutaneous cancers (7.2/100.000) and the prostate (6.1/100.000). For female the main localization are the breast (19.7/100.000), skin (5.8/100.000) and the cervix uteri (4.8,100.000). These results illustrate the interest of tobacco control, screening of the breast cancer of and cervix uteri cancer, as components fundamental of the cancer control.
    La Tunisie médicale 03/2002; 80(2):57-64.
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    ABSTRACT: To assess tobacco use and the awareness of and attitudes towards tobacco and its control in the adult population of Tunisia. A cross-sectional study was conducted in 1996 of a representative national sample of 5696 subjects aged 25 and over. Data were collected by means of a questionnaire in Arabic. Tobacco use was reported by 30.4% of the respondents, of whom 24.6% smoked cigarettes and 5.8% consumed traditional tobacco, i.e. snuff, chewing tobacco and/or water pipe tobacco. Whereas 55.6% of men used tobacco, only 5.2% of women did so. Among men the proportion of tobacco users diminished with age as the rate of cessation increased. Among women, smoking peaked in the 35-54 age group. The proportion of men consuming traditional tobacco alone increased from 2.4% in the 25-34 age group to 20.4% in the 55+ age group; the corresponding values for women were 0.1% and 14.3%. Tobacco use was more widespread in rural than in urban areas and was relatively high among poorly educated men from economically deprived backgrounds. The use of tobacco was believed to be harmful to health by 98.6% of the respondents. Over 90% of the interviewees were aware that tobacco played a part in the development of heart disease. However, there were some gaps in awareness. A fear of cancer was expressed by 85% of the respondents, whereas only 5.6% were fearful of accidents. Informational and educational campaigns relating to tobacco control should be directed at individuals and communities, taking into account the gaps in awareness of the effects of tobacco on health.
    Bulletin of the World Health Organisation 02/2002; 80(5):350-6. · 5.11 Impact Factor
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    ABSTRACT: To know nature and the dimension of the change of the customs of life leads by the Ramadan, we led a comparative descriptive inquiry before and during the month of the fast at 84 adults residents in the district of Tunis. Our results underline an increase of the consumption of meat and eggs with an average frequency of 4.3 and 6.1 times a week respectively. This overconsumption of the animal proteins contrasts with a tendency in the decline of the consumptions of vegetables. The exciting (tea, coffee, tobacco) are less consumed during the Ramadan. Also, we noted a decline of 50% of the average number of smoked cigarettes. There is an intensification of domestic links with an increase of the frequency of exchange of domestic visits. It's crossed of average from 0.7 to 1.2 times a week (p < 0.001). The phenomenon of irritability is frequently lived by near 20% of the investigated. We recommend under shape of an educational program the intensification of positive customs and the correction of negative customs, to benefit of sacred month, to tighten towards a more balanced life all year.
    La Tunisie médicale 10/2001; 79(10):508-14.
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    ABSTRACT: Because tobacco-related diseases are a growing health problem, we assessed tobacco smoking in Tunisia since 1970 using different sources. The average consumption of tobacco calculated over the period of 10 years (1981-90) was 1493 g per person and per year; equivalent of 75 packets of cigarettes. Cigarettes are the most popular form of tobacco smoking. Cigarette smoking increased from 1981 to 1993 but since has decreased slightly. According to a national study of respiratory diseases conducted in 1996, the current prevalence of tobacco smoking is 30.4% for both sexes: around 52% for males and 6% for females. Average consumption is 17.7 cigarettes/day, irrespective of sex. For young people, the prevalence is 29.21%: 50% for males and 3.9% for females. Young people who attend school smoke less than those who do not (18.1% versus 38.4%). Most started smoking between 14 years and 18 years.
    Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 08/2000; 6(4):678-86.
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    ABSTRACT: Reexpansion pulmonary edema is an uncommon complication which sometimes occurs after evacuation of a large amount of air or fluid from the pleural space. We report two cases that illustrate the diversity of the clinical expression, severe in one case and latent in the other. The pathophysiology of reexpansion pulmonary edema remains obscure. Increased pulmonary capillary permeability, favored by previous atelectatic parenchyma and rapid reexpansion appears to be the main cause. Treatment is basically preventive. Curative treatment is based on adequate oxygenation and circulation. Lower aspiration pressure and oxygenation were sufficient in our patients. Severe clinical prognosis has been reported in the literature with a 15 to 20% mortality despite use of mechanical ventilation in particularly serious situations.
    Revue de Pneumologie Clinique 05/1999; 55(2):105-8. · 0.19 Impact Factor
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    ABSTRACT: The association between bronchopulmonary carcinoma and pulmonary tuberculosis would not be fortuitous but related to increased susceptibility to opportunistic infections and tuberculosis in cancer patients. We present four cases demonstrating the gravity of the situation and the difficulties encountered in diagnosis and treatment. Diagnosis of tuberculosis in patients with bronchopulmonary carcinoma requires pathological evidence from histology biopsies or bacteriology samples. The diagnosis is further complicated in early stage neoplasms. In case of tuberculosis, surgical treatment of bronchopulmonary carcinoma may have to be postponed or even contraindicated. Inversely, chemotherapy and radiotherapy may favor extension of the tuberculosis.
    Revue de Pneumologie Clinique 03/1998; 54(1):23-5. · 0.19 Impact Factor
  • La Tunisie médicale 03/1996; 74(3):119-24.
  • La Tunisie médicale 05/1994; 72(3):419-39.
  • La Tunisie médicale 06/1993; 71(5):265-8.
  • La Tunisie médicale 03/1993; 71(2):85-9.
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    ABSTRACT: The management of hypertensive outpatients in a primary health care center raises problems of follow-up and effectiveness. This study attempts to assess the management of high blood pressure, using the Medical Audit method, essentially. For that purpose, 194 medical records of hypertensive outpatients registered between 1980 and 1986 were studied. More than 80% of these patients were women between the ages of 40 and 70 years. The medical records of these patients were compared to a standard management scale including 68 items devised by cardiologists and general practitioners. Globally, 32% of the items were cardiologists and general practitioners. Globally, 32% of the items were respected during management of the outpatients. The initial check-up was the least followed item (6.9%), but afterwards care of patients improved, giving ratings of: 29% for respect of treatment protocol, and 35% for surveillance of treatment. As concerns treatment effectiveness, only 28% of the patients (n = 36) actually completed the five-year follow-up period. In these patients average blood pressure fell from 193 to 143 mmHg (systolic), and from 113 to 93 mmHg (diastolic), between the beginning of monitoring and the end of the fifth year. The insufficiency of high blood pressure management results not only from a shortage of resources, but also from underuse of existing ones, and the practitioners' lack of information.
    Revue d Épidémiologie et de Santé Publique 02/1993; 41(3):200-7. · 0.66 Impact Factor
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    ABSTRACT: The health care system in Tunisia is composed of two sectors, public and private. Given the social and economic development level of the country, it can be said that the hospitals, health centers and workforce devoted to health are not severely limited. However, these structures are under-equipped and finance management is not relevant. The establishment of a National Health Service would render all the system more efficient.
    Cahiers de sociologie et de démographie médicales 01/1992; 32(2-3):225-39.
  • La Tunisie médicale 03/1990; 68(2):77-82.
  • La Tunisie médicale 01/1990; 67(12):785-9.
  • La Tunisie médicale 11/1989; 67(10):637-40.

Publication Stats

127 Citations
14.67 Total Impact Points


  • 2012
    • University of Tunis El Manar
      Tunis-Ville, Tūnis, Tunisia
  • 2000–2011
    • Ministère de la Santé Publique de Tunisie
      Tunis-Ville, Tūnis, Tunisia
  • 1992–2005
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 2002
    • Institut National de Santé Publique du Québec (INSPQ)
      Québec, Quebec, Canada
  • 1999
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia