[Show abstract][Hide abstract] ABSTRACT: Objectives:
To determine the distribution of cervical high-risk human papillomavirus genotypes and their association to cellular abnormalities in women from Fez and its neighborhood.
Women attending the Hassan II University Hospital for cervical pap smears were recruited after an informed consent. Interviews and two cervical samples were performed for each woman. Cervical samples were used for cytological analysis and HPV DNA detection. HPV was typed using a method based on multiplex PCR with fluorescently labeled specific primers followed by capillary electrophoresis. The study was approved by the ethics committee of the Faculty of Medicine and Pharmacy of Fez.
The HPV prevalence in the studied population was 43.1% and the most prevalent types were HPV 53 (23 cases); HPV 16 (20 cases); HPV 35 (18 cases); HPV 51 (10 cases) and HPV 56 (7 cases). From the 619 confirmed pap smears, 20% were abnormal. The cytological abnormalities were significantly associated to HPV infection, women age, number of pregnancies and parity (p < 0.05).
More attention should be given to HPV in Morocco because it represents an important public health concern. The distribution of carcinogenic HPV types in the studied population is different from the data in other regions but epidemiological studies in other Moroccan regions are required.
[Show abstract][Hide abstract] ABSTRACT: Background
This study aims to explore the perception and satisfaction of cervical cancer screening by Visual Inspection with Acetic acid (VIA) in Meknes-Tafilalet Region among target women.
A cross-sectional study was conducted using face-to-face interviews with women, routinely attending health centers, who met the inclusion criteria. Descriptive analysis was undertaken to report data.
A total of 324 women were included in the study. Results revealed low awareness about cervical cancer (19.6 %) and a very high acceptability of VIA screening (94.5 %). Of the 306 women screened, 99 % stated that they would recommend the VIA testing to their friends and female relatives. All those women who were screened negative expressed their intent to repeat the test every three years. Those found VIA positive affirmed they would perform confirmatory explorations. The majority (96.3 %) of the women believed that screening by VIA could save their lives; cervical cancer was a concern for 98.6 %; and only 11.6 % felt anxious about repeating the VIA test. The majority of women (98.6 %) were satisfied with the service received at the health center.
This study showed that the participants had a strong perception about cervical cancer screening and were willing to have further confirmation or future retests.
Electronic supplementary material
The online version of this article (doi:10.1186/s12905-015-0268-0) contains supplementary material, which is available to authorized users.
[Show abstract][Hide abstract] ABSTRACT: Background:
Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students.
From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria.
A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use.
The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.
[Show abstract][Hide abstract] ABSTRACT: Degenerative complications as a result of diabetes impose a heavy disease burden and increase mortality. This study presents epidemiological and clinical profiles of diabetic patients in the EpiDiaM cohort study, which include 1196 diabetic cases recruited from the basic health care network in the city of Fez. The mean age of the participants was 57.5 (SD 10.4) years with 47.1% aged between 50 and 60 years. The majority (77.7%) were women. The mean duration of diabetes was 8 (SD 6.6) years. Hypertension was found in 49.3% of the cohort, 77.9% were overweight or obese and 63.8% had one or more complications. Among those with complications, retinopathy was the most common (69.4%), followed by heart conditions (50.8%), neuropathy (45.6%) and renal disease (4.8 %). The high prevalence of complications emphasizes the need to address the avoidable risk factors and prevent complications.
No preview · Article · Sep 2015 · Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age 40 years), living in the city of Fez, Morocco.DESIGN: Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.RESULTS: Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for
No preview · Article · Jul 2015 · The International Journal of Tuberculosis and Lung Disease
[Show abstract][Hide abstract] ABSTRACT: Colorectal Cancers (CRC) are one of the most common malignancies in the world. Their incidence in Morocco, between 2005 and 2007, was 5.6 for 100000 inhabitants, which is very low compared to what found in developed countries. In addition, CRCs show a high frequency of rectal localizations, and occurs in a younger population in Morocco compared to what found in developed countries. The purpose of this study is to confirm these CRC peculiarities in Morocco and try to explain them by exploring the microsatellite instability molecular pathway.
This is a prospective observational study conducted since January 2010, including 385 patients admitted in Hassan II University Hospital of Fez. We collected clinical, radiological and pathological data. We investigated the expression of mismatch repair (MMR) proteins in 214 patients and BRAF gene mutations in 159 patients.
Mean age was 55.08 +/- 15.16 years. 36.5 % of patients were less than 50 years old and 49.3 % of tumors were localized in the rectum. Loss of MMR protein expression was observed in 11.2 % of cases. It was independently associated with individual or family history of cancer belonging to Hereditary Non-Polyposis Colorectal Cancer (HNPCC) spectrum (p = 0.01) and proximal localization (p = 0.02). No BRAF mutation was detected in all cases.
These results confirm the high occurrence of CRCs to young patients and the high frequency of rectal localizations in Moroccan population. They mostly show an absence of BRAF mutation, supposing a rarity of MLH1 promoter hypermethylation pathway, which may even partially explain the CRC peculiarities in our context.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5868184711716884.
Full-text · Article · Jun 2015 · Diagnostic Pathology
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations.
No preview · Article · Jan 2015 · The International Journal of Tuberculosis and Lung Disease
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective: To carry out an inventory on the availability, challenges and needs of Dietary Assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. Methods: The inventory was performed within the framework of the "Africa's Study on Physical Activity and Dietary Assessment Methods" (AS-PADAM) project. It involves International Institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. Results: Various DA tools were reported in Africa, 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerised software or other new (web) technologies were reported. No tools were standardised across countries. Conclusions: The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that have been validated and standardised in other settings, with the view to standardizing methods for wider use.
Full-text · Article · Dec 2014 · Critical Reviews in Food Science and Nutrition
[Show abstract][Hide abstract] ABSTRACT: Background
In Morocco, knowledge of cancer risk factors, a crucial element in the process of behavioral change, has never been evaluated. This study aims to provide information on the level of awareness of cancer risk factors among the Moroccan general population.
A cross sectional survey was carried out in May 2008, using a stratified sampling method in a representative sample of the Moroccan adult population. The used questionnaire included social and demographic data as well as questions about 14 cancer related factors regarding passive or active smoking, alcoholic beverages, obesity, physical inactivity, food coloring, red meat, fat, salt, fruit, vegetables, olive oil, green tea, coffee, breast-feeding. Subjects had to choose between 3 propositions for each proposed factor (risk factor/Protective factor/Don’t Know). The knowledge score was calculated by summing the correct answer for each proposed factor except coffee and food coloring. The answer was assigned 1 if it’s correct or 0 if it was incorrect or the participant responded ‘don’t know. The maximum knowledge score was 12. Multivariate linear regression model was used to evaluate the determinants of knowledge score.
Among 2891 subjects who participated to the survey, 49.5% were men and 42% were from a rural area. The mean age was 41.6 ± 15.2 years. The mean knowledge score of cancer related factors was 8.45 ± 3.10 points. Knowledge score increased with educational level (β = −0.65 if school year ≤6 versus >6) and housing category (β = 1.80 in high standing housing vs rural housing). It was also higher in urban area, among never smokers and among people never consuming alcohol compared to others groups.
These results provide valuable information necessary to establish relevant cancer prevention strategies in Morocco aiming to enhance and improve people’s knowledge about risk factors especially in some target groups.
[Show abstract][Hide abstract] ABSTRACT: Background
Diet and lifestyle may modulate lung function and COPD but most evidence comes from richer countries. We have systematically investigated the evidence on the association between diet and lung function in Africa and the Middle East, where the burden of COPD is increasing.
Protocol-driven strategies were used to search the Cochrane library, MEDLINE, and Web of Science for all studies published up to September 2013 on any dietary or related lifestyle exposures and lung function (LF) or COPD. We used the PRISMA (Preferred Reporting Items for Systematic Reviews (SR) and Meta-Analyses) guidelines for data extraction. Quality of eligible papers was assessed using the Critical Appraisal Skills Programme (CASP).
782 potentially relevant studies were identified. 631 titles and abstracts were examined for eligibility after eliminating 151 duplicate studies. 22 studies met the inclusion criteria: 16 cross-sectional, 3 case-control, and 3 interventions. 18 were on lung function and 4 on COPD. Exposures were limited to vitamins A, C and E, omega 3 fatty acids, use of nutrient supplements, obesity, body fat, and prolonged periods of fasting (Ramadan). The samples studied were mostly unrepresentative of the general population. Most studies shown a positive association between antioxidant nutrients and LF but data were too heterogeneous to carry out meta-analyses.
This first systematic review on diet and related risk factors for lung function and COPD in Africa and the Middle East highlights the need for improved studies in the general population of this region.
ERS fellowshipSTRTF - 2013-3077 supported Dr El-Rhazi
[Show abstract][Hide abstract] ABSTRACT: Introduction
Au Maroc, le suicide des adolescents est un phénomène rarement étudié. L’objectif de cette étude était d’évaluer les déterminants et la prévalence du risque suicidaire et des tentatives de suicide chez les élèves de la région Centre Nord du Maroc.
Une enquête transversale a été réalisée entre avril 2012 et novembre 2013, au sein des collèges et lycées publiques. Un questionnaire anonyme auto-administré explorant le risque suicidaire selon les critères du MINI DSM-IV a été utilisé.
Au total, 2885 élèves (52,7 % garçons) âgés de 11 à 23 ans ont rempli le questionnaire. Le risque suicidaire global était de 35,3 % (n = 1017) avec des différences significatives entre les garçons et les filles (27 % versus 44,5 % ; p < 0,001). La prévalence du risque suicidaire léger était de 16,9 % (IC-95 % : 15,6–18,4), celle du risque moyen était de 8,1 % (IC-95 % : 7,1–9,1), et celle du risque élevé était de 10,1 % (IC-95 % : 9–11,3). Les tentatives de suicide au cours de la vie ont été déclarées par 10,6 % d’élèves (IC-95 % : 9,4–11,7). L’analyse multivariée a montré que le risque suicidaire est hautement associé au sexe féminin (OR = 2,9 ; IC-95 % [2,4–3,4]), au tabagisme (OR = 2,1 ; IC-95 % : [1,6–2,8]), et à l’usage de toxiques (OR = 2 ; IC-95 % : [1,4–2,8]).
Une telle prévalence élevée du risque suicidaire au milieu scolaire est choquante et inattendue. D’où la nécessité urgente de l’élaboration d’une stratégie nationale de prévention contre le suicide chez les adolescents.
No preview · Article · Sep 2014 · Revue d Épidémiologie et de Santé Publique
[Show abstract][Hide abstract] ABSTRACT: Understanding the effects of cancer on the quality of life of affected patients is critical to clinical research as well as to optimal management and care. The aim of this study was to adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire into Moroccan Arabic and to determine its psychometric properties. After translation, back translation and pretesting of the pre-final version, the translated version was submitted to a committee of professionals composed by oncologists and epidemiologists. The psychometric properties were tested in patients with cancer. Internal consistency was tested using Cronbach's alpha and the test-retest reliability using interclass correlation coefficients. Construct validity was assessed by examining item-convergent and divergent validity. It was also tested using Spearman's correlation between QLQ-C30 scales and EQ-5D.
The study was conducted in 125 patients. The Moroccan version was internally reliable, Cronbach's α was 0.87 for the total scale and ranged from 0.34 to 0.97 for the subscales. The intraclass correlation coefficient of the test-retest reliability ranged from 0.64 for "social functioning" to 0.89 for "physical activities" subscales. The instrument demonstrated a good construct and concomitant validity.
We have developed a semantically equivalent translation with cultural adaptation of EORTC QLQ-C30 questionnaire. The assessment of its measurement properties showed that it is quite reliable and a valid measure of the effect of cancer on the quality of life in Moroccan patients.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors.
In Dordogne and Gironde, South Western France.
A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included.
Main outcome measures:
dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes.
The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects , 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10⁻⁴). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10⁻³). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01-1.26]); this risk increases to HR=1.42 (CI95%=[1.25-1.63]) for level-2 and to HR=1.90 (CI95%=[1.61-2.25]) for level-3 and 4.
These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.
Full-text · Article · Mar 2014 · The Journal of Nutrition Health and Aging
[Show abstract][Hide abstract] ABSTRACT: H. pylori persistent infection induces chronic gastritis and is associated with peptic ulcer disease and gastric carcinoma development. The severity of these diseases is related to human's genetic diversity, H. pylori genetic variability and environmental factors. To identify the prevalence of histo-pathological damages caused by H. pylori infection in Moroccan population, and to determine their association to H. pylori genotypes, a prospective study has been conducted during 3 years on patients attending the gastroenterology department of Hassan II University Hospital (CHU) of Fez, Morocco. A total of 801 Moroccan adults' patients were recruited; H. pylori was diagnosed and genotyped by PCR in biopsy specimens and histological exam was performed. We found a high rate of glandular atrophy. Chronic inflammation, neutrophil activity and glandular atrophy showed statistically significant association with H. pylori infection. However, intestinal metaplasia was inversely associated to this infection and no association was observed with gastric cancer cases. A statistically significant association was found between intestinal metaplasia and vacAs1 and vac Am1 genotypes in patients aged 50 years and more but not in younger. This last genotype is also associated to gastric cancer. In this study, gastric cancer showed no significant association with H. pylori. Further studies are warranted to determine the role of other etiological agents such as Epstein-Barr virus, human papillomavirus and possibly environmental and dietetic factors in the occurrence of this pathology.