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Longitudinal Connection between Too much Excess weight as well as Weight problems in Academic Performance associated with Primary School Boys in various Socio-Economic Statuses: Your NW-CHILD Examine.
In order to readjust the national policy of Basic Health Care (SSB) to the declaration of Primary Health Care (SSP) of Astana (2018), 40 years after that of Alma Ata (1978), this paper summarizes the lessons learned from the international and national experience of PHC / SSB and presents the originator lines of the roadmap of the second version of SSB in Tunisia. WHO and Unicef have identified four lessons from PHC policy 1. Political leadership, prioritizing primary care. 2. Sufficient funding to ensure the availability of basic services and their access by the population served. 3. Health personnel specifically trained in primary care, with decent working conditions. 4. A support strategy for the quality of care, based on financial and moral motivation. In Tunisia, the history of SSBs has memorized images of successes such as the organization of simulation sessions for the preparation of the "oral rehydration solution", "mobile teams" of home visits, "deadlines" for monitoring vaccination and "school social action units" for multisectoral management of the problem of school backwardness. The "Think Tank" groups, having reflected on the perspectives of SSBs in Tunisia, came up with a roadmap made up of four fundamental axes. 1. Creation of a National Health Insurance Fund (CNAS), affiliated with the Ministry of Health, and promoting prevention and health promotion. 2. Focus on non-communicable diseases, both young and old. 3. Establishment of a periodic health assessment, stratified by sex and age, guiding health behaviors and "self-care" skills. 4. The development of "nursing homes", providing continuous care, by multi-functional and multidisciplinary teams. Thus, the reform of the SSB policy of Tunisia, by referring to the Astana declaration and the cumulative national expertise, is essential to revitalize the first line of care and ensure the Tunisian population a "health for all", leaving no one behind".
Colorectal cancer (CRC) is a real public health issue in Tunisia. A screening program based on fecal immunological occult blood test, followed in case of a positive test by colonoscopy, was launched in Tunis region in 2016. We aimed to evaluate this screening program in order to make recommendations for a better implementation of this program in years to come.

A mixed approach has been adopted with a quantitative component based on the production of indicators related to activity, monitoring and screening quality; and a qualitative component conducted through focus groups with frontline health care professionals (HCP) and individual interviews with those lost to follow-up after a positive screening test. SWOT analysis was then performed in order to assess main strengths, weaknesses, opportunities and threats of the program.

This study showed a coverage rate of 41.2% [40.5-41.8] for population consulting the first line of care, and an effective participation rate estimated at 23.1% [22.6-23.6]. Out of 58lity for any CCR mass screening program in Tunisia.
This evaluation underlined certain strengths regarding the program implementation and revealed, in return, several shortcomings which certainly impair the program's effectiveness and efficiency. The involvement of the national health insurance fund in CRC screening tests and colonoscopies reimbursement, as well as the establishment of a performance-based payment modality for HCP, constitute main key pillars to reach success and sustainability for any CCR mass screening program in Tunisia.
Describe the cancer control strategies adopted by the Maghreb countries and identify their main weaknesses.

Data on cancer epidemiology and "Cancer plans" in the Maghreb were collected through a search in bibliographic databases, on GLOBOCAN and the sites of international and national organizations responsible for surveillance and cancer control.

In the Maghreb, cancer registries observed low population coverage (Morocco 20%; Tunisia 60%; Algeria 82%) and a lack of computerization. Primary prevention strategies remains insufficient as evidenced by the high prevalence of smoking in 2018 (Tunisia 26%; Algeria 19%; Morocco 14%). selleck screening library Screening coverage for major cancers are still low in the Maghreb; In Tunisia for example the levels observed for cervical and breast cancers are respectively 14% and 10%. Regarding cancer care, the main problem is a limited access to cancer health services, due to poorly decentralized infrastructure and equipment (Morocco six oncology centers; Algeria three oncology centers; Tunisia only one institute specializing in cancer care). Palliative care is mainly supported by civil society in the Maghreb countries.

The resources dedicated to cancer control in the Maghreb are limited, explaining its poor performance. Better governance in cancer control is required, with the adoption of multisectoral approach for prevention, and the strengthening of cancer surveillance and research.
The resources dedicated to cancer control in the Maghreb are limited, explaining its poor performance. Better governance in cancer control is required, with the adoption of multisectoral approach for prevention, and the strengthening of cancer surveillance and research."Prevention", a component of primary health care since Alma Ata's declaration (1978), has been a strategic axis of health policy in Tunisia for four decades. If the Tunisian Revolutionary Constitution (2014) declared in its Article 38 that "the State guarantees prevention", the regulatory texts, organizing preventive structures and its operational programs, have today become ill-suited with the global burden of disease and current scientific evidence. The analysis of current preventive practices in Tunisia, based on the "health continuum", the taxonomy of "preventive strategies" and the identification of "vulnerable populations", has shown the need to implement prevention activities. "Primordial" and "quaternary" (for the management of cardiovascular diseases and cancers), extension of the fields of health education and epidemiological surveillance, towards Therapeutic Education of Patients / Health Promotion, and health monitoring, and coverage of new groups at risk adolescents and the elderly. Faced with the multitude of prevention structures and the fragmentation of health programs, the reform of the national preventive policy and its practices should be based on the principles of integration, relevance and efficiency, through the establishment of a National Health Protection Agency (NHPA).
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