Publications by authors named "Demetris Lamnisos"

24 Publications

  • Page 1 of 1

Intrauterine exposure to Zika virus and hearing loss within the first few years of life: A systematic literature review.

Int J Pediatr Otorhinolaryngol 2021 Jun 12;147:110801. Epub 2021 Jun 12.

Department of Health Sciences, School of Sciences, European University Cyprus, Diogenis Str 6, Nicosia, 2404, Cyprus. Electronic address:

Background: Identification of the factors that could potentially lead to congenital hearing loss is of paramount importance, as early detection of congenital hearing loss and intervention could prevent developmental delays in speech, language development as well as childhood cognitive impairment. Hitherto, intrauterine exposure to Zika virus has emerged as a cause of various fetal malformations, including cases of congenital hearing loss. The aim of this systematic review is to investigate the association between intrauterine exposure to Zika virus and hearing loss in children.

Methods: A systematic literature search was conducted to the databases PubMed, Cochrane library, Scopus, ClinicalTrials.gov, SciELO and Lilacs in order to identify studies that examine the association between prenatally Zika exposure and hearing loss within the first few years of life. Studies were eligible for inclusion, if solely objective methods for hearing evaluation of patients such as otoacoustic emissions (OAEs) and/or auditory brainstem response (ABR) were used, in children who intrauterine exposed to the Zika virus.

Results: Thirteen studies were included, which included 1275 children who are prenatally exposed to Zika virus. In 852 of the cases an objective hearing evaluation was performed using either OAEs or ABR. 709 children were tested with ABR and 79 had a failed outcome. 143 children were tested with OAEs whilst of these, 30 had a failed outcome. Altered OAEs ranged from 8.7% to 30.2%, while altered ABR ranged from 0% to 19.9%. The initial sample includes 428 children with microcephaly, while 5 of the studies comprise microcephaly to the inclusion criteria.

Conclusion: It seems to be a possible association between prenatal Zika virus exposure and hearing loss in children during the first years of their life. It is of great importance that in future studies possible confounding factors, like microcephaly, will be appropriately controlled. Additionally, the follow-up period of monitoring hearing loss in children should be prolonged in order to identify potential late onset hearing problems caused by intrauterine exposure to Zika virus.
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http://dx.doi.org/10.1016/j.ijporl.2021.110801DOI Listing
June 2021

Sociometric Risk Network Structure, HIV Prevalence, and Drug Injection-Related Norms among People Who Inject Drugs (PWID) in Athens, Greece.

Subst Use Misuse 2021 11;56(8):1190-1201. Epub 2021 May 11.

Medical School, University of Cyprus, Nicosia, Cyprus.

Structural properties of sociometric networks have been associated with behaviors related to HIV transmission. Very few studies, however, have explored the correlation between sociometric network factors and drug injection-related norms. This exploratory work: (i) describes basic structural qualities of a sociometric risk network of participants in the Transmission Reduction Intervention Project (TRIP) in Athens, Greece, in the context of a large HIV outbreak among people who inject drugs (PWID); (ii) measures HIV prevalence within specific structures within the sociometric risk network of PWID in TRIP; and (iii) explores the association of structural properties of the sociometric risk network in TRIP with drug injection-related norms. The sociometric risk network in TRIP consisted of a large component (=241, 67.8%), a few small components (=36, 10.1%) with 2-10 individuals each, and some isolates (=79, 22.2%). HIV prevalence was significantly higher in the large component (55.6%), the 2-core (59.1%) and 3-core (66.3%) of the large component, and the 3-cliques of the cores. Drug injection-related norms were significantly associated with structural characteristics of the sociometric risk network. A safe behavioral pattern (use of unclean cooker/filter/rinse water was never encouraged) was significantly (=0.03) less normative among people who TRIP participants of the 2-core injected with (40.5%) than among network contacts of TRIP participants outside the 2-core (55.6%). On the contrary, at drug-using venues, 2-core members reported that safer behaviors were normative compared to what was reported by those without 2-core membership. Sociometric network data can give useful insights into HIV transmission dynamics and inform prevention strategies.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1914103 .
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http://dx.doi.org/10.1080/10826084.2021.1914103DOI Listing
May 2021

Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution.

Front Psychol 2021 14;12:640955. Epub 2021 Apr 14.

Department of Psychology, University of Cyprus, Nicosia, Cyprus.

Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors. This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors. There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context. The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution.
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http://dx.doi.org/10.3389/fpsyg.2021.640955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079952PMC
April 2021

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis.

Int J Environ Res Public Health 2021 04 14;18(8). Epub 2021 Apr 14.

Clinic for Psychiatry, Clinical Center of Montenegro, 81110 Podgorica, Montenegro.

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all s = 0.001-0.021). Seeking social support was the significant mediator across subgroups (all s range = <0.001-0.005) except from the Hong Kong sample ( = 0.06) and the North and South American sample ( = 0.53). No mediation was found for problem-solving (except from the Northern European sample, = 0.009). Prosociality was the significant mediator in the Hong Kong sample ( = 0.016) and the Eastern European sample ( = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.
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http://dx.doi.org/10.3390/ijerph18084143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070933PMC
April 2021

Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography.

Thyroid Res 2021 Apr 9;14(1). Epub 2021 Apr 9.

European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus.

Background: Fine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.

Methods: Retrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.

Results: Eighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1-2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).

Conclusions: Irregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.
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http://dx.doi.org/10.1186/s13044-021-00098-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033666PMC
April 2021

Demographic forecasting of population aging in Greece and Cyprus: one big challenge for the Mediterranean health and social system long-term sustainability.

Health Res Policy Syst 2021 Feb 15;19(1):21. Epub 2021 Feb 15.

Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.

Background: With an increasing aging population and a lower ratio between the active and the dependent population, population aging is considered a global social and health challenge, associated with increased demand in health care needs and social pension. This study projects the Greek and Cypriot population to guide future planning of social and health policies and services.

Methods: The total population by sex and age groups, Total Fertility Rate (TFR), life-expectancies at birth and Potential Support Ratio PSR (persons aged 20-64 years per person 65+ years) are projected probabilistically by the year 2100 using Bayesian hierarchical models and United Nations' population data for Greece and Cyprus from the period of 1950 to 2015.

Results: The TFR is projected to be around 1.5 children per woman in 2050 and around 1.75 in 2100 for both countries, with all values of prediction intervals being around or below the Replacement level fertility. PSR is expected to decrease remarkably and be 2.5 in 2050 and 1.6 in 2100 for Cyprus while for Greece it will be around 1.5 for both years 2050 and 2100. Life-expectancy is expected to increase to 84 years for men and 87 years for women in 2050 and 90 years for men and 94 years for women in 2100 for both countries. The share of the population aged 65 years and over is projected to increase in both countries and be the one third of the population by 2100.

Conclusions: Greece and Cyprus will acquire the characteristics of an aging population, putting a significance pressure on the social and health systems of both countries. Both countries should reform their social and health policy agenda to confront population aging and its consequence. They should adopt fertility incentives and family policies to increase fertility and migrants' inclusiveness policies to improve the demographic structure and the economic activity. The national health systems should promote prevention strategies at the primary health sector and promote healthy aging while health research policy should aim to promote research in innovative technologies and digital health to create assistive technology for self-care and greater independence of older people.
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http://dx.doi.org/10.1186/s12961-020-00666-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885460PMC
February 2021

Impact of COVID-19 pandemic on mental health: An international study.

PLoS One 2020 31;15(12):e0244809. Epub 2020 Dec 31.

Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.

Background: The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected.

Methods: The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors.

Results: Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies.

Conclusions: These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244809PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774914PMC
January 2021

Corrigendum: Assessment of Alzheimer's Disease Based on Texture Analysis of the Entorhinal Cortex.

Front Aging Neurosci 2020 22;12:596070. Epub 2020 Oct 22.

Department of Computer Science, University of Cyprus, Nicosia, Cyprus.

[This corrects the article DOI: 10.3389/fnagi.2020.00176.].
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http://dx.doi.org/10.3389/fnagi.2020.596070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642872PMC
October 2020

Drug Injection-Related Norms and High-Risk Behaviors of People Who Inject Drugs in Athens, Greece.

AIDS Res Hum Retroviruses 2021 02 26;37(2):130-138. Epub 2020 Nov 26.

Medical School, University of Cyprus, Nicosia, Cyprus.

Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds-with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86-2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42-2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12-5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.
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http://dx.doi.org/10.1089/AID.2020.0050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020521PMC
February 2021

Assessment of Alzheimer's Disease Based on Texture Analysis of the Entorhinal Cortex.

Front Aging Neurosci 2020 2;12:176. Epub 2020 Jul 2.

Department of Computer Science, University of Cyprus, Nicosia, Cyprus.

Alzheimer's disease (AD) brain magnetic resonance imaging (MRI) biomarkers based on larger-scale tissue neurodegeneration changes, such as atrophy, are currently widely used. Texture analysis evaluates the statistical properties of the tissue image quantitatively; therefore, it could detect smaller-scale changes of neurodegeneration. Entorhinal cortex is the first region affected, and no study has investigated texture analysis on this region before. This study aims to differentiate AD patients from Normal Control (NC) and Mild Cognitive Impairment (MCI) subjects using entorhinal cortex texture features. Furthermore, it was evaluated whether texture has association to MCI beyond that of volume, to evaluate if atrophy development may precede. Texture features were extracted from 194 NC, 200 MCI, 84 MCI who converted to AD (MCIc), and 130 AD subjects. Receiving operating characteristic curves determined the performance of the various features in discriminating the groups, and a predictive model was used to predict conversion of MCIc subjects to AD. An area under the curve (AUC) of 0.872, 0.710, 0.730, and 0.764 was seen between NC vs. AD, NC vs. MCI, MCI vs. MCIc, and MCI vs. AD subjects, respectively. Including entorhinal cortex volume improved the AUCs to 0.914, 0.740, 0.756, and 0.780, respectively. For the disease prediction, binary logistic regression was applied on five randomly selected test groups and achieved on average AUC's of 0.760 and 0.764 on the training and validation cohorts, respectively. Entorhinal cortex texture features were significantly different between the four groups and in many cases provided better results compared to other methods such as volumetry.
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http://dx.doi.org/10.3389/fnagi.2020.00176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351503PMC
July 2020

Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected.

J Thyroid Res 2020 24;2020:3567658. Epub 2020 Mar 24.

European University Cyprus, Engomi, Nicosia, Cyprus.

Objective: To determine the prevalence of lymph node (LN) metastasis and extrathyroidal extension (ETE) in patients with papillary thyroid microcarcinoma (PTMC) in Cyprus and to evaluate the role of preoperative ultrasound (U/S) examination.

Methods: A retrospective study of 102 patients who underwent thyroidectomy for PTMC in a 2-year period. Preoperatively, all patients had a thyroid and neck U/S examination with LN mapping. Tumor size according to the largest diameter, number of foci, LN metastasis, and ETE data was collected from the histopathological report and was compared to the preoperative U/S reports.

Results: LN metastasis was present in 23.5% of patients. 15.7% had central, 3.9% had lateral, and 3.9% had both central and lateral LN metastasis. ETE was present in 27.5% of patients. 21.6% had multifocal disease, and in this group, 40.9% had LN metastasis and 36.4% had ETE. Multifocality ( = 0.03), size of tumor ( = 0.05), and ETE ( ≤ 0.001) were significantly associated with LN metastasis. The prevalence of LN metastasis in multifocal PTMC ≤5 mm was the same with multifocal PTMC >5 mm. The preoperative U/S sensitivity for the suspicious lateral neck and central LN was 100%, and the specificity was 100%. The preoperative U/S sensitivity for nodules suspicious for ETE was 53.6%, and the specificity was 100%.

Conclusion: The presence of LN metastasis and ETE in our PTMC patients in Cyprus is frequent. Neck U/S mapping is a highly reliable and accurate tool in identifying metastatic nodes. LN metastasis is associated with ETE and multifocality. Suspicious subcentimeter nodules should undergo FNA irrespective of size when multifocality is suspected.
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http://dx.doi.org/10.1155/2020/3567658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128046PMC
March 2020

Knowledge of Blood Transfusion in Medical And Biology Students.

Cureus 2019 Nov 12;11(11):e6133. Epub 2019 Nov 12.

Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, GRC.

Introduction: Blood transfusion (hemotherapy) is a therapeutic intervention used in treatment strategies of multiple diseases, thus, proper education is of utmost importance. Since currently there are no specified educational programs, undergraduate students were evaluated for the knowledge gained during university courses.

Purpose: To evaluate and compare the level of knowledge of students of the faculty of Health Science, Department of Medicine (DM), and Department of Molecular Biology-Genetics (DMB&Gs) on issues related to the transfusion of blood products.

Methods: A cross-sectional observational study was carried out with 123 students from the aforementioned departments of the Democritus University of Thrace, from the third year to the last year of study. A questionnaire was used, weighted, and was based on the European Commission's Guide to the Preparation, Use and Quality Assurance for Blood Components. Statistical tests such as chi-square (χ2), t-test, analysis of variance (ANOVA), and linear regression were used to investigate the factors that affect the overall score.

Results: The mean score of the students was 42.55 while the standard deviation (SD) was 12.27. The difference in the scores between the students of the DM (M = 44.63, SD = 13.2) and those of the DMB&Gs (mean = 38.25, SD = 9.05) was statistically significant in the univariable analysis (t= 3.1, p = 0.0), but in the multivariable analysis, it was not statistically significant (β = -4.1, p = 0.1.). The results of the multiple regression model indicated that the year of study, the professional status of the father, and the grade in the hematology course were associated with the total score.

Conclusions: The level of knowledge regarding blood product transfusion among students of the faculty of Health Science is insufficient.
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http://dx.doi.org/10.7759/cureus.6133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903875PMC
November 2019

Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus.

Int J Environ Res Public Health 2019 08 15;16(16). Epub 2019 Aug 15.

Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus.

Geographical investigations are a core function of public health monitoring, providing the foundation for resource allocation and policies for reducing health inequalities. The aim of this study was to develop geodemographic area classification based on several area-level indicators and to explore the extent of geographical inequalities in mortality. A series of 19 area-level socioeconomic indicators were used from the 2011 national population census. After normalization and standardization of the geographically smoothed indicators, the k-means cluster algorithm was implemented to classify communities into groups based on similar characteristics. The association between geodemographic area classification and the spatial distribution of mortality was estimated in Poisson log-linear spatial models. The k-means algorithm resulted in four distinct clusters of areas. The most characteristic distinction was between the ageing, socially isolated, and resource-scarce rural communities versus metropolitan areas with younger population, higher educational attainment, and professional occupations. By comparison to metropolitan areas, premature mortality appeared to be 44% (95% Credible Intervals [CrI] of Rate Ratio (RR): 1.06-1.91) higher in traditional rural areas and 36% (95% CrI of RR: 1.13-1.62) higher in young semi-rural areas. These findings warrant future epidemiological studies investigating various causes of the urban-rural differences in premature mortality and implementation policies to reduce the mortality gap between urban and rural areas.
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http://dx.doi.org/10.3390/ijerph16162927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720657PMC
August 2019

Small-area socioeconomic deprivation indices in Cyprus: development and association with premature mortality.

BMC Public Health 2019 May 22;19(1):627. Epub 2019 May 22.

Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.

Background: Area-level measures of socioeconomic deprivation are important for understanding and describing health inequalities. The aim of this study was the development and validation of a small-area index of socioeconomic deprivation for Cypriot communities and the investigation of its association with the spatial distribution of all-cause premature adult mortality.

Methods: Six area-level socioeconomic indicators were used from the 2011 national population census (low educational attainment, unemployment, not owner occupied household, single-person household, divorced or widowed and single-parent households). After normalization and standardization of the geographically smoothed indicators, Principal Component Analysis (PCA) was used to construct indicator weights. The association between deprivation indices and the spatial distribution of all-cause premature adult mortality was estimated in Poisson log-linear spatial models.

Results: PCA resulted in two principal components explaining the 65.7% of the total variance. The first principal component included four indicators (low educational attainment, single-person households, divorced or widowed and single-parent households, the latter however with a negative loading) and it thought more likely to capture rural-related aspects of deprivation. The second principal component included the other two indicators (unemployment and not owner occupied households) and it is more likely to capture urban-related aspects of material deprivation. Restricting the analysis in the metropolitan areas of the island resulted in a different set of indicators for the urban-specific deprivation index. All developed indices were linearly associated with all-cause premature adult mortality. The all-cause premature adult mortality increased by 17% per 1 standard deviation (SD) increase in rural-related socioeconomic deprivation (95% CrI: 8-27%) and 8% per 1 SD increase in urban-related aspects of material deprivation (95% CrI: 3-15%) in the nationwide analysis and 9% per 1 SD increase in urban-specific socioeconomic deprivation (95% CrI: 4-15%) across metropolitan areas.

Conclusions: The results of this study demonstrate that a set of small-area indices of socioeconomic deprivation across Cypriot communities have good construct and predictive validity. However, the study indicates that different aspects of socioeconomic deprivation may be important in rural and urban areas in Cyprus. The developed socioeconomic deprivation indices could offer a valid new tool for Cypriot public health research and policy in terms of identifying areas in greatest need, guiding resource allocation and developing area-targeted public health programmes and policies.
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http://dx.doi.org/10.1186/s12889-019-6973-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532164PMC
May 2019

Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review.

Laser Ther 2018 Sep;27(3):174-186

Department of Health Sciences, European University Cyprus, Nicosia, Cyprus.

Purpose: The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence.

Methods: A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement).

Results: Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data.

Conclusion: This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET.
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http://dx.doi.org/10.5978/islsm.27_18-OR-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034252PMC
September 2018

Risk factors for carriage of Streptococcus pneumoniae in children.

BMC Pediatr 2018 04 26;18(1):144. Epub 2018 Apr 26.

Cyprus Institute of Biomedical Sciences (CIBS), Nicosia, Cyprus.

Background: During the past decades Streptococcus pneumoniae has developed significant resistance to many classes of antimicrobial drugs. Potential risk factors for colonization of the nasopharynx by Streptococcus pneumoniae in children and for carriage of drug resistant strains were examined.

Methods: Between 2007 and 2008 nasopharyngeal swabs were collected from 402 children 6 months to 5 years old visiting the public sector immunization centers and outpatient departments as well as offices of paediatricians from private practice in Nicosia district in Cyprus. Information on demographic characteristics and potential risk factors of participating children were collected using a standardized questionnaire distributed to parents.

Results: In multivariable analyses we found that attendance at day care center, having siblings in the family and having both parents originating from Cyprus, statistically increased the risk of pneumococcal colonization. Full immunization with PCV7 appears to be a protective factor against colonization by pneumococcus. Previous administration of antimicrobials during the last month prior to specimen collection appeared to be the most consistent risk factor for carrying a non susceptible strain of Streptococcus pneumoniae to either penicillin or erythromycin. Factors such as age, nationality, previous or current breastfeeding, passive exposure to cigarette smoke and attendance in a day care center do not appear as independent risk factors for colonization by non susceptible strains.

Conclusions: Prudent use of antibiotics especially for upper respiratory tract infections in children as well as increased vaccination coverage by the pneumococcal conjugate vaccines could prove effective in reducing levels of colonization by drug resistant pneumococcal strains.
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http://dx.doi.org/10.1186/s12887-018-1119-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921789PMC
April 2018

The Greek version of the 9-item European Heart Failure Self-care Behaviour Scale: a multidimensional or a uni-dimensional scale?

Heart Lung 2014 Nov-Dec;43(6):494-9. Epub 2014 Aug 7.

Nursing Department, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Str., 3041 Limassol, Cyprus.

Objectives: To evaluate the dimensionality of the Greek version of the European Heart Failure Self-care Behaviour Scale (Gr9-EHFScBS) in a Greek-Cypriot population.

Background: EHFScBS is a valid and reliable scale which is widely used for assessing heart failure (HF) patients' self-care behaviors.

Methods: EHFScBS was translated into Greek and was administered to 128 Greek-Cypriot HF patients. The internal consistency, construct validity and discriminant validity of the scale were assessed.

Results: Confirmatory factor analysis failed to capture the proposed theoretical structure. Further exploratory factor analysis provided a three-factor solution accounting for 53.35% of the variance, though the scale is better used as a whole. Cronbach's alpha was moderate 0.66, but deletion of any item decreased the alpha coefficient. Discriminant validity was supported by the poor correlation between EHFScBS and Minnesota Living with Heart Failure Questionnaire scores.

Conclusion: Even though results do not conform to the multidimensionality of the scale, assessment of the tool provided acceptable validity and reliability measures to support its usage among Greek speaking populations.
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http://dx.doi.org/10.1016/j.hrtlng.2014.07.001DOI Listing
June 2015

Association of vitamin D with adiposity measures and other determinants in a cross-sectional study of Cypriot adolescents.

Public Health Nutr 2015 Jan 17;18(1):112-21. Epub 2014 Jan 17.

2Department of Nursing,School of Health Sciences,Cyprus University of Technology,Limassol,Cyprus.

Objective: To assess vitamin D status among Cypriot adolescents and investigate potential determinants including BMI and body fat percentage (BF%).

Design: Participants had cross-sectional assessments of serum vitamin D, physical activity, dietary vitamin D intake and sun exposure. Linear and logistic regression models were used to explore the associations of vitamin D with potential predictors.

Setting: Hospitals, Cyprus, November 2007-May 2008.

Subjects: Adolescents (n 671) aged 16-18 years.

Results: Mean serum vitamin D was 22·90 (sd 6·41) ng/ml. Only one in ten children had sufficient levels of vitamin D (≥30 ng/ml), while the prevalence of vitamin D deficiency (12-20 ng/ml) and severe deficiency (<12 ng/ml) was 31·7 % and 4·0 %, respectively. Lower vitamin D was associated with winter and spring season, female gender, reduced sun exposure in winter and darker skin. Participants with highest BMI and BF% when compared with a middle reference group had increased adjusted odds of vitamin D insufficiency (OR = 3·00; 95 % CI 1·21, 7·45 and OR = 5·02; 95 % CI 1·80, 13·97, respectively). A similar pattern, although not as strong, was shown for vitamin D deficiency with BF% (OR = 1·81; 95 % CI 1·04, 3·16) and BMI (OR = 1·51; 95 % CI 0·85, 2·67). Participants in the lowest BMI and BF% groups also displayed compromised vitamin D status, suggesting a U-shaped association.

Conclusions: Vitamin D deficiency in adolescence is very prevalent in sunny Cyprus, particularly among females, those with darker skin and those with reduced sun exposure in winter. Furthermore, vitamin D status appears to have a U-shaped association with adiposity measures.
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http://dx.doi.org/10.1017/S1368980013003480DOI Listing
January 2015

Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis.

Diabetes Metab Syndr Obes 2013 Oct 24;6:403-19. Epub 2013 Oct 24.

Research and Education Institute of Child Health, Strovolos, Cyprus.

Background And Objectives: The identification of increased cardiometabolic risk among asymptomatic individuals remains a huge challenge. The aim of this meta-analysis was to compare the association of body mass index (BMI), which is an index of general obesity, and waist-to-height ratio (WHtR), an index of abdominal obesity, with cardiometabolic risk in cross-sectional and prospective studies.

Methods: PubMed and Embase databases were searched for cross-sectional or prospective studies that evaluated the association of both BMI and WHtR with several cardiometabolic outcomes. The strength of relative risk (RR) with 95% confidence interval (CI) was calculated using the optimal cutoffs of BMI and WHtR in cross-sectional studies, while any available cutoff was used in prospective studies. The pooled estimate of the ratio of RRs (rRR [=RRBMI/RRWHtR]) with 95% CIs was used to compare the association of WHtR and BMI with cardiometabolic risk. Meta-regression was used to identify possible sources of heterogeneity between the studies.

Results: Twenty-four cross-sectional studies and ten prospective studies with a total number of 512,809 participants were identified as suitable for the purpose of this meta-analysis. WHtR was found to have a stronger association than BMI with diabetes mellitus (rRR: 0.71, 95% CI: 0.59-0.84) and metabolic syndrome (rRR: 0.92, 95% CI: 0.89-0.96) in cross-sectional studies. Also in prospective studies, WHtR appears to be superior to BMI in detecting several outcomes, including incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality. The usefulness of WHtR appears to be better in Asian than in non-Asian populations. BMI was not superior to WHtR in any of the outcomes that were evaluated. However, the results of the utilized approach should be interpreted cautiously because of a substantial heterogeneity between the results of the studies. Meta-regression analysis was performed to explain this heterogeneity, but none of the evaluated factors, ie, sex, origin (Asians, non-Asians), and optimal BMI or WHtR cutoffs were significantly related with rRR.

Conclusion: The results of this meta-analysis support the use of WHtR in identifying adults at increased cardiometabolic risk. However, further evidence is warranted because of a substantial heterogeneity between the studies.
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http://dx.doi.org/10.2147/DMSO.S34220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810792PMC
October 2013

Prevalence of asthma and allergies in children from the Greek-Cypriot and Turkish-Cypriot communities in Cyprus: a bi-communal cross-sectional study.

BMC Public Health 2013 Jun 16;13:585. Epub 2013 Jun 16.

Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.

Background: The Greek-Cypriot (G/C) and Turkish-Cypriot (T/C) communities have lived apart since 1974, with the former presumably adopting a more westernized way of life. We estimated the prevalence of asthma and allergies among children in the two communities and investigated differences in socio-demographic and lifestyle risk factors.

Methods: The ISAAC questionnaire was completed by 10156 children aged 7-8 and 13-14 years. Relative differences in asthma and allergic symptoms between the two communities were expressed as odds ratios (OR), estimated in multivariable logistic regression models before and after adjusting for participants' risk characteristics.

Results: In contrast to our original speculation, consistently lower prevalence rates were observed for respiratory outcomes (but not eczema) among G/C compared to T/C children in both age-groups. For instance, the prevalence of current wheeze among 7-8 year-olds was 8.7% vs 11.4% (OR = 0.74, 95%, CI: 0.61, 0.90) and of current rhinoconjuctivitis 2.6% vs 4.9% (OR = 0.52, 95% CI: 0.37, 0.71). Surprisingly, the proportion reporting family history of allergy was almost double in the G/C community. With the exception of early life nursery attendance, several protective factors were more prevalent amongst T/C, such as bedroom sharing, less urbanized environment and exposure to farm animals. In contrast, exposure to tobacco smoke was more frequent in the T/C community. Controlling for risk factors did not account for the observed lower prevalence of current wheeze (in the younger age-group) and rhinoconjuctivitis (in both age-groups) among G/C children while differences in the prevalence of eczema between the two communities were no longer statistically significant.

Conclusions: A mixed picture of potential risk factors was observed in the two communities of Cyprus, not consistently favoring one over the other community since, for example, bedroom sharing and rural living but also exposure to tobacco smoke were more common among T/C children. Investigated risk factors do not fully account for the lower prevalence of asthma and allergies among G/C children, especially against a background of higher family history of allergy in this community.
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http://dx.doi.org/10.1186/1471-2458-13-585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698153PMC
June 2013

Evaluation of the psychometric properties of the Greek version of the Minnesota Living With Heart Failure questionnaire.

J Cardiopulm Rehabil Prev 2013 Jul-Aug;33(4):229-33

Nursing Department, School of Health Sciences, Cyprus University of Technology, Nicosia, Cyprus.

Purpose: One of the major challenges for health care professionals in heart failure (HF) management is to maintain and/or improve HF patient health-related quality of life. The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is one of the most comprehensive and widely used tools for measuring health-related quality of life among patients with HF. The aim of the study was to assess the psychometric properties of the Greek version of the tool.

Methods: The MLHFQ was administered among 128 Greek-Cypriot HF patients to assess the internal consistency, content validity, and contrast validity of its Greek version. Exploratory factor analysis was undertaken to establish its construct validity.

Results: The factor analysis in this study provided support for a 3-factor solution explaining 64.15% of the variance (physical, emotional, and social subscales). The internal consistency for the Greek version of the MLHFQ total scale (0.95) and subscales (0.80-0.94) were found to be high. The contrast validity of the Greek version of the MLHFQ was explored through cumulative MLHFQ scores and comparisons that were able to distinguish among all different levels of HF severity, as defined by the New York Heart Association functional class grouping.

Conclusion: This study provides support for the reliability and validity of the Greek version of the MLHFQ.
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http://dx.doi.org/10.1097/HCR.0b013e3182930cbbDOI Listing
February 2014

Associations of body fat percent and body mass index with childhood asthma by age and gender.

Obesity (Silver Spring) 2013 Sep 21;21(9):E474-82. Epub 2013 May 21.

Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.

Objective: High body mass index (BMI) has been shown to be associated with asthma, but the pattern of this association is still unclear and may differ by gender or stage of puberty. BMI is only a proxy of adiposity, whereas estimation of body fat percent (BF%) by the bioimpedance technique is considered an accurate measure of adiposity. We investigated whether BMI and BF% behave differently in their association with asthma between genders, before and during adolescence.

Design And Methods: In this cross-sectional study of 10,981 schoolchildren, we used logistic regression models to examine the pattern of association of BMI and BF% with asthma.

Results: In the case of BF%, both the highest (odds ratio [OR]: 1.68, 95% confidence interval [95% CI]: 1.21-2.30) and lowest (OR: 1.59, 95% CI: 1.13-2.23) z-score categories conferred an increased adjusted risk for active asthma. The likelihood ratio test (LRT) of nonlinearity yielded significant results (P < 0.01) for BF%. In contrast, the LRT for BMI yielded a nonsignificant result (P = 0.45) indicating a linear association of asthma with BMI. A unit increase in BMI z-score conferred an increase in the adjusted odds of active asthma (OR: 1.14, 95% CI: 1.02-1.27). In the case of BF%, the adjusted ORs for active asthma at the highest and lowest z-score categories in both genders, before and during adolescence, were similarly elevated, exhibiting a U-shape pattern.

Conclusions: In contrast to the linear association observed with BMI, BF% displayed a U-shaped association with asthma and may be the preferred measure of adiposity in epidemiological studies of asthma in children.
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http://dx.doi.org/10.1002/oby.20284DOI Listing
September 2013

Asthma and atopy in children born by caesarean section: effect modification by family history of allergies - a population based cross-sectional study.

BMC Pediatr 2012 Nov 16;12:179. Epub 2012 Nov 16.

Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.

Background: Studies on the association of birth by caesarean section (C/S) and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies.

Methods: Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents' responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models.

Results: After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71), asthma diagnosis (OR 1.41, 95% CI 1.09-1.83) and be atopic (OR 1.67, 95% CI 1.08-2.60). There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06) but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00), no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11).

Conclusions: Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.
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http://dx.doi.org/10.1186/1471-2431-12-179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511167PMC
November 2012

Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: a systematic review and meta-analysis.

Int J Nurs Stud 2012 May 22;49(5):610-24. Epub 2011 Dec 22.

Cyprus University of Technology, School of Health Sciences, Nursing Department, Limassol, Cyprus.

Background: Heart failure (HF) is a clinical condition with major socioeconomic burden. Scientists are trying to find effective solutions to eliminate the effects of the disease and the current innovations in research address the introduction of HF management programmes (HF-MPs).

Objectives: A meta-analysis was undertaken to estimate the effect of HF-MP with a nurse-driven pre-discharge phase on the outcomes of HF and all-cause re-admission.

Data Sources: A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (reviews and clinical trials) was performed to locate randomised controlled trials (RCTs), published in English language, which implemented any HF-MP with discharge planning carried out by a nurse. Identified articles were further screened for additional studies.

Study Selection: Two reviewers independently screened relevant abstracts or titles using a standardised predefined check list. Pilot studies, studies additionally assessing other conditions and studies that evolved technology utilities or included medication management beyond optimisation of therapy, were excluded.

Data Extraction: Selected articles were thoroughly screened and data of interest (characteristics and outcomes) were obtained. Quality assessment was done by two reviewers separately.

Data Synthesis: Nineteen RCTs were selected for the meta-analysis. The overall pooled effect (relative risk, RR) of the intervention group compared with the control group was estimated by using a random effects analysis (95% confidence interval (CI)) for the outcomes of HF-related re-admission and all-cause re-admission. The overall RR of HF re-admissions was 0.68, 95% CI (0.53, 0.86), p<0.05 and of all-cause re-admission was 0.85, 95% CI (0.76, 0.94), p<0.05 favouring the intervention. Metaregression analysis was performed while trying to explain the observed heterogeneity but none of the factors (environment, duration of follow-up, origin and complexity) were significantly related with the RR. No significant publication bias was observed regarding both HF and all-cause re-admission.

Conclusions: The results of the current meta-analysis highlight the potential of HF-MPs with nurse-driven pre-discharge interventions to reduce hospital re-admissions. Essential characteristics or components of a successful HF-MP are still to be determined; thus more studies are required to solve this issue.
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http://dx.doi.org/10.1016/j.ijnurstu.2011.11.002DOI Listing
May 2012