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Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by convincing evidence. We searched PubMed and ISI Web of Science from inception to December 2018 to identify meta-analyses examining associations between putative risk factors for GDM. For each meta-analysis we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. Thirty eligible meta-analyses were identified, providing data on 61 associations. Fifty (82%) associations had nominally statistically significant findings (P<0.05), while only 15 (25%) were significant at P<10-6 under the random-effects model. Only four risk factors presented convincing evidence:, low vs. normal BMI (cohort studies), BMI ~30-35 kg/m2 vs. normal BMI, BMI >35 kg/m2 vs. normal BMI, and hypothyroidism. The compilation of results from synthesis of observational studies suggests that increased BMI and hypothyroidism show the strongest consistent evidence for an association with GDM. Diet and lifestyle modifications in pregnancy should be tested in large randomized trials. Our findings suggest that women with known thyroid disease may be offered screening for GDM earlier in pregnancy.

Coronavirus 2019 disease (COVID-19) is caused by the virus SARS-CoV-2, transmissible both person-to-person and from contaminated surfaces. Early COVID-19 detection among healthcare workers (HCWs) is crucial for protecting patients and the healthcare workforce. Because of limited testing capacity, symptom-based screening may prioritize testing and increase diagnostic accuracy. We performed a retrospective study of HCWs undergoing both COVID-19 telephonic symptom screening and nasopharyngeal SARS-CoV-2 assays during the period, March 9-April 15, 2020. HCWs with negative assays but progressive symptoms were re-tested for SARS-CoV-2. Among 592 HCWs tested, 83 (14%) had an initial positive SARS-CoV-2 assay. Fifty-nine of 61 HCWs (97%) who were asymptomatic or reported only sore throat/nasal congestion had negative SARS-CoV-2 assays (P = 0.006). HCWs reporting three or more symptoms had an increased multivariate-adjusted odds of having positive assays, 1.95 (95% CI: 1.10-3.64), which increased to 2.61 (95% CI: 1.50-4.45) for six or more symptoms. The multivariate-adjusted odds of a positive assay were also increased for HCWs reporting fever and a measured temperature ≥ 37.5°C (3.49 (95% CI: 1.95-6.21)), and those with myalgias (1.83 (95% CI: 1.04-3.23)). Anosmia/ageusia (i.e. loss of smell/loss of taste) was reported less frequently (16%) than other symptoms by HCWs with positive assays, but was associated with more than a seven-fold multivariate-adjusted odds of a positive test: OR = 7.21 (95% CI: 2.95-17.67). Of 509 HCWs with initial negative SARS-CoV-2 assays, nine had symptom progression and positive re-tests, yielding an estimated negative predictive value of 98.2% (95% CI: 96.8-99.0%) for the exclusion of clinically relevant COVID-19. Symptom and temperature reports are useful screening tools for predicting SARS-CoV-2 assay results in HCWs. Anosmia/ageusia, fever, and myalgia were the strongest independent predictors of positive assays. The absence of symptoms or symptoms limited to nasal congestion/sore throat were associated with negative assays.

Despite suggestive observational epidemiology and laboratory studies, there is limited experimental evidence regarding the effect of organic diet on human health. A cluster-randomized 40-day-organic (vs. 40-day-conventional) crossover trial was conducted among children (11-12 years old) from six schools in Cyprus. One restaurant provided all organic meals, and adherence to the organic diet intervention was measured by parent-provided diet questionnaire/diary data. Biomarkers of pyrethroid and neonicotinoid pesticide exposures were measured using tandem mass spectrometry, and oxidative stress/inflammation (OSI) biomarkers using immunoassays or spectrophotometry. Associations were assessed using mixed-effect regression models including interactions of treatment with time. Seventy-two percent of neonicotinoid biomarkers were non-detectable and modeled as binary (whether detectable). In post-hoc analysis, we considered the outcome of age-and-sex-standardized BMI. Multiple comparisons were handled using Benjamini-Hochberg correction for 58 regression parameters. Outcome data were available for 149 children. Children had lower pesticide exposures during the organic period (pyrethroid geometric mean ratio, GMR = 0.297; [95% confidence interval (95% CI): 0.237, 0.373], Q-value<0.05); odds for detection of neonicotinoids (OR = 0.651; [95% CI: 0.463, 0.917), Q-value<0.05); and decreased OSI biomarker 8-OHdG (GMR = 0.888; [95% CI: 0.808, 0.976], Q-value<0.05). An initial increase was followed by a countervailing decrease over time in the organic period for OSI biomarkers 8-iso-PGF2a and MDA. BMI z-scores were lower at the end of the organic period (β = -0.131; [95% CI: 0.179, -0.920], Q-value<0.05). Energy intake during the conventional period was reported to be higher than the recommended reference levels. The organic diet intervention reduced children's exposure to pyrethroid and neonicotinoid pesticides and, over time lowered biomarkers of oxidative stress/inflammation (8-iso-PGF2a, 8-OHdG and MDA). The several-week organic diet intervention also reduced children's age-and-sex-standardized BMI z-scores, but causal inferences regarding organic diet's physiological benefits are limited by the confounding of the organic diet intervention with caloric intake reduction and possible lifestyle changes during the trial. Trial registration: This trial is registered with ClinicalTrials.gov, number: NCT02998203.

Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Our aim was to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases. A representative sample of n = 1140 individuals over 18 years old was surveyed during 2018-2019. Demographic characteristics as well as the presence of chronic conditions, including mental disorders, were collected through a standardized questionnaire. Diseases were classified according to the International Classification of Diseases, 10.sup.th Revision (ICD-10). The age and gender standardized prevalence of multimorbidity was 28.6%. Multimorbidity was associated with age (p<0.001), with the highest rate observed among people aged 65+ years old (68.9%). Multimorbidity was higher in women than men (28.2% vs. 22.5%, p < .001) but similar in urban and rural regions (26.4% vs. 23.8%, p = 0.395). The most prevalent chronic diseases among people with multimorbidity were hyperlipidemia (44.7%), followed by hypertension (37.5%), gastric reflux (23.9%), and thyroid diseases (22.2%), while the most common combinations of diseases were in the circulatory and endocrine systems. The profile of the multimorbid individual indicated this to be a person at an older age with a higher BMI, a current smoker with a higher salary. More than one quarter of the general population of Cyprus has multimorbidity, and this rate is almost 70% among the elderly. Multimorbidity is relatively common even in younger ages too. This underlines the need for prevention strategies and health awareness programs for the entire population.

National data on deaths among on-duty firefighters between 1994 and 2004 were assessed in relation to estimates of the proportions of time spent by firefighters in various duties. The rate of death from coronary heart disease during active fire suppression was approximately 10 to 100 times as high as the expected rate. This study suggests that firefighting is associated with an unusually high risk of death from cardiac causes. Deaths among on-duty firefighters between 1994 and 2004 were assessed in relation to various duties. The rate of death from coronary heart disease during active fire suppression was approximately 10 to 100 times as high as the expected rate. Firefighting is known to be a dangerous occupation. What is less appreciated is that the most frequent cause of death among firefighters is heart disease rather than burns or smoke inhalation. Cardiovascular events, largely due to coronary heart disease, account for 45% of deaths among firefighters on duty. 1 , 2 In contrast, such events account for 22% of deaths among police officers on duty, 11% of deaths among on-duty emergency medical services workers, and 15% of all deaths that occur on the job. 2 , 3 The high rate of death from cardiovascular causes among firefighters raises questions about contributing factors. Possible factors, . . .

Epidemiological studies have yielded conflicting results regarding climate and incident SARS-CoV-2 infection, and seasonality of infection rates is debated. Moreover, few studies have focused on COVD-19 deaths. We studied the association of average ambient temperature with subsequent COVID-19 mortality in the OECD countries and the individual United States (US), while accounting for other important meteorological and non-meteorological co-variates. The exposure of interest was average temperature and other weather conditions, measured at 25 days prior and 25 days after the first reported COVID-19 death was collected in the OECD countries and US states. The outcome of interest was cumulative COVID-19 mortality, assessed for each region at 25, 30, 35, and 40 days after the first reported death. Analyses were performed with negative binomial regression and adjusted for other weather conditions, particulate matter, sociodemographic factors, smoking, obesity, ICU beds, and social distancing. A 1 °C increase in ambient temperature was associated with 6% lower COVID-19 mortality at 30 days following the first reported death (multivariate-adjusted mortality rate ratio: 0.94, 95% CI 0.90, 0.99, p = 0.016). The results were robust for COVID-19 mortality at 25, 35 and 40 days after the first death, as well as other sensitivity analyses. The results provide consistent evidence across various models of an inverse association between higher average temperatures and subsequent COVID-19 mortality rates after accounting for other meteorological variables and predictors of SARS-CoV-2 infection or death. This suggests potentially decreased viral transmission in warmer regions and during the summer season.

Non-communicable diseases (NCDs) account for 71% of all deaths globally, including 15 million premature deaths each year (deaths between 30-69 years of age). Instead of waiting until disease manifestation, focusing on the origins of NCDs during childhood offers a critical window of disease prevention and control. The CHILDREN_(F)IRST international cohort observatory study aims to investigate how the spatio-temporal evolution of the children's exposome profiles in the Mediterranean region influences early-life programming of chronic disease risk during the critical window of susceptibility in primary school years (6-11 years of age). The study protocol adopts the human exposome framework integrated with a personalized prevention approach, using multi-omics platforms and advanced machine learning algorithms implemented across Mediterranean countries, namely Cyprus, Greece, and Albania. The cohort will consist of children enrolled in the first grade of primary school, who will undergo annual follow-up assessments until completion of primary education. During the annual assessments, children's exposome parameters from the three main exposome domains will be evaluated using different assessment types, i.e., molecular biomarkers of exposure/effect, sensors, and questionnaires. Standardized biospecimen and data collection methods will be employed following harmonized standardized operating procedures. The reference model of Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) developed and maintained as part of the Observational Health Data Sciences and Informatics (OHDSI) initiative will be used to conduct federated data analysis. This CHILDREN_(F)IRST study protocol is a human exposome-based initiative to establish a long-term prospective cohort infrastructure for biomedical research on children's health in the Mediterranean region. The cohort's exposome-based findings will systematically feed into the evaluation and design of chronic disease prevention programs. Expected results would inform evidence-based policy making and the development of health interventions for reducing the risk of NCDs in childhood and later in adult life.

ContextThe degree to which changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) relate to corresponding changes in plasma sex steroids is not known.ObjectiveWe examined whether changes in VAT and SAT areas assessed by computed tomography were associated with changes in sex hormones [dehydroepiandrosterone sulfate (DHEAS), testosterone, estradiol, estrone, and sex hormone binding globulin (SHBG)] among Diabetes Prevention Program participants.DesignSecondary analysis of a randomized trial.ParticipantsOverweight and glucose-intolerant men (n = 246) and women (n = 309).InterventionsIntensive lifestyle change with goals of weight reduction and 150 min/wk of moderate intensity exercise or metformin administered 850 mg twice a day or placebo.Main Outcome MeasuresAssociations between changes in VAT, SAT, and sex hormone changes over 1 year.ResultsAmong men, reductions in VAT and SAT were both independently associated with significant increases in total testosterone and SHBG in fully adjusted models. Among women, reductions in VAT and SAT were both independently associated with increases in SHBG and associations with estrone differed by menopausal status. Associations were similar by race/ethnicity and by randomization arm. No significant associations were observed between change in fat depot with change in estradiol or DHEAS.ConclusionsAmong overweight adults with impaired glucose intolerance, reductions in either VAT and SAT were associated with increased total testosterone in men and higher SHBG in men and women. Weight loss may affect sex hormone profiles via reductions in visceral and subcutaneous fat.In a randomized trial of weight loss, reductions in visceral and subcutaneous adiposity were associated with increases in total testosterone in men and increases in SHBG in men and women.

Background The frequency and intensity of heat waves is projected to increase in many parts of the world, particularly in regions such as the Eastern Mediterranean and Middle East (EMME), where the warming trends are much larger than the global average. The relationship between air temperature and premature mortality is widely recognized, however, it is not well defined in the aforementioned region. The objective of this study is to assess the relationship between cardiovascular mortality risk and air temperature in Cyprus, an island located centrally in the EMME. Methods Daily cardiovascular mortality data and spatially aggregated daily mean, maximum, and minimum temperatures for the period 2004-2010 were analyzed using a case-crossover design combined with a distributed lag non-linear model. Results A relationship between high temperatures and cardiovascular mortality was observed for cerebrovascular diseases, ischaemic and other heart diseases; this relationship was exacerbated on days with high temperatures. The highest relative risk was observed on the day of the heat event and remained significantly elevated for another day. The results were consistent regardless whether the minimum, maximum, or mean temperatures were used, although the association seems to be more pronounced with the mean temperatures, which suggests that consecutive high day- and night-time temperatures are the most hazardous. Conclusions The identification of a positive relationship between high temperatures and cardiovascular mortality in Cyprus raises concerns. In view of the projected climate changes and strong increases in extreme heat events in the region, appropriate interventions need to be developed.

Background Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance. Methods We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population. Results A total of 474 deaths were observed. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value < 0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR = 145, 95% CI 100-203, p-value = 0.047) and cancer of the kidney and other genitourinary organs among women (SMR = 368, 95% CI 119-858, p-value = 0.025). Elevated SMRs for several other cancers were also noted (lip, oral cavity and pharynx 344, stomach 121, female breast 134, prostate 128, and leukaemias 168), but these did not reach statistical significance. Conclusions Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations.