Explore the vast range of titles available.

Parents often must take decisions regarding their children's health, which requires certain skills and competences. Parental health literacy (HL) is important in establishing positive health-promoting behaviours and better health outcomes to their children. Limited parental HL has been associated with various negative children's health outcomes. The aim of the study was to explore perceived and functional HL among parents in Cyprus. A cross-sectional study was conducted with a convenience sample of 416 parents of children, aged 6 months to 15 years old, presenting in pediatric outpatient departments across three Cypriot cities. Participants completed the HLS-EU-Q47, a self-reported measure of HL, and the NVS (Newest Vital Sign), a performance-based measure of HL. Associations with socio-demographic characteristics and health behaviors were explored. Based on suggested ranges, among 416 parents, mostly mothers (83.2%), almost half of parents (42.6%) were classified as having inadequate or problematic perceived HL. Consistently, 62.8% showed high likelihood or significant possibility of limited functional HL, based on the NVS with a mean score of 2.73 out of 6 (SD = 2.02). Nevertheless, no correlation was observed between the two measures of HL. Limited parental perceived HL was statistically significantly associated with lower educational attainment, lower number of children in the family, increased self-assessed health status, and limited exercise habits. Limited parental functional HL was statistically significantly associated with female gender, younger age, lower educational attainment, receiving financial aid, lower family income, and lower alcohol consumption. Even though there was lack of agreement in the classification according to the HLS-EU-Q47 and the NVS, moderate-to-low levels of perceived HL appear consistent with a performance-based measure of HL. As a high number of parents may face challenges in assessing and applying health information to improve outcomes for their children, with evidence of social gradient, healthcare services should be oriented towards identifying problematic HL while Public Health interventions are needed to enhance parental HL.

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.

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.

Background Arterial stiffness, which is estimated by pulse wave velocity (PWV), has been associated with cardiovascular morbidity and mortality; however, there is sparse literature on socioeconomic (SES) indicators and PWV. Methods In this systematic review and meta-analysis, evidence was retrieved from cross-sectional and cohort studies on the association of SES indicators (both single and composite) with arterial stiffness. A total of 16,331 records were reviewed and 9 studies included. Results Low educational level was associated with an increase of 0.26 m/s in PWV (95% CI: 0.15 to 0.37; p  < 0.001; I 2  = 78.2%), whereas low SES was associated with a 0.32 m/s increase of PWV (95%CI: 0.09 to 0.56, p  = 0.008, I 2  = 93.6%). Conclusion Results underscore the importance of socioeconomic position as a determinant of arterial stiffness. Future studies could benefit from longitudinal designs and more homogeneous SES measures, as well as considering composite indicators of SES like neighborhood/area environment and characteristics, along with individual indicators.

Background The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which impact on health and well-being. The aim of this study was to survey citizens’ perceptions of Place across diverse settings in Cyprus. While the PST has been extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored. Methods An open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position (10-step ladder). Results With the exception of safety (M = 4.4, SD = 1.7), 492 participants (mean age 42, 50% residents for > 10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder, 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR = 4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α = 0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment. Conclusions The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation.

Background Teamwork and job satisfaction are important among the multidisciplinary team who care patients with chronic illnesses such as heart failure (HF) patients. TeamSTEPPS teamwork perceptions questionnaire (T-TPQ) and Minnesota Satisfaction Questionnaire “short form” (MSQ-short) are both self-report questionnaires which examine multiple dimensions of perceptions of teamwork and job satisfaction within healthcare settings, respectively. The aim of the study was to examine the psychometric properties of the Greek versions of the TeamSTEPPS Teamwork perceptions questionnaire (Gr-T-TPQ) and Minnesota Satisfaction Questionnaire “short form” (Gr-MSQ-short). Methods A methodological study was contacted in order to assess the construct validity and reliability of the Gr-T-TPQ and Gr-MSQ-short. For that reason, 292 questionnaires were administrated to Greek-Cypriot health care professionals (HCPs). Confirmatory factor analysis (CFA) was conducted for the data collected with the GrT-TPQ and Exploratory factor analysis (EFA) and CFA were also conducted for the data collected with the GrMSQ-short questionnaire. Cronbach’s a was calculated as well. Results CFA of the data collected with Gr-T-TPQ confirmed the initial scale structure with excellent fit indices (× 2 (df) 1124.75 (550), p < 0.0001, AGFI = 0.986, TLI = 0.994, CFI = 0.994, RMSEA = 0.06, 90%, C.I.[0.055–0.065]). Furthermore, all dimensions were found to be correlated (r = 0.65 to r = 0.88) and internal consistency was found adequate (Cronbach’s α = 0.96). Subscales also, demonstrated high internal consistency (α = 0.87–0.95). CFA for the data collected with Gr-MSQ-short, did not confirm the initial scale’s dimensions. In EFA items 1, 5, 6, 12 and 18 were eliminated from the analysis due to low communalities and multiple components loading. The oblimin rotation with two factors was explaining 58% of the variance. These two factors identified were Supervisor/Autonomy and Task Enrichment. Conclusions In general, the Gr-T-TPQ and Gr-MSQ-short are construct-valid instruments for measuring perceptions of teamwork and job satisfaction in Greek speaking HCPs’ population.

Background Device-associated health care-associated infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit. The aim of this study was to assess the incidence of DA-HAIs, mortality and crude excess mortality at a General Hospital’s Intensive Care Unit (ICU) in the Republic of Cyprus for 1 year period. Methods A prospective cohort, active DA-HAIs surveillance study with the use of Health Acquired Infections (HAIs) ICU Protocol (v1.01 standard edition) as provided by ECDC/NHSN for the active DA-HAIs surveillance study was conducted. The study sample included 198 ICU patients admitted during the research period and hospitalized for over 48 h. The Ventilator-Associated Pneumonia (VAP), Central Line-Associated Bloodstream Infection (CLABSI), and Catheter-Associated Urinary Tract Infection (CAUTI) rates, length of stay (LOS), mortality, and crude excess mortality were calculated. Results CLABSI was the most frequent DA-HAI with 15.9 incidence rate per 1000 Central Venus Catheter (CVC) days. The VAP rate, was 10.1 per 1000 ventilator days and the CAUTI rate was 2.7 per 1000 urinary catheter days. Device associated infections were found to be significantly associated with the length of ICU stay ( p  < 0.001), the CVC days ( p  < 0.001), ventilator days ( p  < 0.001), and urinary catheter days ( p  < 0.001). The excess mortality was 22.1% for those who acquired a DA-HAI (95% CI, 2–42.2%) compared to the patients who remained DA-HAI free. Mortality of patients with VAP infection was 2.3 times higher (RR = 2.33 95% CI, 1.07–5.05) than those patients admitted without a HAI and subsequently did not acquire a DA-HAI. The most frequently isolated pathogen was Staphylococcus epidermidis (13.9%) and Candida albicans (13.9%). Conclusions Higher DA-HAIs rates and device utilization than the international benchmarks were found in this study, calling into question the safety of preventative practices employed in this unit.

Diagnostic testing for primary ciliary dyskinesia (PCD) usually includes transmission electron microscopy (TEM), nasal nitric oxide, high-speed video microscopy, and genetics. Diagnostic performance of each test should be assessed toward the development of PCD diagnostic algorithms. We systematically reviewed the literature and quantified PCD prevalence among referrals and TEM detection rate in confirmed PCD patients. Major electronic databases were searched until December 2015 using appropriate terms. Included studies described cohorts of consecutive PCD referrals in which PCD was confirmed by at least TEM and one additional test, in order to compare the index test performance with other test(s). Meta-analyses of pooled PCD prevalence and TEM detection rate across studies were performed. PCD prevalence among referrals was 32% (95% CI: 25–39%, I 2 = 92%). TEM detection rate among PCD patients was 83% (95% CI: 75–90%, I 2 = 90%). Exclusion of studies reporting isolated inner dynein arm defects as PCD, reduced TEM detection rate and explained an important fraction of observed heterogeneity (74%, 95% CI: 66–83%, I 2 = 66%). Approximately, one third of referrals, are diagnosed with PCD. Among PCD patients, a significant percentage, at least as high as 26%, is missed by TEM, a limitation that should be accounted toward the development of an efficacious PCD diagnostic algorithm.

The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000-2019. To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods. Suicide deaths (ICD-10 taxonomy, including 'undetermined' code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods. There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as 'violent' for both genders. The male suicide rate doubled from 4-5 to 9-10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; = 0.002). From 2013, the trend reversed (effect modification < 0.001) with a 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across all age groups; rates in males aged 45-64 years continued to rise, surpassing the previously high rate in males aged 25-44 years. Rates in females declined from 4-5 per 100 000 to 2-3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020, compared with 2.73 (1.88, 3.95) in 2004-2008. Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.

Background Previous findings suggest that stressful life events have a causal relationship with depressive symptoms. However, to date little is known concerning the contribution of the number and severity of recent stressful life events on the prevalence of depressive symptoms among university students. The aim of this study was to investigate the prevalence of depressive symptoms and its association with the number and the severity of self-reported stressful life events among university students in Cyprus. Methods A descriptive correlational design with cross sectional comparison was used. The CES-D scale was applied for the assessment of depressive symptoms and the LESS instrument for stressful life events. Both scales were completed anonymously and voluntarily by 1.500 students (response rate 85%). Results The prevalence of mild to moderate depressive symptoms [CES-D score between 16 and 21] and of clinically significant depressive symptoms [CES-D score ≥ 22] were 18.8% and 25.3% respectively. There were statistically significant differences in clinically significant depressive symptoms by gender, with higher rates among women (x 2  = 8.53, df = 1, p = 0.003). Higher scores on the LESS scale were associated with more frequent reports of clinical depressive symptoms (x 2  = 70.63, df = 4, p < 0.001). Similarly, an association was found between the number of life events and clinical depressive symptoms (x 2  = 40.06, df = 4, p < 0.001). Logistic regression analysis after adjusting for socio-demographic characteristics confirmed that the responders who reported a high number (n = 12–21) of stressful life events during the previous year (OR = 2.64 95% CI: 1.02, 6.83) and a severe degree of stress due to these events (total LESS score > 351, OR = 3.03 95% CI: 1.66, 5.39) were more likely to manifest clinical depressive symptoms. Conclusions The high frequency of occurrence of depressive symptoms among Cypriot university students, as well as the strong association with stressful life events, highlights the need for psychological empowerment strategies towards students by institutional counseling services.