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National responses should be improved and accelerated to meet the target of ending the Acquired ImmunoDeficiency Syndrome (AIDS) epidemic by 2030. In the Republic of Cyprus, Men who have Sex with Men (MSM) are disproportionately affected by Human Immunodeficiency Virus (HIV), accounting approximately for half of all annual HIV diagnoses. This study assesses the evolution of HIV incidence in MSM in Cyprus until 2030 using a model calibrated to Cypriot epidemiological data. Four scenarios were examined: status quo, two scenarios focusing on introducing Pre-Exposure Prophylaxis (PrEP), and a 90% HIV incidence reduction scenario. Reaching only the 95-95-95 HIV cascade of care targets among MSM would reduce HIV incidence by 48.6% by 2030 compared to 2015. Initiating a PrEP intervention only for high risk MSM would cause a modest further reduction in HIV incidence. To meet the 90% reduction target, PrEP should be expanded to both high and medium risk MSM and, after 2025, behavioral interventions should be implemented so as high-risk MSM gradually move to the medium-risk category. Cyprus will not reach the HIV incidence reduction target by 2030 unless PrEP is gradually promoted and delivered to all high and medium risk MSM along with awareness and behavioral interventions.

The human immunodeficiency virus type 1 (HIV-1) epidemic has been a major public health threat on a global scale since the early 1980s. Despite the introduction of combination antiretroviral therapy (cART), the incidence of new HIV-1 infections continues to rise in some regions around the world. Thus, with the continuous transmission of HIV-1 and the lack of a cure, it is imperative for molecular epidemiological studies to be performed, to monitor the infection and ultimately be able to control the spread of this virus. This work provides a comprehensive molecular epidemiological analysis of the HIV-1 infection in Cyprus, through examining 305 HIV-1 sequences collected between 9 March 2017 and 14 October 2021. Employing advanced statistical and bioinformatic techniques, the research delved deeply into understanding the transmission dynamics of the HIV-1 epidemic in Cyprus, as well as the monitoring of HIV-1's genetic diversity and the surveillance of transmitted drug resistance. The characterization of Cyprus's HIV-1 epidemic revealed a diverse landscape, comprising 21 HIV-1 group M pure subtypes and circulating recombinant forms (CRFs), alongside numerous uncharacterized recombinant strains. Subtypes A1 and B emerged as the most prevalent strains, followed by CRF02_AG. The findings of this study also revealed high levels of transmitted drug resistance (TDR) patterns, raising concerns for the efficacy of cART. The demographic profiles of individuals involved in HIV-1 transmission underscored the disproportionate burden borne by young to middle-aged Cypriot males, particularly those in the MSM community, who reported contracting the virus in Cyprus. An assessment of the spatiotemporal evolutionary dynamics illustrated the global interconnectedness of HIV-1 transmission networks, implicating five continents in the dissemination of strains within Cyprus: Europe, Africa, Asia, North America, and Oceania. Overall, this study advances the comprehension of the HIV-1 epidemic in Cyprus and highlights the importance of understanding HIV-1's transmission dynamics through continuous surveillance efforts. Furthermore, this work emphasizes the critical role of state-of-the-art bioinformatics analyses in addressing the challenges posed by HIV-1 transmission globally, laying the groundwork for public health interventions aimed at curbing its spread and improving patient outcomes.

Vector-borne diseases have been a growing health concern in recent decades due to the global warming, globalization, and increased international travel. With the typical Mediterranean climate and geographical features, Cyprus provides favorable conditions for the growth and survival of arthropod species. For the purpose of this review article, the terms "Cyprus", "vectors" and "vectorborne diseases" were searched in the National Library of Medicine ('PubMed') and the Google Scholar databases. Published articles in the literature have documented mosquito (including Anopheles, Aedes, Culex, and Culiseta), sandfly (Phlebotomus, Sergentomyia), flea (including Ctenocephalides, Xenopsylla, Leptopsylla), and tick (including Rhipicephalus, Ixodes, Hyalomma, Haemaphysalis) species in the island. The presence of these arthropods poses a risk to public health as they can transmit a variety of diseases to both humans and animals. Research studies in Cyprus have identified infectious agents such as West Nile virus, Leishmania spp., sandfly viruses, Rickettsia spp., Coxiella burnetii, and Bartonella spp. in the local arthropods. More importantly, West Nile virus infection and imported malaria cases (mosquitoborne diseases); leishmaniasis and sandfly fever (sandfly-borne diseases); rickettsiosis, tularemia, Q fever, anaplasmosis, tick-borne relapsing fever, and Lyme disease (tick-borne diseases); and flea-borne rickettsiosis were reported in Cyprus. Taken together with the presence of arthropod vectors, published evidence in the literature suggests that Cyprus is an important region for VBDs. In addition to its climatic and geographical conditions, international travels particularly from endemic countries pose a risk for the circulation of VBDs on the island. Therefore, vector control programs should be continuously implemented, and public awareness must be raised in the region. This review, which to the best of our knowledge is the first comprehensive report on VBDs from Cyprus, will provide insight into future islandwide studies and also will be an important contribution to the elimination of VBDs in the region.

Background: Heat-related mortality has become a growing public health concern in light of climate change. However, few studies have quantified the climate-attributable health burden in Cyprus, a recognized climate change hotspot. This study aims to estimate the heat-related mortality in Cyprus for all future decades in the 21st century under moderate (SSP2-4.5) and extreme (SSP5-8.5) climate scenarios., Methods: We applied distributed lag non-linear models to estimate the baseline associations between temperature and mortality from 2004 to 2019 (data obtained from Department of Meteorology of the Ministry of Agriculture, Rural Development and Environment and the Health Monitoring Unit of the Cyprus Ministry of Health). The relationships were then extrapolated to future daily mean temperatures derived from downscaled global climate projections from General Circulation Models. Attributable number of deaths were calculated to determine the excess heat-related health burden compared to the baseline decade of 2000-2009 in the additive scale. The analysis process was repeated for all-cause, cardiovascular, and respiratory mortality and mortality among males, females, and adults younger or older than 65. We assumed a static population and demographic structure, no adaptation to hot temperatures over time, and did not evaluate potential interaction between temperature and humidity., Results: Compared to 2000-2009, heat-related total mortality is projected to increase by 2.7% (95% empirical confidence interval: 0.6, 4.0) and 4.75% (2.2, 7.1) by the end of the century in the moderate and extreme climate scenarios, respectively. Cardiovascular disease is expected to be an important cause of heat-related death with projected increases of 3.4% (0.7, 5.1) and 6% (2.6, 9.0) by the end of the century. Reducing carbon emission to the moderate scenario can help avoid 75% of the predicted increase in all-cause heat-related mortality by the end of the century relative to the extreme scenario., Conclusions: Our findings suggest that climate change mitigation and sustainable adaptation strategies are crucial to reduce the anticipated heat-attributable health burden, particularly in Cyprus, where adaptation strategies such as air conditioning is nearing capacity., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

The number of Methicillin-resistant Staphylococcus aureus (MRSA) cases in communities and hospitals is on the rise worldwide. In this work, a nonlinear deterministic model for the dynamics of MRSA infection in society was developed to visualize the significance of awareness in interventions that could be applied in the prevention of transmission with and without optimal control. Positivity and uniqueness were verified for the proposed corruption model to identify the level of resolution of infection factors in society. Furthermore, how various parameters affect the reproductive number R 0 and sensitivity analysis of the proposed model was explored through mathematical techniques and figures. The global stability of model equilibria analysis was established by using Lyapunov functions with the first derivative test. A total of seven years of data gathered from a private hospital consisting of inpatients and outpatients of MRSA were used in this model for numerical simulations and for observing the dynamics of infection by using a non-standard finite difference (NSFD) scheme. When optimal control was applied as a second model, it was determined that increasing awareness of hand hygiene and wearing a mask were the key controlling measures to prevent the spread of community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA). Lastly, it was concluded that both CA-MRSA and HA-MRSA cases are on the rise in the community, and increasing awareness concerning transmission is extremely significant in preventing further spread., (© 2024. The Author(s).)

The island of Cyprus was a historical endemic area for cystic echinococcosis (CE) in the Mediterranean. During the last decades, Cyprus has been an open-air laboratory and a model for testing and implementing control measures aiming to eliminate CE as a public health problem. Despite control and surveillance measures implemented during last 50 years, molecular characterization of Echinococcus granulosus sensu lato specimens has been never provided. In February 2023, the carcass of a stray dog collected in the Nicosia district was examined by the Veterinary Services and found infected with Echinococcus spp. worms. The worms were sent to the European Union Reference Laboratory (EURLP) for species/genotype identification. The sequences analyses of nad2 and nad5 genes allowed us to identify the tapeworms as Echinococcus canadensis , genotype G7b. In November 2023, a parasitic liver cyst was observed during the post-mortem examination of a mouflon from the same area of the dog's finding. The cyst sample was also referred to EURLP for identification and comparison with tapeworms previously collected from the dog. The sequences analysis of cox1 gene allowed to identify the cyst as E. granulosus sensu stricto , genotype G1. The finding of 2 different species of E. granulosus s.l. in a limited area raises epidemiological questions on the origin of the samples: whether distinct transmission cycles are present or a recent introduction event have occurred. From a public health perspective, it will be essential to conduct further molecular epidemiology studies to clarify the recent transmission dynamics of Echinococcus species in Cyprus.

The distribution of human immunodeficiency virus-1 (HIV-1) subtypes indicates difference from region to region and in risk groups acquiring the disease worldwide. Although subtype C is more in terms of total cases, subtype B is dominant in certain regions, especially in western and central Europe. Molecular epidemiological studies are essential for the control, effective treatment, and understanding in transmission routes of HIV-1 infection. This study aims to determine the molecular epidemiology and antiretroviral drug resistance profiles of HIV-1 in northern Cyprus. The study involved 71 naive HIV-positive patients diagnosed in northern Cyprus between 2016 and 2022. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method) of pol gene sequences. Drug resistance mutations were analyzed using the World Health Organization (WHO) lists of mutations for surveillance. The Stanford University HIVdb program was used to interpret drug resistance mutations. In our study, 40 of 71 samples were successfully sequenced. Subtype B of HIV-1 was dominant with a rate of 52.5%, followed by CRF02_AG (20%) and G (7.5%) subtypes. The rate of subtype B (71.4%) in northern Cyprus was significantly higher than in the other country of origin ( p  = .028). Antiretroviral drug resistance was found in 15% of the sequenced serum samples. Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI), non-nucleoside nucleotide reverse transcriptase inhibitor (NNRTI), and protease inhibitor (PI) resistance rates were 10% (4/40), 7.5% (3/40), and 2.5% (1/40), respectively. According to the results, it is noteworthy that the dominant subtype circulating in northern Cyprus is the B subtype, and CRFs were detected at a higher rate than expected.

Background: Cancer is one of the leading causes of morbidity and mortality, worldwide. Little information is available for the temporal trends of cancer in the Mediterranean region, including Cyprus., Aims: We aimed to analyze cancer incidence trends overall and by sex for the period 2004-2017 regarding the five most common cancer sites for the population of Cyprus., Methods and Results: Data were obtained from the nationwide cancer registry dataset that included 27 017 total cancer cases in Cyprus (2004-2017). We estimated the crude, sex-, and age-specific, as well as age-standardized (ASR) cancer incidence rates and we analyzed the time trends of ASR using the joinpoint regression program. For the general population (0-85+ years of age), the most common cancer sites in descending order, were breast, prostate, lung, colorectal, and thyroid cancer. During the study period, breast and thyroid cancer ASR presented a significant (p < .05) increasing temporal trend. Lung cancer ASRs seemed to stabilize (no increase or decrease) during the more recent years (2009 onwards) for both sexes; a similar pattern was observed for colorectal cancer in males. The ASRs of prostate cancer in men were in steady decline from 2012 onwards and the same was observed for the female ASRs of colorectal cancer from 2007 onwards. The colorectal cancer ASR temporal patterns overall, during the whole study period appeared unchanged., Conclusion: This temporal analysis would feed into cancer surveillance and control programs that focus on prevention, early detection, and treatment, particularly for cancer sites of higher mortality rates or those with temporally increasing trends., (© 2024 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

Background: Breast cancer is the type of cancer that is seen all over the world and ranks first among female cancers in terms of incidence and cause of death., Objective: This research was conducted to determine the breast cancer risk level and breast cancer knowledge level in women living in Northern Cyprus., Methods: The study, which was planned as a relational survey, was carried out as web-based. The research was completed with 657 adult female participants living in Northern Cyprus who volunteered to participate in the study. In order to collect data, the first section includes the introductory features, the second section includes the "Breast Cancer Risk Assessment Form" for determining breast cancer risk levels, the third section includes the "Comprehensive Breast Cancer Knowledge Test" to determine the breast cancer knowledge levels of the participants, and the fourth section includes the "Champion Health Belief Model Scale" was used., Results: It was determined that 95.2% of women were in the low risk group for breast cancer. The knowledge test mean score is 12.05, and it can be said that the scores obtained are above the average (min:4- max:18). It was found that 55.7% of the women knew how to do Breast Self-Examination (BSE), but only 15.4% of them regularly performed BSE every month. It was found that 80.9% of the women never had mammography and their knowledge scores increased with increasing education level (p< 0.001) and there was a significant relationship between non-smokers and their knowledge levels (p< 0.01)., Implications for Practice: Despite the high scores of women in knowledge tests, it was observed that the frequency of applying BSE and having mammography was very low. Regardless of the risk factors for breast cancer, the importance of regular check-ups and BSE for every woman should be taught to women by health professionals, and group trainings should be planned for women who do not have training on this subject., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

This study used a questionnaire to examine how academic staff members in Greece and Cyprus feel about the changes in undergraduate medical education during the COVID-19 pandemic. In general, e-learning was not considered an adequate way of teaching and was less enjoyable. Participants aged 31-40 years experienced more ( P  = .001), while staff in higher academic ranks less difficulty ( P  < .001) in adjustment. There was a small increase in workload, which was higher among respondents researching into COVID-19 ( P  = .001). During the pandemic, daily screen use >6 h was increased from 28.8% to 57.5%. The majority (74.2%) stated that scientific and educational training opportunities were not affected by the pandemic. In conclusion, the pandemic has induced important changes in undergraduate medical education. This new condition was considered adequate but not pleasant, with younger faculty members being more burdened., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Cryptosporidium is an intestinal zoonotic protozoan parasite that infects domesticated and wild animals. There are no reports on the prevalence and molecular characterisation of Cryptosporidium in the endemic Cyprus mouflon. The mouflon is strictly protected by national and international legislation. Its main distribution is Paphos State Forest and surrounding areas, where it may share the same water sources as free-ranging domestic goats. Therefore, the present study aimed to determine the prevalence of Cryptosporidium spp. and genotypes in mouflon and free-ranging goats within the mouflon range., Methods: Faecal samples of 70 mouflons and 34 free-ranging goats were screened for Cryptosporidium by PCR amplification and sequencing., Results: Only one sample (1/70) belonging to a mouflon was PCR positive for Cryptosporidium. Based on sequencing of the 18S rRNA locus, this species was identified as Cryptosporidium parvum (C. parvum). No positive sample was detected in the free-ranging goats (0/34)., Conclusion: This is the first report on the molecular identification of this Cryptosporidium species in a Cyprus mouflon. The results indicate that the prevalence of Cryptosporidium in Cyprus mouflon is low., (© 2023. The Author(s).)

Inherited cardiomyopathies represent a highly heterogeneous group of cardiac diseases. DNA variants in genes expressed in cardiomyocytes cause a diverse spectrum of cardiomyopathies, ultimately leading to heart failure, arrythmias, and sudden cardiac death. We applied massive parallel DNA sequencing using a 72-gene panel for studying inherited cardiomyopathies. We report on variants in 25 families, where pathogenicity was predicted by different computational approaches, databases, and an in-house filtering analysis. All variants were validated using Sanger sequencing. Familial segregation was tested when possible. We identified 41 different variants in 26 genes. Analytically, we identified fifteen variants previously reported in the Human Gene Mutation Database: twelve mentioned as disease-causing mutations (DM) and three as probable disease-causing mutations (DM?). Additionally, we identified 26 novel variants. We classified the forty-one variants as follows: twenty-eight (68.3%) as variants of uncertain significance, eight (19.5%) as likely pathogenic, and five (12.2%) as pathogenic. We genetically characterized families with a cardiac phenotype. The genetic heterogeneity and the multiplicity of candidate variants are making a definite molecular diagnosis challenging, especially when there is a suspicion of incomplete penetrance or digenic-oligogenic inheritance. This is the first systematic study of inherited cardiac conditions in Cyprus, enabling us to develop a genetic baseline and precision cardiology.

Background: Late-onset neonatal sepsis (LOS) is common in preterm neonates, with increasing incidence in recent years. In the present study, we examined the epidemiology, clinical presentation, and complications of LOS in Cyprus and quantified possible risk factors for the development of this condition., Methods: The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as "Confirmed LOS": positive blood culture - microorganism isolated and LOS symptoms, "Unconfirmed LOS": negative blood culture and LOS symptoms, and "Controls" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression., Results: A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as "Confirmed LOS", and "unconfirmed LOS" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25)., Conclusions: The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended., (© 2024. The Author(s).)

Individuals with high health literacy, such as healthcare workers, are expected to appreciate vaccination benefits and ensure the vaccination of their children. The objective of this study was to examine the factors influencing nurses' decision to vaccinate their children against COVID-19. An online cross-sectional study was conducted in December 2020 (8 th -28 th ), before COVID-19 vaccine availability in Cyprus, and employed an anonymous self-administered survey with questions related to socio-demographic characteristics, general vaccine knowledge, and COVID-19 vaccination. Three hundred five nurses with at least one minor child completed the online questionnaire. A small proportion of participants (15.2%) planned to get their children vaccinated against COVID-19. Interestingly, a higher level of vaccination knowledge score was linked with increased likelihood of vaccination intention (OR = 1.35, 95% CI:1.08-1.68), which remained statistically significant after adjusting for age and gender (OR = 1.33, 95% CI:1.06-1.66), socioeconomic (OR = 1.35, 95% CI:1.07-1.70), and demographic characteristics (OR = 1.38, 95% CI:1.07-1.77). Specific characteristics such as older age and being married/in cohabitation status were linked to higher odds of accepting the childhood vaccination against COVID-19. Acceptance of childhood vaccination against COVID-19 is linked with nurses' vaccination knowledge, therefore, public health authorities may focus on educational campaigns to promote childhood vaccination.

The COVID-19 pandemic has given rise to a large-scale crisis that has also impacted the well-being and, more specifically, the life satisfaction of university students. Factors such as attachment dimensions and psychological resilience can provide us with a better understanding of students' life satisfaction levels during the recent pandemic. While previous literature has revealed a significant association between attachment dimensions, resilience, and life satisfaction, very few studies have attempted to address a more complex relationship among all three variables for university students, and even fewer have explored this topic during the COVID-19 pandemic. Therefore, the aim of the current study was to investigate the impact of attachment dimensions on university students' life satisfaction after the fourth wave of COVID-19 in Cyprus, with a focus on the mediating role of psychological resilience. The sample comprised 780 university students, consisting of 323 men and 457 women, aged between 18 and 61 years. Participants were recruited electronically, and after being directed to Google Forms, they completed the ECR-R for their attachment dimensions, the RES for psychological resilience, and the SWLS for life satisfaction. The results indicated significant correlations between attachment dimensions, psychological resilience, and life satisfaction. Notably, psychological resilience was found to partially mediate the relationship between attachment anxiety, as well as attachment avoidance, and life satisfaction. Specifically, attachment anxiety and avoidance negatively affected life satisfaction, partially due to lower levels of psychological resilience. These findings are discussed in relation to the existing literature, and implications for practice are provided., Competing Interests: The authors declare no conflicts of interest.

Molecular investigations of the HIV-1 pol region (2253-5250 in the HXB2 genome) were conducted on sequences obtained from 331 individuals infected with HIV-1 in Cyprus between 2017 and 2021. This study unveiled four distinct HIV-1 putative transmission clusters, encompassing 19 previously unidentified HIV-1 recombinants. These recombinants, each comprising eight, three, four, and four sequences, respectively, did not align with previously established Circulating Recombinant Forms (CRFs). To characterize these novel HIV-1 recombinants, near-full-length genome sequences were successfully obtained for 16 of the 19 recombinants (790-8795 in the HXB2 genome) using an in-house-developed RT-PCR assay. Phylogenetic analyses, employing MEGAX and Cluster-Picker, along with confirmatory neighbor-joining tree analyses of subregions, were conducted to identify distinct clusters and determine subtypes. The uniqueness of the HIV-1 recombinants was evident in their exclusive clustering within generated maximum likelihood trees. Recombination analyses highlighted the distinct chimeric nature of these recombinants, with consistent mosaic patterns observed across all sequences within each of the four putative transmission clusters. Conclusive genetic characterization identified four novel HIV-1 CRFs: CRF129&#95;56G, CRF130&#95;A1B, CRF131&#95;A1B, and CRF138&#95;cpx. CRF129&#95;56G exhibited two recombination breakpoints and three fragments of subtypes CRF56&#95;cpx and G. Both CRF130&#95;A1B and CRF131&#95;A1B featured seven recombination breakpoints and eight fragments of subtypes A1 and B. CRF138&#95;cpx displayed five recombination breakpoints and six fragments of subtypes CRF22&#95;01A1 and F2, along with an unclassified fragment. Additional BLAST analyses identified a Unique Recombinant Form (URF) of CRF138&#95;cpx with three additional recombination sites, involving subtype F2, a fragment of unknown subtype origin, and CRF138&#95;cpx. Post-identification, all putative transmission clusters remained active, with CRF130&#95;A1B, CRF131&#95;A1B, and CRF138&#95;cpx clusters exhibiting further growth. Furthermore, international connections were identified through BLAST analyses, linking one sequence from the USA to the CRF130&#95;A1B strain, and three sequences from Belgium and Cameroon to the CRF138&#95;cpx strain. This study contributes valuable insights into the dynamic landscape of HIV-1 diversity and transmission patterns, emphasizing the need for ongoing molecular surveillance and global collaboration in tracking emerging viral variants.

Background: The COVID-19 Pandemic, which started to be seen in Northern Cyprus (NC) as of March 2020, has affected the psychological mood of many people in our country as well as all over the world., Objectives: It was aimed to evaluate the post-illness anxiety and depression levels of people who were diagnosed with COVID-19 positive, completed the quarantine period and then received a negative PCR report., Methods: Through the questionnaire used in the study carried out between 1-30 April 2021, the sociodemographic characteristics of the participants and their personal experiences about COVID-19 were questioned and they were asked to answer the questions about the hospital anxiety and depression (HAD) scale., Results: The average score of the participants (n=120) in the HAD scale was determined as 11.66±5.90. According to the average scores of the scale, the anxiety and depression levels of the patients fall into the category of '11 and above abnormal'. The patients' general average scores of anxieties were 6.20±3.48 (normal) and depression was 5.46±3.55 (normal)., Conclusion: Although it was determined that the HAD scores of the individuals from NC infected with COVID-19 were not high, most of them needed psychological support as they stated in their own statements., Competing Interests: The authors declare that they have no conflicts of interest., (© 2023 Kaya U et al.)

Background: While the initial wave of the COVID-19 pandemic was controlled much better in North Cyprus, the number of cases saw a rapid increase as of November 2020. Local authorities implemented further restrictions with a second lockdown across the country to bring the cases under control. The present study aims to identify the potential predictors of COVID-19 related obsessions of adults during the second lockdown., Subjects and Methods: This is a descriptive survey conducted with 652 participants over the age of 18. The Obsession with COVID-19 Scale, Coronavirus Anxiety Scale, and a Demographic Information Form were used to obtain information. Data were analyzed using SPSS and Spearman's Rho was calculated to examine existing relationships between COVID-19 anxiety and other research variables. A linear regression analysis was conducted to identify potential predictors of COVID-19 related obsessions., Results: Participants infected with the COVID-19 virus had higher levels of anxiety and obsessions than those who weren't. The sample multiple correlation coefficient was .66, indicating that approximately 43% of the variance of the COVID-19 related obsessions was accounted for by the linear combination of strength measures. As expected, anxiety, positively and being infected with COVID-19 negatively predicted COVID-19 related obsessions., Conclusion: The similarities and differences of the findings were compared with the results from the literature, yet the relationship between variables was identified to be higher when compared to similar studies.

Recent studies combining macroscopical observations and microCT analysis strongly suggested the diagnosis of tuberculosis for a child from the site of Khirokitia (Cyprus, 7th - early 6th millennium cal. BC), whose age at death is between 5 and 7 years. Many single primary burials were discovered at the site where the dead (MNI = 243) are buried in the same way, whatever their age. Nevertheless, the burial of this child presents a unique feature on the site (a male Ovis trophy marking the limit of the burial pit), probably indicating specific attention for this young deceased. This case is the oldest known in the Mediterranean islands and presents a particular interest from a paleoepidemiological point of view. Indeed, considering, on the one hand, the settlement pattern of the island of Cyprus by migrants from the Near East, and on the other hand, the presence of human tuberculosis in the Near East as early as about 10,500 years BP, it is very likely that the prehistoric migrants brought the disease from mainland to Cyprus., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Research on the link between diet and multimorbidity is scarce, despite significant studies investigating the relationship between diet and individual chronic conditions. This study examines the association of dietary intake of macro- and micronutrients with multimorbidity in Cyprus's adult population. It was conducted as a cross-sectional study, with data collected using a standardised questionnaire between May 2018 and June 2019. The questionnaire included sociodemographic information, anthropometrics, medical history, dietary habits, sleep quality, smoking habits, and physical activity. The participants were selected using a stratified sampling method from adults residing in the five government-controlled municipalities of the Republic of Cyprus. The study included 1137 adults with a mean age of 40⋅8 years, of whom 26 % had multimorbidity. Individuals with multimorbidity consumed higher levels of sodium ( P = 0⋅009) and vitamin A ( P = 0⋅010) compared to those without multimorbidity. Additionally, higher fibre and sodium intake were also observed in individuals with at least one chronic disease of the circulatory system or endocrine system, compared to those with no chronic diseases in these systems ( P < 0⋅05). Logistic regression models revealed that individuals with ≥2 chronic diseases compared to 0 or 1 chronic disease had higher fat intake (OR = 1⋅06, 95 % CI: 1⋅02, 1⋅10), higher iron intake (OR = 1⋅05, 95 % CI: 1⋅01, 1⋅09), lower mono-unsaturated fat intake (OR = 0⋅91, 95 % CI: 0⋅86, 0⋅96), and lower zinc intake (OR = 0⋅98, 95 % CI: 0⋅96, 0⋅99). Future research should replicate these results to further explore the intricate relationships between nutrient intake and multimorbidity. Our study's findings suggest that specific dietary components may contribute to preventing and managing multimorbidity., (© The Author(s) 2023.)

Commencing in December 2019 with the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), three years of the coronavirus disease 2019 (COVID-19) pandemic have transpired. The virus has consistently demonstrated a tendency for evolutionary adaptation, resulting in mutations that impact both immune evasion and transmissibility. This ongoing process has led to successive waves of infections. This study offers a comprehensive assessment spanning genetic, phylogenetic, phylodynamic, and phylogeographic dimensions, focused on the trajectory of the SARS-CoV-2 epidemic in Cyprus. Based on a dataset comprising 4700 viral genomic sequences obtained from affected individuals between October 2021 and October 2022, our analysis is presented. Over this timeframe, a total of 167 distinct lineages and sublineages emerged, including variants such as Delta and Omicron (1, 2, and 5). Notably, during the fifth wave of infections, Omicron subvariants 1 and 2 gained prominence, followed by the ascendancy of Omicron 5 in the subsequent sixth wave. Additionally, during the fifth wave (December 2021-January 2022), a unique set of Delta sequences with genetic mutations associated with Omicron variant 1, dubbed "Deltacron", was identified. The emergence of this phenomenon initially evoked skepticism, characterized by concerns primarily centered around contamination or coinfection as plausible etiological contributors. These hypotheses were predominantly disseminated through unsubstantiated assertions within the realms of social and mass media, lacking concurrent scientific evidence to validate their claims. Nevertheless, the exhaustive molecular analyses presented in this study have demonstrated that such occurrences would likely lead to a frameshift mutation-a genetic aberration conspicuously absent in our provided sequences. This substantiates the accuracy of our initial assertion while refuting contamination or coinfection as potential etiologies. Comparable observations on a global scale dispelled doubt, eventually leading to the recognition of Delta-Omicron variants by the scientific community and their subsequent monitoring by the World Health Organization (WHO). As our investigation delved deeper into the intricate dynamics of the SARS-CoV-2 epidemic in Cyprus, a discernible pattern emerged, highlighting the major role of international connections in shaping the virus's local trajectory. Notably, the United States and the United Kingdom were the central conduits governing the entry and exit of the virus to and from Cyprus. Moreover, notable migratory routes included nations such as Greece, South Korea, France, Germany, Brazil, Spain, Australia, Denmark, Sweden, and Italy. These empirical findings underscore that the spread of SARS-CoV-2 within Cyprus was markedly influenced by the influx of new, highly transmissible variants, triggering successive waves of infection. This investigation elucidates the emergence of new waves of infection subsequent to the advent of highly contagious and transmissible viral variants, notably characterized by an abundance of mutations localized within the spike protein. Notably, this discovery decisively contradicts the hitherto hypothesis of seasonal fluctuations in the virus's epidemiological dynamics. This study emphasizes the importance of meticulously examining molecular genetics alongside virus migration patterns within a specific region. Past experiences also emphasize the substantial evolutionary potential of viruses such as SARS-CoV-2, underscoring the need for sustained vigilance. However, as the pandemic's dynamics continue to evolve, a balanced approach between caution and resilience becomes paramount. This ethos encourages an approach founded on informed prudence and self-preservation, guided by public health authorities, rather than enduring apprehension. Such an approach empowers societies to adapt and progress, fostering a poised confidence rooted in well-founded adaptation.

Conspiracy theories flourish during periods of crisis. One way to counteract the believability of conspiracy theories is trust in science and knowledge about the "perceived threat", such as the SARS-CoV-2 virus. A total of 363 adults from Cyprus were recruited via convenience and snowball sampling methods. The data were collected via an internet-based questionnaire that examined participants' belief in 17 conspiracy theory statements, trust in science and scientists, knowledge about the symptoms and the spread of the SARS-CoV-2 virus, phobic anxiety, hostility, somatization, and personality traits based on the Big Five. The results suggest (a) the overall belief in conspiracy theories in Cyprus is low, even though a notable percentage holds a neutral stance towards these theories; (b) trust in science and knowledge about the symptoms and the spread of the SARS-CoV-2 virus is negatively related to conspiracy theories, indicating the importance of trusting science and having knowledge as a means to counteract conspiracy theories; (c) young adults, those residing in rural areas, and those with a low education level are more likely to believe in conspiracy theories; (d) there are no significant associations between conspiracy theories and the psychological dimensions of phobic anxiety, hostility, and somatization; (e) there is difficulty in identifying specific traits related to conspiracy ideation. Public health officials could benefit from the findings when communicating information during periods of crisis.

Background: RT-PCR is the leading method used in the diagnosis of COVID-19, caused by 2019-nCoV. CT applications also provide a fast and easy diagnosis for detecting pneumonia caused by the SARS-CoV-2 virus. The current study, aimed to compare the lung involvement of vaccinated (two-dose CoronaVac) and unvaccinated patients in the early stage of COVID-19 disease., Methods: In the current retrospective study, which included patients diagnosed with RT-PCR COVID-19 positivity (n=651) between 01 July 2021-15 September 2021, patient information was obtained from the authorized hospital of the pandemic. Data included patients' chest CT scans and whether patients had been vaccinated (two-dose CoronaVac) information., Results: The ratio of vaccination with double-dose CoronaVac in positive patients was 74.3%. The ratio of patients with normal lung appearance was 61.8%. It was determined that the ratio of involvement in both lungs of patients who were vaccinated with a double dose was significantly lower than the ratio of involvement in patients who were never vaccinated (p <0.001)., Conclusion: In this study, it was determined that pneumonia cases were less common in individuals vaccinated with double-dose CoronaVac. In this study, it was also determined that the protection of the vaccine was higher in females than in males and that the protection of the double-dose CoronaVac vaccine was higher in the 50-60 age group compared to 60 older patients., (© 2023 Ersan B., et al.)

Objective: Although contraception methods are an important factor affecting sexual life, no literature has been recorded about the contraceptive methods used and the sexual life of thalassemia patients. The aim of this study is to document the effects of and preferences of contraception methods used in the sexual lives of patients with thalassemia., Methods: The descriptive and cross-sectional study took place in Northern Cyprus at a Thalassemia Center in a State Hospital. The study sample consisted of 100 thalassemia major or intermedia patients. The data includes descriptive characteristics, the preference of contraception methods used by men and women and Sexual Quality of Life Questionnaires., Results: Participants learned about contraception methods mostly from social media/internet, and 58.3% of the women and 46.2% of the men did not use any contraception method within the last year. Women's sexual quality of life score was 70.3±19.9 and men's Sexual Quality of Life score was 78.9±20.6. Women having knowledge of contraception methods had higher scores than man (p<0.05). Male patients not having physical exercise had sexual quality of life scores significantly lower than those who followed exercise programs (p<0.05)., Conclusions: Results indicate a significant need to include family planning and sexual health subjects that specifically address thalassemia patients., Competing Interests: The authors declare that they have no conflict of interest., (© 2023 Tastan S et al.)

Kidney transplantation provides a higher quality of life, a longer life expectancy for end-stage renal disease patients, and a lower cost than other treatments. Unfortunately, organ shortage for kidney transplantation is a major obstacle for countries with long waiting lists. Approaches to solving organ shortages with laws and regulations differ between countries. The reasons for these differences are evaluated by considering many factors, such as religious beliefs, sociocultural differences, and distrust in health systems. Until another evidence-based treatment becomes available, efforts to increase dead donor transplants are the main solution to reducing waiting lists. In a retrospective study conducted in our region, we investigated the prevalence and potential correlation of deceased organ transplantation based on family refusal and other issues., Competing Interests: Declaration of Competing Interest The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

This study aims to understand the levels of fear experienced by individuals regarding future pandemics and/or epidemics among the general population of Cyprus and comprehensively examine the diverse factors that influence this perceived fear. The cross-sectional study was conducted from October 1st, 2022, to February 19th, 2023. A proportionate quota sampling method was used for the recruitment, by recruiting a fixed number of participants from each age group, sex, and place of residence. The study collected information on sociodemographic and health-related characteristics, health literacy, trust, COVID-19 vaccination information, and perceived fear of future epidemics and/or pandemics using a self-administered questionnaire. The survey included 1075 participants, with 53.7% of them reporting fear of future pandemics. Logistic regression analysis revealed that women (OR = 2.37, 95% CI 1.78, 3.16) and individuals vaccinated against COVID-19 (OR = 1.57, 95% CI 1.02, 2.43) were significantly more likely to experience fear of future pandemics. Moreover, higher levels of trust (OR = 1.04, 95% CI 1.02, 1.06) and higher health literacy (OR = 1.05, 95% CI 1.03, 1.08) were associated with an increased likelihood of fearing future pandemics. Conversely, unemployment (OR = 0.30, 95% CI 0.13, 0.65) and having a postgraduate education decreased the likelihood of fearing future pandemics (OR = 0.56, 95% CI 0.34, 0.90). The linear regression model revealed that older age (β = - 0.10, 95% CI - 0.14, - 0.05) was negatively associated with a higher score of fear regarding future pandemics. Conversely, being in a vulnerable group (β = 2.02, 95% CI 0.75, 3.28) and having at least one chronic disease (β = 1.76, 95% CI 0.68, 2.84) showed positive associations with increased fear of future epidemics and/or pandemics. The findings emphasize the need for relevant authorities to prioritize mental health and disseminate information in a manner that avoids spreading fear and panic, particularly among vulnerable population groups., (© 2023. The Author(s).)

Background: Human papillomavirus (HPV) is the most common sexually transmitted pathogen both in men and women. Accumulating epidemiological evidence supports a strong association between HPV infection and cancer of the cervix, vulva, vagina, anus, and penis. Currently, data on the HPV prevalence and genotyping is lacking in Northern Cyprus, a region in which HPV vaccination is not freely accessible via the national immunization program. The aim of this study was to evaluate the HPV type-specific prevalence in women with and without cytological abnormalities living in Northern Cyprus., Methods: A total of 885 women who presented to the Department of Gynecology and Obstetrics Clinic between January 2011 and December 2022 were included in the study. Samples were collected for cytology. Cervical specimens were investigated for the presence of HPV-DNA and genotyping of HPV was performed using real-time polymerase chain reaction (rtPCR). Cytological examination was interpreted according to the Bethesda system., Results: Among all patients, overall high-risk HPV DNA prevalence was 44.3%. HPV-16 and HPV-18 positivity was found in 10.4% and 3.7% of women respectively, while other high-risk HPV (OHR-HPV) was the most frequent type of HPV (30.2%). The highest frequency of HPV infection was observed in the 30-55 age group (51.0%), followed by the < 30 age group (45.7%). Co-infection with two or more HPV types was observed in 17.0% of all positive samples, in which the prevalence of HPV-16 + HPV-18 was 2.3%, HPV-16 + OHR-HPV and HPV-18 + OHR-HPV was 12.0% and 5.1%, respectively. Among the screened patients, 37.5% had abnormal and 62.5% had normal cytology results. HR-HPV positivity was 65.7% and 34.0% in patients with abnormal and normal cytology. The highest incidence of HRC-HPV was OHR-HPV types (44.7%) in positive cytology cases. Among women with a cytology result of ASCUS, L-SIL, H-SIL and unspecified dysplasia, 52.1%, 67.6%, 97.5% and 75.6% were respectively infected with HR-HPV., Conclusion: The present study provides the latest epidemiological data related to HPV prevalence and genotype distribution among women living in Northern Cyprus. Considering the unavailability of free vaccination in the community, it is imperative to implement local HPV screening programs and provide guidelines on HPV prevention and measures during early school education., (© 2023. The Author(s).)

Background: It has been claimed that COVID-19 vaccination is associated with excess mortality during the COVID-19 pandemic, a claim that contributes to vaccine hesitancy. We examined whether all-cause mortality has actually increased in Cyprus during the first two pandemic years, and whether any increases are associated with vaccination rates., Methods: We calculated weekly excess mortality for Cyprus between January 2020 and June 2022, overall and by age group, using both a Distributed Lag Nonlinear Model (DLNM) adjusted for mean daily temperature, and the EuroMOMO algorithm. Excess deaths were regressed on the weekly number of confirmed COVID-19 deaths and on weekly first-dose vaccinations, also using a DLNM to explore the lag-response dimension., Results: 552 excess deaths were observed in Cyprus during the study period (95% CI: 508-597) as opposed to 1306 confirmed COVID-19 deaths. No association between excess deaths and vaccination rates was found overall and for any age group except 18-49 years, among whom 1.09 excess deaths (95% CI: 0.27-1.91) per 10,000 vaccinations were estimated during the first 8 weeks post-vaccination. However, detailed cause-of-death examination identified just two such deaths potentially linked to vaccination, therefore this association is spurious and attributable to random error., Conclusions: Excess mortality was moderately increased in Cyprus during the COVID-19 pandemic, primarily as a result of laboratory-confirmed COVID-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of COVID-19 vaccines., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Iodine supply is crucial during pregnancy to ensure that the proper thyroid function of mother and baby support fetal brain development. Little is known about iodine status or its dietary determinants in pregnant women in the Republic of Cyprus. We therefore recruited 128 pregnant women at their first-trimester ultrasound scan to a cross-sectional study. We collected spot-urine samples for the measurement of urinary iodine concentration (UIC, µg/l) and creatinine concentration (Creat, g/l), the latter of which allows us to correct for urine dilution and to compute the iodine-to-creatinine ratio (UI/Creat). Women completed a FFQ and a general questionnaire. We used a General Linear model to explore associations between maternal and dietary characteristics with UI/Creat. The median UIC (105 µg/l) indicated iodine deficiency according to the WHO criterion (threshold for adequacy = 150 µg/l), and the UI/Creat was also low at 107 µg/g. Only 32 % ( n 45) of women reported the use of iodine-containing supplements; users had a higher UI/Creat than non-users (131 µg/g v. 118 µg/g), though this difference was NS in the adjusted analysis ( P = 0·37). Of the dietary components, only egg intake was significantly associated with a higher UI/Creat in adjusted analyses ( P = 0·018); there was no significant association with milk, dairy products or fish intake. Our results suggest that pregnant women in Cyprus have inadequate iodine status and are at risk of mild-to-moderate iodine deficiency. Further research on dietary sources in this population is required.

Kawasaki disease (KD) is one of the most common vasculitides of early childhood. There are no previous studies on KD in Cyprus. The aim of this study was to evaluate the epidemiology of KD in Cyprus, risk factors for resistance to treatment and the development of cardiac complications. This is a retrospective multicenter study of pediatric patients with KD hospitalized between January 2000 and-December 2019. The data were collected from medical records. A total of 136 patients with KD were included in the study. 83% of patients were < 5 years of age and 10% were < 6 months. Thirty patients (22%) developed coronary artery lesions. Serum sodium ≤ 133 mmol/L, albumin ≤ 3.2 g/dl, ALT ≥ 80 U/L and neutrophils percentage ≥ 80% at diagnosis, were identified as risk factors for resistance to IVIG. Clinical and epidemiological characteristics of KD in Cyprus population were similar to those reported in the literature. Although the majority of cases received appropriate treatment in time, cardiac complications still occurred., (© 2023. The Author(s).)

The outbreak and spread of COVID-19 impacted through various ways the lives of millions of humans globally. In this work, wastewater-based epidemiology (WBE) was applied to investigate the effect of the actions taken by the Republic of Cyprus to confine COVID-19 on the use of illicit stimulant drugs. Daily influent samples were collected from the six main wastewater treatment plants (WWTPs) of the country i) before lockdown (3-9 April 2019), ii) during lockdown (21-27 April 2020), iii) during the post-lockdown period (14-20 July 2020), and, iv) during each season of the following year (20-26 April 2021, 19-25 July 2021, 11-17 October 2021, 25 December 2021-2 January 2022), and analyzed for amphetamine, methamphetamine, MDMA and cocaine. In most areas, amphetamine and methamphetamine use was not affected during the confinement period, but as availability of the substances decreased with time, a drop in their use was observed when most restriction measures were eased (up to 9- and 22-fold decrease, respectively). The limitations on social interactions and events during the quarantine period seem to have led to the reduction of MDMA and cocaine and driven a sharp decrease of their use in most areas studied (up to 11 and 6 times lower, respectively). However, the re-opening of activities led to a pronounced consumption increase, reaching maximum daily values of 800 and 2691 mg/1000 inhabitants/day, respectively. In 2021, drug use was re-established to lower levels. The examination of weekly patterns during this year revealed higher weekend use of methamphetamine, MDMA and cocaine. Our results suggest that both the implementation and the easing of COVID-19 related measures affected the availability and the use of drugs. This study also provides the first insight on the consumption of illicit drugs in the Republic of Cyprus during pre-, post- and pandemic times and demonstrates the importance of WBE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Cryptosporidium is an important intestinal zoonotic pathogen that can infect various hosts and cause diarrheal disease. There are no reports on the prevalence and molecular characterization of Cryptosporidium in wild birds in Cyprus. Therefore, the present study aimed to determine the prevalence of Cryptosporidium spp. and genotypes in wild birds found at Phassouri Reedbeds (Akrotiri Wetlands), Cyprus. Fecal samples of 75 wild birds (Eurasian coot Fulica atra, N = 48; Eurasian teal Anas crecca, N = 20; duck - Anas spp., Ν = 7) were screened for Cryptosporidium by PCR amplification and sequencing. Only one sample (1.3%) belonging to a Eurasian coot was PCR-positive for Cryptosporidium. Based on sequencing of the 18S rRNA locus, this species was identified as Cryptosporidium proventriculi. This is the first report on the molecular identification of this Cryptosporidium species in a Eurasian coot., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus., Methods: The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons., Results: The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives., Conclusion: The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care., Level of Evidence: Level V., (© 2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 resulted in the coronavirus disease 2019 (COVID-19) pandemic, which has had devastating repercussions for public health. Over the course of this pandemic, the virus has continuously been evolving, resulting in new, more infectious variants that have frequently led to surges of new SARS-CoV-2 infections. In the present study, we performed detailed genetic, phylogenetic, phylodynamic and phylogeographic analyses to examine the SARS-CoV-2 epidemic in Cyprus using 2352 SARS-CoV-2 sequences from infected individuals in Cyprus during November 2020 to October 2021. During this period, a total of 61 different lineages and sublineages were identified, with most falling into three groups: B.1.258 & sublineages, Alpha (B.1.1.7 & Q. sublineages), and Delta (B.1.617.2 & AY. sublineages), each encompassing a set of S gene mutations that primarily confer increased transmissibility as well as immune evasion. Specifically, these lineages were coupled with surges of new infections in Cyprus, resulting in the following: the second wave of SARS-CoV-2 infections in Cyprus, comprising B.1.258 & sublineages, during late autumn 2020/beginning of winter 2021; the third wave, comprising Alpha (B.1.1.7 & Q. sublineages), during spring 2021; and the fourth wave, comprising Delta (B.1.617.2 & AY. sublineages) during summer 2021. Additionally, it was identified that these lineages were primarily imported from and exported to the UK, Greece, and Sweden; many other migration links were also identified, including Switzerland, Denmark, Russia, and Germany. Taken together, the results of this study indicate that the SARS-CoV-2 epidemic in Cyprus was characterized by successive introduction of new lineages from a plethora of countries, resulting in the generation of waves of infection. Overall, this study highlights the importance of investigating the spatiotemporal evolution of the SARS-CoV-2 epidemic in the context of Cyprus, as well as the impact of protective measures placed to mitigate transmission of the virus, providing necessary information to safeguard public health.

Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.

Background: Tools that can predict breast cancer risk in women will have a significant impact on women and healthcare systems in low- and middle-income countries., Aims: We compared the performances of the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model, the International Breast Cancer Intervention Study (IBIS) model, and the Gail model in predicting breast cancer risk among women in Cyprus., Methods: We recruited 655 women from Dr Burhan Nalbantoglu Devlet Hastanesi Hospital in Lefkosa: 318 had breast cancer and 337 did not have breast cancer (hospital-based controls). We collected retrospective data from the hospital's medical records and interviews with the women after informed consent. Data collected included: age, age at diagnosis, age at menarche, menopausal status, presence of benign breast disease, breast cancer in relatives, BRCA-1 and BRCA-2 mutations, history of hormone replacement therapy, and breast density. We calculated the 5-year risk of breast cancer and the risk values were used to plot receiver operating curves., Results: For the area under the curve (95% confidence interval, CI), sensitivity and specificity for the models were: BOADICEA 0.81 (95% CI: 0.77-0.84), 26.4% and 98.8%; IBIS 0.80 (95% CI: 0.77-0.84), 19.4% and 97.3%; and Gail 0.76 (95% CI: 0.73-0.80), 17.3% and 98.5%., Conclusions: The breast cancer risk prediction models performed similarly although on closer appraisal, the BOADICEA and IBIS models performed slightly better. These models are simple, appropriate, cost-effective, and non-invasive tools for identifying high-risk women in low- and middle-income countries who could benefit from mammography screening., (Copyright © Authors 2022; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Non-pharmacological interventions (e.g., stay-at-home orders, school closures, physical distancing) implemented during the COVID-19 pandemic are expected to have modified routines and lifestyles, eventually impacting key exposome parameters, including, among others, physical activity, diet and cleaning habits. The objectives were to describe the exposomic profile of the general Cypriot population and compliance to the population-wide measures implemented during March-May 2020 to lower the risk of SARS-CoV-2 transmission, and to simulate the population-wide measures' effect on social contacts and SARS-CoV-2 spread. A survey was conducted in March-May 2020 capturing different exposome parameters, e.g., individual characteristics, lifestyle/habits, time spent and contacts at home/work/elsewhere. We described the exposome parameters and their correlations. In an exposome-wide association analysis, we used the number of hours spent at home as an indicator of compliance to the measures. We generated synthetic human proximity networks, before and during the measures using the dynamic-[Formula: see text] 1 model and simulated SARS-CoV-2 transmission (i.e., to identify possible places where higher transmission/number of cases could originate from) on the networks with a dynamic Susceptible-Exposed-Infectious-Recovered model. Overall, 594 respondents were included in the analysis (mean age 45.7 years, > 50% in very good health and communicating daily with friends/family via phone/online). The median number of contacts at home and at work decreased during the measures (from 3 to 2 and from 12 to 0, respectively) and the hours spent at home increased, indicating compliance with the measures. Increased time spent at home during the measures was associated with time spent at work before the measures (β= -0.87, 95% CI [-1.21,-0.53]) as well as with being retired vs employed (β= 2.32, 95% CI [1.70, 2.93]). The temporal network analysis indicated that most cases originated at work, while the synthetic human proximity networks adequately reproduced the observed SARS-CoV-2 spread. Exposome approaches (i.e., holistic characterization of the spatiotemporal variation of multiple exposures) would aid the comprehensive description of population-wide measures' impact and explore how behaviors and networks may shape SARS-CoV-2 transmission., (© 2022. The Author(s).)

Background: Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients., Study Objectives: The purpose of this study was to explore the strategies nurses use when taking care of conscious, intubated patients in the intensive care unit and the barriers they encounter in their effort to communicate., Methods: For this study, a qualitative design was employed. Data were collected using in-depth semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis., Results: We identified several strategies of unaided (movements-lips, hands, legs-facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. However, barriers to communication were reported by the participating nurses mainly pertaining to patients and nurses' characteristics as well as the ICU environment. The health protocols imposed by the pandemic added more obstacles to the communication between nurses and patients mostly related to the use of protective health equipment., Conclusions: The results of this study point to the difficulties nurses in Cyprus face when trying to communicate with conscious patients during mechanical ventilation. It appears that the lack of nurses' training and of appropriate equipment to facilitate augmentative and alternative communication leave the complex communication needs of critically ill patients unaddressed. However, further research including patients' opinions, after they recover, would bring more clarity on this topic. Our study adds evidence to the communication crisis created by the protective health protocols imposed by the pandemic. As such, it highlights the need to educate nurses in augmentative and alternative ways of communication to address communication with mechanically ventilated, conscious patients during their ICU stay., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Kyranou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Neck circumference is one of the anthropometric parameters that is widely used in practical applications, clinical and epidemiological studies in children. It is aimed to determine the neck circumference cut-off points and to use them in the detection of overweight and obesity in children living in Northern Cyprus., Subjects: This cross-sectional study was conducted between October 2019 and January 2020, and covered a sample of 692 children (367 girls and 325 boys) aged 6-10 years attending primary schools in the Northern Cyprus., Methods: Body weight, height, neck circumference, waist circumference, subscapular and triceps skinfold tickness were measured. BF% was calculated with Slaughter equations. World Health Organization BMI cut-off points for age and gender percentiles were used to categorize obesity. BMI, WHtR, NC, body fat were calculated. The Pearson Correlation co-efficient between NC and the other anhtropometric measurements were calculated. Receiver operating characteristics analysis, sensitivity, specificity, PV + ve PV- was used to determine the optimal NC cut-off points for identifying children with overweight and obesity., Results: NC was a statistically significant positive and strong relationship with body weight, BMI, waist circumference and hip circumference (p < 0,005). NC cut-off values to define overweight and obesity were calculated as 26,9 cm in girls (AUC: 0,851, 95% CI: 0,811-0,891, sensitivity 70,50%, specificity 84,65%) and 27,9 cm in boys (AUC: 0,847, 95% CI: 0,805-0,888, sensitivity 76,4%, specificity 79,3%). The ROC curves accurately define overweight and obesity of the whole cohort regardless of age for both sexes of children., Conclusions: The cut-off points for neck circumference were found to be 27,9 cm for boys and 26,9 cm for girls in determining overweight and obesity in children aged 6-10 years. The NC cut-off points obtained in this study can be used to define overweight and obesity in children in epidemiological studies. It is considered to shed light on studies that will examine the relationship between neck circumference and diseases with more people in future studies., (© 2022. The Author(s).)

Introduction: Studies on the clinical and socio-demographic characteristics of those involuntarily admitted to psychiatric settings could help professionals and researchers to develop effective, targeted interventions, alternative to compulsory psychiatric care., Aim: The association between socio-demographic and clinical characteristics in adults under involuntary hospitalization for psychiatric treatment in the Republic of Cyprus was assessed., Method: This was a descriptive, cross-sectional and correlational study. Data collection was achieved (December 2016 to February 2018) via a census sampling method. Socio-demographic and clinical data of individuals involuntarily admitted to the reference psychiatric hospital of Cyprus with psychotic symptomatology were recorded., Results: The sample encompassed 144 females and 262 males. The most frequent diagnosis was schizophrenia or a relevant psychotic disorder (72.9%). The most frequent cause of admission was "Disorganized behaviour" along with non-adherence to pharmacotherapy (53.7%). Approximately 42.8% of the participants confirmed positive substance use history, which was more frequently reported in males than in females (88.5% vs. 11.5%, respectively, p < 0.001). Additionally, males were more frequently admitted due to Disorganized behaviour with substance use compared to females (31.3% vs. 4.9%, respectively, p < 0.001), while females were more frequently admitted due to d"Disorganized behaviour with non-adherence to pharmacotherapy (70.1% vs. 44.7%, respectively, p < 0.001). Also, males were more frequently involuntarily hospitalized due to suicidal/self-harming behaviour compared to females (12.2% vs. 5.6%, respectively, p = 0.031)., Conclusion: Gender differences were noted in relation to clinical characteristics of the participants, highlighting the need for gender-specific interventions to decrease compulsory psychiatric care, including enhancement of adherence to therapy., Competing Interests: Declaration of competing interest The researchers have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Despite its rarity, cancer in children and adolescents (CAC) is a major health issue worldwide. The lack of appropriate cancer registries is an obstacle for defining its incidence and survival, and informing cancer control. As in Cyprus, CAC epidemiology has not previously been comprehensively examined, we determined incidence rates and temporal trends of cancer in the 0-19 age group during 1998-2017., Methods: We established the population based Paediatric Oncology Registry of Cyprus (PORCY) for the period 1998-2017. World age standardised incidence rate per million children and adolescents per year (ASRW) were calculated and time trends were assessed using Joinpoint regression analysis. Comparisons were made with other countries using the International Incidence of Childhood Cancer, third volume., Results: For all cancers combined, for ages 0-19-years, ASRW was 203.54 (95% CI 189.49, 217.59) one of the highest rates globally. The most frequent CAC were leukaemias followed by lymphomas, specified epithelial neoplasms and central nervous system tumours, differing to what is described in most other countries. For all cancers, both combined and individual types, except thyroid carcinoma (where incidence was rising), no significant temporal variation was found., Conclusions: To inform cancer control activities, we conducted the first ever population-based epidemiological study of childhood and adolescent cancer (0-19 years) in Cyprus. The striking findings indicate high overall incidence rates that are among the world's highest, a higher frequency of lymphomas and thyroid cancer than brain tumours, and rising incidence for thyroid, but not for other, cancers. These novel findings, will help the formulation of hypotheses to provide explanation for the high rates for all CAC in Cyprus and may contribute to the global efforts for improving prevention of cancer in this age group., Competing Interests: Declarations of interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The current COVID-19 pandemic is a unique stressor with potentially challenging and negative consequences on the experiences of pregnant and postpartum women. International literature highlights the pandemic's negative impact on women's perinatal experiences. This is the first study in the scientific literature reporting on the impact of the COVID-19 pandemic, on the perinatal experiences of a large sample of women living in Cyprus., Aim: To examine the impact of the COVID-19 pandemic on the experiences, concerns and needs of pregnant and postpartum women in Cyprus., Method: The cross-sectional study was conducted from July 2020 to January 2021. A total of 695 women, 355 pregnant and 340 postpartum women (with infants up to 6 months of age), residing in Cyprus were surveyed., Results: The great majority of the participants (80.9%) perceived the impact of the COVID-19 pandemic on their life as negative. The greatest sources of stress were identified and quantified for their impact on the participants. Our findings indicate that 74.1% of the pregnant women were concerned about changes due to COVID-19 measures impacting the presence of their family at the time of delivery, 57.2% about their newborn's health, and 43.1% about changes related to perinatal care. Postpartum women's concerns were mainly related to the welfare and health of their child (70.3%), whilst half of them (49.1%) expressed concerns about how they were going to care for their baby because of pandemic-related changes. Qualitative data revealed emerging themes as the basis of the pregnant and postpartum women's concerns and needs., Conclusions: The COVID-19 pandemic and the associated imposed measures and restrictions had adverse effects on pregnant and postpartum women's perinatal experiences in Cyprus. The women's concerns emphasized the need for the development of specialized, evidenced-based support systems which are essential particularly in pandemic-like situations, when pregnant and postpartum women are more vulnerable to isolation., (© 2022. The Author(s).)

The Cyprus mouflon (Ovis gmelini ophion) is a subspecies of wild sheep, endemic to Cyprus and strictly protected by national and international legislation. In the present study, 107 Cyprus mouflon faecal samples were collected from locations within the species geographical range and examined by standard parasitological methods, i.e. flotation, sedimentation and Ziehl-Neelsen stained smears. Parasites were found in 104 (97.39%) samples. First stage larvae of the lungworms Muellerius capillaris and Cystocaulus ocreatus were found in 93 (86.9%) and in 65 (60.7%) of the samples, respectively, strongylid eggs in 46 (43%), Eimeria spp. oocysts in 44 (41.1%) and Nematodirus spp. Trichuris spp. and Moniezia spp. eggs in 10 (9.3%), 7 (6.5%) and 1 (0.9%) sample, respectively. To the best of the authors' knowledge, this is the first survey on the endoparasites of Cyprus mouflon. The possible role of the parasites found on the health status of the animals and the risk of endoparasite transmission from domestic ruminants to Cyprus mouflon are discussed., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Leishmaniasis is an infectious disease caused by Leishmania parasites, transmitted by sand flies and common in the Mediterranean region. Cyprus is located in the east of Mediterranean Sea and is considered endemic for Leishmaniasis. In our study, it was aimed to investigate Leishmania infantum IgG seropositivity in healthy volunteers living in different regions of Northern Cyprus and to determine the risk factors for Leishmaniasis and measure the level of public knowledge about the disease. A total of 300 healthy volunteers (farmer/livestock: 100, hunter: 100, control group: 100) from five different regions of Northern Cyprus were included in the study, including Nicosia, Kyrenia, Famagusta, Morphou/Lefka, and Trikomo/Karpasia. The participants' blood was drawn and prepared questionnaire forms were filled out. Collected blood was centrifuged and the serum samples were separated and stored at -80ºC until the day of the test. All serum samples were tested for L.infantum IgG specific antibodies using the ELISA method (NovaTec, Immundiagnostica GmbH, Germany) in accordance with the manufacturer's recommendations. L.infantum IgG positivity was found to be 4.7% (14/300). The mean ages of L.infantum IgG positive and negative participants were 43.64 ± 11.74 and 42.17 ± 14.32 respectively. There was no statistically significant relationship between seropositivity and age (p= 0.706). The positivity rate was found to be significantly higher in hunters and farmers/livestocks compared with the control group (p= 0.020). In addition, it was determined that having a dog and the number of dogs owned were significantly associated with Leishmaniasis (p= 0.017, p= 0.020, respectively). On the other hand, 77% (231/300) of the volunteers included in our study had no prior knowledge about the disease. When compared to the other study groups, it was determined that hunters had the most knowledge of the Leishmaniasis infection (p= 0.001). Moreover, it was observed that as the education level of the participants increased, the level of knowledge about the disease also increased in parallel (p≤ 0.001). According to the results in our study, L.infantum IgG seropositivity was undeniably high in the healthy population living in Northern Cyprus. It is clear that outdoor activities such as hunting or dealing with farming/livestock are risk factors for the disease. In this context, it is apparent that more clear results will be obtained about the prevalence of the disease with the conduction of large-scale epidemiological studies. As a result, we concluded that especially risk groups should be informed about the current status of Leishmaniasis infection and necessary precautions should be taken.