Papers by Alexandros Heraclides
International journal of environmental research and public health/International journal of environmental research and public health, Jun 25, 2024
Background: The mental well-being of university students has been a growing concern in Public Hea... more Background: The mental well-being of university students has been a growing concern in Public Health and has been exacerbated by the COVID-19 pandemic. The pandemic (including the post-pandemic era) introduced and exacerbated a variety of potential stressors for vulnerable individuals and communities, resulting in an increase in mental health issues among university students. Resilience, as a process, is the ability of a system to adapt and grow in the face of adversity. This is a crucial aspect to consider when examining the coping of university students in critical situations such as COVID-19. Objective: This study aims to assess the association between resilience and mental health outcomes among university students in Cyprus during the post-COVID-19 pandemic era. Methods: A parallel embedded mixed methods research design will be utilized to assess resilience, measured by the Conner–Davidson Resilience Scale (CD-RISC), the COVID-19 Impact Scale (CIS) and mental health outcomes measured by the Symptom Checklist 90-Revised (SCL 90-R), during the COVID-19 post-pandemic era (January 2022–July 2024) among university students in the Republic of Cyprus. The study will be conducted in two stages: a pilot study followed by the main study. Quantitative data will be collected through a web-based survey, while qualitative data will be obtained through in-person focus groups designed to capture participants’ experiences. Participants will be recruited using a proportional quota sampling approach to achieve representativeness based on predefined demographics. The study protocol has been approved by the Cyprus Bioethics Committee (approval no: EEC/EP/2023/31). Discussion: This study is expected to broaden our understanding of the intricate interactions between the COVID-19 pandemic’s impact, resilience, and mental health outcomes. The focus on university students’ psychological wellbeing is consistent with the call by the WHO to focus on mental health (World Health Organization, 2019). Keywords: COVID-19 pandemic era; university students; mental health; COVID-19 pandemic’s impact, resilience, and mental health outcomes. The focus on university students’ psychological wellbeing is consistent with the call by the WHO to focus on mental health (World Health Organization, 2019).
Scientific reports, Apr 26, 2024
Archaeological evidence supports sporadic seafaring visits to the Eastern Mediterranean island of... more Archaeological evidence supports sporadic seafaring visits to the Eastern Mediterranean island of Cyprus by Epipaleolithic hunter-gatherers over 12,000 years ago, followed by permanent settlements during the early Neolithic. The geographical origins of these early seafarers have so far remained elusive. By systematically analysing all available genomes from the late Pleistocene to early Holocene Near East (c. 14,000-7000 cal BCE), we provide a comprehensive overview of the genetic landscape of the early Neolithic Fertile Crescent and Anatolia and infer the likely origins of three recently published genomes from Kissonerga-Mylouthkia (Cypriot Late Pre-Pottery Neolithic B, c. 7600-6800 cal BCE). These appear to derive roughly 80% of their ancestry from Aceramic Neolithic Central Anatolians residing in or near the Konya plain, and the remainder from a genetically basal Levantine population. Based on genome-wide weighted ancestry covariance analysis, we infer that this admixture event took place roughly between 14,000 and 10,000 BCE, coinciding with the transition from the Cypriot late Epipaleolithic to the Pre-Pottery Neolithic A (PPNA). Additionally, we identify strong genetic affinities between the examined Cypro-LPPNB individuals and later northwestern Anatolians and the earliest European Neolithic farmers. Our results inform archaeological evidence on prehistoric demographic processes in the Eastern Mediterranean, providing important insights into early seafaring, maritime connections, and insular settlement. The Fertile Crescent, extending from the southern Levant to eastern Anatolia, and further east to Upper Mesopotamia and the Central Zagros, is the region where agriculture and the domestication of ungulates first emerged during the Pleistocene-Holocene transition in Western Eurasia (around 12,000 years ago) 1,2 . Prior to these major shifts in human subsistence strategies, archaeological evidence testifies to sporadic maritime trips made by hunter-gatherers from the core Fertile Crescent to the Eastern Mediterranean island of Cyprus during the Epipaleolithic (c. 10,500 years cal BCE) 3 . In the ensuing two millennia, groups of early Near Eastern farmers introduced agriculture to Cyprus, evidenced by tools, crops, livestock, and domesticated wild animals (e.g. cats and dogs) at sites on the island during the Initial/Early Aceramic Neolithic or Cypriot Pre-Pottery Neolithic 4 (Cypro-PPNA and Cypro-PPNB, terms used throughout the present study) . Although developments during the Cypro-PPN period are well documented archaeologically , the geographical origins of the earliest settlers in Cyprus have remained elusive . The presence of suids at the Epipaleolithic site of Akrotiri-Aetokremnos over 12,500 years ago 3,13 and the initial Neolithic zooarchaeological record, as well as assemblages of worked stone and buildings attested at initial Cypro-PPNA sites, have been interpreted as cultural expressions of Levantine groups . Imported obsidian found at early Cypro-PPN sites (particularly during Cypro-PPNB), however, has been geochemically characterised as deriving from Central Anatolia 15 , indicating maritime contacts. Ancient maritime navigation data also put forward south-central Anatolia and the northwestern Levant as the two most plausible starting points of early seafaring journeys to and from Cyprus from the surrounding mainland . Archaeogenetics provide an additional line of evidence in long-standing debates of archaeological and historical processes. In a Near Eastern context, ancient DNA (aDNA) evidence revealed significant genetic heterogeneity in the early Neolithic Levant 17 , Anatolia , Mesopotamia , and further east in the Central Zagros 23 , and
Frontiers in Neurology, Oct 17, 2019
Conclusions: Collectively, this case-control study has shed some light on the nature of PD epidem... more Conclusions: Collectively, this case-control study has shed some light on the nature of PD epidemiology in Cyprus, by demonstrating a number of genetic and environmental determinants of PD in the Cypriot population.
Frontiers in Public Health, Nov 19, 2021
University students represent a highly active group in terms of their social activity in the comm... more University students represent a highly active group in terms of their social activity in the community and in the propagation of information on social media. We aimed to map the knowledge, attitudes, and perceptions of University students in Cyprus about severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19) to guide targeted future measures and information campaigns. We used a cross-sectional online survey targeting all students in conventional, not distance-learning, programs in five major universities in the Republic of Cyprus. Students were invited to participate through the respective Studies and Student Welfare Office of each institution. The survey was made available in English and Greek on REDCap. Participation was voluntary and anonymous. The questionnaire was developed based on a consensus to cover the main factual information directed by official channels toward the general public in Cyprus at the time of the survey. In addition to sociodemographic information (N = 8), the self-administered questionnaire consisted of 19 questions, assessing the knowledge regarding the characteristics of SARS-CoV-2 and COVID-19, infection prevention and control measures (N = 10), perceptions related to COVID-19, for instance, whether strict travel measures are necessary (N = 4), and attitudes toward a hypothetical person infected (N = 2). Furthermore, participants were asked to provide their own assessment of their knowledge about COVID-19 and specifically with regard to the main symptoms and ways of transmission (N = 3). The number of students who completed the survey was 3,641 (41% studying Health/Life Sciences). Amongst them, 68.8% responded correctly to at least 60% of knowledgerelated questions. Misconceptions were identified in 30%. Only 29.1% expressed a Middleton et al. COVID-19 Attitudes Among University Students positive attitude toward a hypothetical person with COVID-19 without projecting judgment (9.2%) or blame (38%). Odds of expressing a positive attitude increased by 18% (95% CI 13-24%; p < 0.001) per unit increase in knowledge. Postgraduate level education was predictive of better knowledge (odds ratio (OR) 1.81; 95% CI 1.34-2.46; p < 0.001 among doctoral students] and positive attitude [OR 1.35; 95% CI 1.01-1.80; p = 0.04). In this study, we show that specific knowledge gaps and misconceptions exist among University students about SARS-CoV-2 and COVID-19 and their prevalence is associated with negative attitudes toward people with COVID-19. Our findings highlight the integrated nature of knowledge and attitude and suggest that improvements to the former could contribute to improvements in the latter.
Public Health Nutrition, Dec 26, 2018
Objective: Evidence suggests that the rate of glucose release following consumption of carbohydra... more Objective: Evidence suggests that the rate of glucose release following consumption of carbohydrate-containing foods, defined as the glycaemic index (GI), is inversely associated with cognitive function. To date, most of the evidence stems from either single-meal studies or highly heterogeneous cohort studies. We aimed to study the prospective associations of diet GI at age 53 years with outcomes of verbal memory and letter search tests at age 69 years and rate of decline between 53 and 69 years. Design: Longitudinal population-based birth cohort study. Setting: MRC National Survey for Health and Development. Participants: Cohort members (n 1252). Results: Using multivariable linear and logistic regression, adjusted for potential confounders, associations of higher-GI diet with lower verbal memory, lower letter search speed and lower number of hits in a letter search test were attenuated after adjustments for cognitive ability at age 15 years, educational attainment, further training and occupational social class. No association was observed between diet GI at 53 years and letter search accuracy or speed-accuracy trade-off at 69 years, or between diet GI at 53 years and rate of decline between 53 and 69 years in any cognitive measure. Conclusions: Diet GI does not appear to predict cognitive function or decline, which was mainly explained by childhood cognitive ability, education and occupational social class. Our findings confirm the need for further research on the association between diet and cognition from a life-course perspective.
Advances in Nutrition, Sep 1, 2020
Growing evidence suggests that personality traits play a role in obesity and cardiometabolic heal... more Growing evidence suggests that personality traits play a role in obesity and cardiometabolic health. In addition, irregularity of food intake has emerged as a potential risk factor for obesity, cardiovascular disease, and metabolic syndrome. Recent studies suggest that when we eat, termed "chrono-nutrition," may be as important to what we eat. This concept covers 3 aspects: 1) irregularity of energy intake in meals (varying amounts of energy intake throughout the day and at different times from one day to the next), 2) frequency (number of meals per day), and 3) timing of food intake (actual time of day). A narrative review was conducted to identify literature evaluating the effect of personality on chrononutrition and subsequently obesity and cardiometabolic health. The search focused on research published since 2000 in MEDLINE using the search terms "personality," "chrono-nutrition," "cardiometabolic," "BMI," "obesity," and "metabolic rate." Findings indicate an inverse relation between conscientiousness and obesity, with people who are more conscientious having a lower risk of obesity. Furthermore, time of day of energy intake has been linked to obesity, since meals consumed in the evening have been associated with lower resting metabolic rate. Inconsistent timing and frequency of meals have also been linked to increased body weight and worse cardiometabolic health. Together, the data indicate that eating meals at the same time every day at regular intervals might be the reason why those who score high in conscientiousness are able to maintain a healthier weight. Despite the reviewed observational evidence, there is an apparent gap in the existing literature on the interplay between personality, chrono-nutrition, and obesity and particularly on how dietary interventions should be designed considering different personality traits. Future research is needed to clarify this association and how it interacts with other factors, thus elucidating the role of chrono-nutrition in health.
PubMed, 2013
Background and aim: Recently, considerable attention has been given to beverage intake as a sourc... more Background and aim: Recently, considerable attention has been given to beverage intake as a source of calories which may be linked to pediatric obesity. The purpose of our study was to evaluate the beverage intake in school children and adolescents aged 7 to 15 years old. Methods: Six hundred and seven (607) out of 655 children participated in the study. One hundred percent fruit juice were classified those beverages that contain 100% fruit juice, without sweetener. Sweetened sugar beverages (SSBs) were included (fruit drinks sweetened fruit juice, fruit-flavored drink or drink that contained fruit juice in part, sweeten soft drinks, coffee, and tea). Results: Around 84% of subjects consumed water while 81% of children who were included in the analysis consumed milk, 49.5% consumed 100% fruit juice, and 79.4 % SSBs. Whole milk was consumed by 40.9% of school children. Skim milk and 1% milk were consumed by 3.6% and 4.7% of the children, respectively. Children and adolescents consuming SSBs were 2.57 (95% CI: 1.06, 3.38) times more likely to become obese compared to normal peers. Conclusion: Sugar beverage drinks but not 100% fruit juices and milk are associated with obesity. Further studies investigating the relationship among beverage consumption, total energy intake, and development of overweight are needed.
European annals of allergy and clinical immunology, Jul 1, 2017
Aim. To determine whether food allergy affects overall dietary intake and food choices in Cypriot... more Aim. To determine whether food allergy affects overall dietary intake and food choices in Cypriot primary school children. Methods. As part of the first epidemiological study in Cyprus on food allergy in primary school children, two 24-hour recalls (one from a week and one from a weekend day) of twenty-eight food allergic children (21 girls) and thirty healthy children (20 girls) aged 6-11 years old, were analysed and compared regarding their macro-and micronutrient content, food choices and meal distribution. Results. Significant differences between the two subgroups of children were estimated regarding the total energy intake and macronutrients, where food allergic children were found to consume in lower quantities, as well as for calcium, niacin, fiber and vitamin E. Food allergic children were also found to avoid combining foods from the various food groups in their meals, and to prefer specific food products from each category, whereas they consumed higher amounts of sugar and fructose. Conclusion. Food allergy in Cypriot food allergic children impacts on both the quality and quantity of food choices, probably due to lack of nutritional education regarding proper elimination diet and alternative nutrient sources.
Diabetic Medicine, Sep 18, 2012
Aims-Skeletal muscle is a major metabolic organ and plays important roles in glucose metabolism, ... more Aims-Skeletal muscle is a major metabolic organ and plays important roles in glucose metabolism, insulin sensitivity, and insulin action. Muscle telomere length reflects the myocyte's exposure to harmful environmental factors. Leukocyte telomere length is considered a marker of muscle telomere length and is used in epidemiologic studies to assess associations with ageingrelated diseases where muscle physiology is important. However, the extent to which leucocyte telomere length and muscle telomere length are correlated is unknown, as are their relative correlations with glucose and insulin concentrations. The purpose of this study was to determine the extent of these relationships. Methods-Leucocyte telomere length and muscle telomere length were measured by quantitative real-time PCR in participants from the Malmö Exercise Intervention (MEI; n=27) and the PPP-Botnia studies (n=31). Participants in both studies were free from type 2 diabetes. We assessed the association between leucocyte telomere length, muscle telomere length and metabolic traits using Spearmen correlations and multivariate linear regression. Bland-Altman analysis was used to assess agreement between leucocyte telomere length and muscle telomere length. Results-In age-, study-, diabetes family history-and sex-adjusted models, leucocyte telomere length and muscle telomere length were positively correlated (r=0.39, 95% CI: 0.15, 0.59). Leucocyte telomere length was inversely associated with 2hr glucose concentrations (r=-0.58,
Obesity, Feb 1, 2012
nature publishing group articles epidemiology IntroductIon The psychosocial hypothesis of chronic... more nature publishing group articles epidemiology IntroductIon The psychosocial hypothesis of chronic disease is centered on the notion that the social environment has the capacity to elicit adverse psychological reactions and that repeated exposure to these has cumulative physiological impact (1,2). In addition, chronic stressors could increase disease risk through an unhealthier lifestyle and subsequent weight gain. Psychosocial stress at work has previously been linked to heart disease (3-5), obesity (6,7), the metabolic syndrome (8), and type 2 diabetes (T2DM) (9-11). We have previously shown that women experiencing psychosocial work stress have twice the risk of T2DM compared to women with no work stress (12). Excess body fat accumulation, for which BMI is a relatively accurate surrogate, has been linked to profound endocrine changes related to T2DM (13). Previous evidence from our study suggests that psychosocial work stress is associated with prospective weight gain among obese men but prospective weight loss among lean men (14). Given this evidence, we hypothesized that body weight status modifies the effect of psychosocial work stress on incident T2DM, in a gender-specific manner. Our aim was to examine the association between work stress and T2DM among a sample of British, middle-aged men and women, stratifying by gender and BMI. Methods and Procedures setting and population The Whitehall II study is an occupational cohort established in 1985 with the broad aim of investigating the social gradient in disease outcomes.
Diabetes Care, Aug 31, 2009
OBJECTIVE-To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, ad... more OBJECTIVE-To investigate the effect of psychosocial stress at work on risk of type 2 diabetes, adjusting for conventional risk factors, among a sample of British, white-collar, middleaged men and women. RESEARCH DESIGN AND METHODS-This was a prospective analysis (1991-2004) from the Whitehall II cohort study. The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline. Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases. The job strain and iso-strain models were used to assess psychosocial work stress. RESULTS-Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men (hazard ratio 1.94 [95% CI 1.17-3.21). This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20% after adjustment for health behaviors, obesity, and other type 2 diabetes risk factors. CONCLUSIONS-Psychosocial work stress was an independent predictor of type 2 diabetes among women after a 15-year follow-up. This association was not explained by potential confounding and mediating factors. More evidence from prospective studies using the same work stress models is needed to support the current findings and provide further information on sex differences.
Frontiers in Public Health, Dec 6, 2022
Editorial on the Research Topic Data science and health economics in precision public health Over... more Editorial on the Research Topic Data science and health economics in precision public health Overview of precision public health Advances in computational and data sciences, such as big data approaches, along with engineering innovations, such as geographic information system (GIS) and artificial intelligence (AI) technologies, have greatly enhanced our capabilities for data management, integration, and visualization (1-3). These scientific developments have prompted demands for more comprehensive and coherent but, most importantly, tailored and targeted strategies to address fundamental issues in public health (4, 5). Combining these novel approaches with more traditional health determinants such as lifestyle, socioeconomic, cultural, and environmental factors has resulted in an exciting new field in the health sciences, Precision Public Health (6). Theory, methods, and models from AI and data science are already changing the public health landscape in community settings (7) and have already shown promising results in multiple applications in public health, including geocoding health data (8), digital public health (9), predictive modeling and decision support (10), and mobile health (11). Overall, Precision Public Health utilizes tools and methods from the above technologies to extract health and non-health data at different levels of granularity, harmonize and integrate information about populations and communities to tailor costeffective interventions for specific population groups, improving people's health. The overarching goal of Precision Public Health is to provide the proper intervention to the right population at the right time (12).
The coronavirus pandemic (COVID-19) resulted in lockdowns and social distancing measures enforced... more The coronavirus pandemic (COVID-19) resulted in lockdowns and social distancing measures enforced by governments. Using a cross-sectional design, this study aimed to identify changes in adherence to the Mediterranean diet (MD) and physical activity (PA) and associations with personality, during lockdown in Qatar. A sample of 543 participants was recruited online between April and May 2020. Results showed a reduction in Mediterranean diet (MD) adherence during lockdown (5.9 ± 0.08) compared to before lockdown (6.1 ± 0.08) (p ˂ 0.001). Although there was an increase in the percentage of participants who consumed ≥4 tablespoons olive oil per day (9% vs 12%; p ˂ 0.001), vegetables (54.3% vs 58.7%; p = 0.005), legumes (11.8% vs 15.3%; p = 0.007) and sofrito (70.9% vs 77.3%; p ˂ 0.001), there was also a significant decrease in the percentage of participants who consumed fresh fruit (39.4% vs 15.8%; p ˂ 0.001) and fish/seafood (5.9% vs 3.9%; p = 0.035) and an increase in saturated fat consumption (45.9% vs 53.8%; p ˂ 0.001), during lockdown compared to before lockdown. Participants who scored high in the extraversion personality dimension had a higher MD adherence (B = 0.84; 95% CI = 0.04, 1.64; p = 0.039) before lockdown compared to participants who scored high in the agreeableness personality dimension, although this difference did not reach statistical significance during lockdown. Those who scored high in openness had the lowest change in MD adherence score (B =-0.31; 95% CI =-0.58,-0.04; p = 0.026). Total PA (B =-506.26; 95% CI =-678.60,-333.92; p ˂ 0.001), vigorous activity (B =-155.95; 95% CI =-274.64,-38.21; p = 0.010), moderate activity (B =-93.04; 95% CI =-148.07,-38.01; p = 0.010) and walking (B =-257.27; 95% CI =-337.87,-176.67; p ˂ 0.001) were decreased during lockdown, while sitting was increased compared to before lockdown (B = 940.91, 95% CI = 831.9, 1049.90; p ˂ 0.001). Openness was positively associated with all PA (B = 562.2; 95% CI = 62.7, 106.7; p = 0.027), including walking (B = 241.7; 95 % CI = 29.4, 454.0; p = 0.026) and negatively associated with sitting (B=-303.4; 95% CI =-590.0;-16.8; p = 0.038) when compared to those with high agreeableness scores, before lockdown. During lockdown, the time spent sitting was lower in those with high scores on neuroticism when compared to those with high agreeableness scores (B=-619.5; 95 % CI =-1215,-23.9; p = 0.042). Differential changes in lifestyle habits by personality dimensions during lockdown, suggest the need to tailor lifestyle interventions based on people's personality types, for more effective lifestyle change.
European Journal of Epidemiology, Nov 20, 2012
Net reclassification improvement (NRI) has received much attention for comparing risk prediction ... more Net reclassification improvement (NRI) has received much attention for comparing risk prediction models, and might be preferable over the area under the receiver operating characteristics (ROC) curve to indicate changes in predictive ability. We investigated the influence of the choice of risk cut-offs and number of risk categories on the NRI. Using data of the European Prospective Investigation into Cancer and Nutrition-Potsdam study, three diabetes prediction models were compared according to ROC area and NRI with varying cut-offs for two and three risk categories and varying numbers of risk categories. When compared with a basic model, including age, anthropometry, and hypertension status, a model extension by waist circumference improved discrimination from 0.720 to 0.831 (0.111 [0.097-0.125]) while increase in ROC-AUC from 0.831 to 0.836 (0.006 [0.002-0.009]) indicated moderate improvement when additionally considering diet and physical activity. However, NRI based on these two model comparisons varied with varying cut-offs for two (range: 5.59-23.20%; -0.79 to 4.09%) and three risk categories (20.37-40.15%; 1.22-4.34%). This variation was more pronounced in the model extension showing a larger difference in ROC-AUC. NRI increased with increasing numbers of categories from minimum NRIs of 18.41 and 0.46% to approximately category-free NRIs of 79.61 and 19.22%, but not monotonically. There was a similar pattern for this increase in both model comparisons. In conclusion, the choice of risk cut-offs and number of categories has a substantial impact on NRI. A limited number of categories should only be used if categories have strong clinical importance.
Tropical Medicine & International Health, Nov 29, 2012
objective The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). How... more objective The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. methods A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cutoff points for diabetes were identified by receiver operating characteristic curves. results The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cutoff points were ! 0.88 in women and ! 0.90 in men. Recommended cutoff points for body mass index and waist circumference had a poor predictive ability. conclusion Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries. keywords obesity, type 2 diabetes, sub-Saharan Africa, ROC curves
Journal of Epidemiology and Community Health, Sep 7, 2009
Background Social mobility (movement up or down the social hierarchy) and social accumulation (ac... more Background Social mobility (movement up or down the social hierarchy) and social accumulation (accumulating social advantage or disadvantage) across the life course have been shown to affect adult health. There is no evidence on how these processes simultaneously affect adult overweight and obesity. Methods Cross-sectional analysis using data from phase 5 of the Whitehall II study (1997e1999), including retrospective information on past socioeconomic position (SEP) for 4598 participants (44e69 years). The effect of social mobility and social accumulation, from childhood social class to educational attainment to current employment grade, on prevalent adult overweight and obesity was examined. Results Upwardly socially mobile participants did not have lower prevalence of overweight and obesity compared to the socially stable at low SEP (62.3 vs 63.9% in women). Downwardly socially mobile participants had higher prevalence of overweight and obesity than the socially stable at high SEP (52.0% vs 36.1% in women). The odds of adult overweight and obesity increased with social accumulation of disadvantage. Among women, one life phase in low SEP was associated with 61% higher odds (OR 1.61; 95% CI 1.05 to 2.47), two phases low with 66% higher odds (1.66; 1.14 to 2.42) and all phases low with 2.6 times the odds (2.61; 1.79 to 3.78) of overweight and obesity compared to women with all phases in high SEP. Conclusions Social mobility and social accumulation can operate simultaneously across the life course. Prevention of downward social mobility and social accumulation of disadvantage could reduce the overall prevalence of adult overweight and obesity.
Nutrients, Jun 30, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European journal of public health, Oct 1, 2022
medRxiv (Cold Spring Harbor Laboratory), Aug 11, 2022
Background: It has been claimed that COVID-19 vaccination is associated with excess mortality dur... more 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 lagresponse 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-ofdeath 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.
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Papers by Alexandros Heraclides