This systematic literature review aimed to provide an overview of the characteristics and methods... more This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 20...
Background Introduction of solids in the infant diet, according to WHO recommendations, should in... more Background Introduction of solids in the infant diet, according to WHO recommendations, should initiate onwards of sixth months. Evidence, however, suggests that solids introduction occurs earlier even if breastfeeding continues. With low breastfeeding rates, Cyprus is ranking last in Europe and little is known about the timing and socio-demographic pattern of solid introduction. Methods Using the retrospective event calendar method at the 4th and 6th month after birth, the timing of initiation of solids was estimated among a consecutive sample of 350 mother-baby dyads from all public (N = 5) and 29 (of 35) private maternity clinics. The likelihood of early introduction according to socio-demographic characteristics and breastfeeding self-efficacy (measured at birth and 1st month) was estimated in logistic regression models. Results Three out of ten women (30.8%) had initiated solids before the 4th month and only 20% hadn't by the 6th month. Almost half of non-Cypriot mothers (4...
Background The Baby-Friendly Hospital Initiative’s (BFHI) ‘‘Ten Steps for Successful Breastfeedin... more Background The Baby-Friendly Hospital Initiative’s (BFHI) ‘‘Ten Steps for Successful Breastfeeding'’ has been the cornerstone of national and international strategies for decades; however, adherence is suboptimal. Despite successive National Strategies, breastfeeding rates remain low in Cyprus. Methods The overall experience of a consecutive sample of 568 mother-baby dyads (response: 70.8%) across all public (N = 5) and 29 (of 35) private maternity clinics was operationalized as the sum score of full, partial or no implementation of each WHO/UNICEF BFHI self-assessment questionnaire item, with the exclusion of Step 6 (exclusivity). Associations with initiation and continuation of any (BF) and exclusive breastfeeding (EBF) up to the 6th month were explored in logistic regression after adjusting for potential confounders, including breastfeeding self-efficacy. Results At mean score 5.6 (SD = 2.4), the overall 10 steps experience was low (theoretical range 0-14), even among those w...
Background Several countries across Europe are engaging in burden of disease (BoD) studies. This ... more Background Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. Methods Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO’s framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. Results Most small states lack the resources and expertise to conduct BoD studies, but nationally repre...
Background Calculating the disease burden due to injury is complex, as it requires many methodolo... more Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results We retrieved 2,914 results of which 48 performed...
Additional file 2 of Burden of non-communicable diseases in Cyprus, 1990–2017: findings from the Global Burden of Disease 2017 study
Additional file 2. Age-standardized YLLs, YLDs, and DALYs and absolute changes for the main NCD d... more Additional file 2. Age-standardized YLLs, YLDs, and DALYs and absolute changes for the main NCD drivers of change, Cypriot males and females, 1990–2017.
Additional file 1 of The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool
Additional file 1. Questions about breastfeeding self-efficacy/confidence.
Background Non-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot p... more Background Non-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot population, in 2018. However, a detailed and comprehensive overview of the impact of NCDs on population health of Cyprus over the period of 1990 to 2017, expressed in disability-adjusted life years (DALYs), is currently not available. Knowledge about the drivers of changes in NCD DALYs over time is paramount to identify priorities for the prevention of NCDs in Cyprus and guide evidence-based decision making. The objectives of this paper were to: 1) assess the burden of NCDs in terms of years of life lost (YLLs), years lived with disability (YLDs), and DALYs in Cyprus in 2017, and 2) identify changes in the burden of NCDs in Cyprus over the 28-year period and assess the main drivers of these changes. Methods We performed a secondary database descriptive study using the Global Burden of Disease (GBD) 2017 results on NCDs for Cyprus from 1990 to 2017. We calculated the percentage change of a...
Individuals with lower childhood SES were more likely to suffer poor sleep quality during old age... more Individuals with lower childhood SES were more likely to suffer poor sleep quality during old age without developing depressive symptoms. Social policies tackling economic disparity between children may be beneficial in reducing poor sleep quality during old age.
Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initi... more Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initiation, duration and exclusivity. The use of valid measurement tools of BSES is important in clinical and community practice. Thus, we aimed to assess the properties of the Breastfeeding Self-Efficacy Scale (BSES-SF) to measure the self-efficacy of mothers in Cyprus and its association with BF and EBF up to the sixth month.Methods: A cross-sectional and longitudinal descriptive study with a nationwide consecutive sample of 586 mother-infant dyads, recruited from all state maternity wards and 24 (of 30) private clinics within 24-48 hours of birth and followed up by telephone up to the 6 th month postpartum. BSES was assessed at the clinic and at the first month with the Greek version of the 14-item 5-point Likert BSES-SF scale. Information on infant feeding practices was collected at all four time points. The association between self-efficacy and breastfeeding outcomes was estimated in log...
To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive b... more To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month. Cross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers' self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall. Maternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide. Consecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month. Although 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-f...
The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool
Introduction While breastfeeding self-efficacy (BSES) is an important modifiable determinant of b... more Introduction While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month. Methods A methodological study with longitudinal design among 586 mother-infant dyads, as part of the “BrEaST Start in Life” project. BSES was assessed 24–48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis. Results With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbac...
The risk of respiratory symptoms near power stations among 15-17 year-old students in Cyprus, 2006-07
Paper presented at DISTRES Conference (Distributed Renewable Energy Sources in the Mediterranean ... more Paper presented at DISTRES Conference (Distributed Renewable Energy Sources in the Mediterranean region) Nicosia, Cyprus, 2009 Exposure to air pollutants has been repeatedly shown to be associated with a range of adverse respiratory effects. Differences in asthma prevalence on an island the size of Cyprus may reflect such environmental factors. This study assessed the geographical distribution of self-reported asthmatic symptoms in 15-17-year old participants recorded in an ISAAC survey across Cypriot schools (N=6393). Using GIS software, circular zones were constructed around each of the three power stations on the island in increments of 5km. vidence of an increased risk among participants with regards to their community’s proximity to the source of emissions was investigated in logistic regression models before and after adjusting for person-based risk factors, co-morbidity and intradistrict correlation. Adjusted odds ratio for active asthma was 1.79 (95%CI: 1.27, 2.53) among res...
This systematic literature review aimed to provide an overview of the characteristics and methods... more This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 20...
Background Introduction of solids in the infant diet, according to WHO recommendations, should in... more Background Introduction of solids in the infant diet, according to WHO recommendations, should initiate onwards of sixth months. Evidence, however, suggests that solids introduction occurs earlier even if breastfeeding continues. With low breastfeeding rates, Cyprus is ranking last in Europe and little is known about the timing and socio-demographic pattern of solid introduction. Methods Using the retrospective event calendar method at the 4th and 6th month after birth, the timing of initiation of solids was estimated among a consecutive sample of 350 mother-baby dyads from all public (N = 5) and 29 (of 35) private maternity clinics. The likelihood of early introduction according to socio-demographic characteristics and breastfeeding self-efficacy (measured at birth and 1st month) was estimated in logistic regression models. Results Three out of ten women (30.8%) had initiated solids before the 4th month and only 20% hadn't by the 6th month. Almost half of non-Cypriot mothers (4...
Background The Baby-Friendly Hospital Initiative’s (BFHI) ‘‘Ten Steps for Successful Breastfeedin... more Background The Baby-Friendly Hospital Initiative’s (BFHI) ‘‘Ten Steps for Successful Breastfeeding'’ has been the cornerstone of national and international strategies for decades; however, adherence is suboptimal. Despite successive National Strategies, breastfeeding rates remain low in Cyprus. Methods The overall experience of a consecutive sample of 568 mother-baby dyads (response: 70.8%) across all public (N = 5) and 29 (of 35) private maternity clinics was operationalized as the sum score of full, partial or no implementation of each WHO/UNICEF BFHI self-assessment questionnaire item, with the exclusion of Step 6 (exclusivity). Associations with initiation and continuation of any (BF) and exclusive breastfeeding (EBF) up to the 6th month were explored in logistic regression after adjusting for potential confounders, including breastfeeding self-efficacy. Results At mean score 5.6 (SD = 2.4), the overall 10 steps experience was low (theoretical range 0-14), even among those w...
Background Several countries across Europe are engaging in burden of disease (BoD) studies. This ... more Background Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. Methods Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO’s framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. Results Most small states lack the resources and expertise to conduct BoD studies, but nationally repre...
Background Calculating the disease burden due to injury is complex, as it requires many methodolo... more Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results We retrieved 2,914 results of which 48 performed...
Additional file 2 of Burden of non-communicable diseases in Cyprus, 1990–2017: findings from the Global Burden of Disease 2017 study
Additional file 2. Age-standardized YLLs, YLDs, and DALYs and absolute changes for the main NCD d... more Additional file 2. Age-standardized YLLs, YLDs, and DALYs and absolute changes for the main NCD drivers of change, Cypriot males and females, 1990–2017.
Additional file 1 of The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool
Additional file 1. Questions about breastfeeding self-efficacy/confidence.
Background Non-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot p... more Background Non-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot population, in 2018. However, a detailed and comprehensive overview of the impact of NCDs on population health of Cyprus over the period of 1990 to 2017, expressed in disability-adjusted life years (DALYs), is currently not available. Knowledge about the drivers of changes in NCD DALYs over time is paramount to identify priorities for the prevention of NCDs in Cyprus and guide evidence-based decision making. The objectives of this paper were to: 1) assess the burden of NCDs in terms of years of life lost (YLLs), years lived with disability (YLDs), and DALYs in Cyprus in 2017, and 2) identify changes in the burden of NCDs in Cyprus over the 28-year period and assess the main drivers of these changes. Methods We performed a secondary database descriptive study using the Global Burden of Disease (GBD) 2017 results on NCDs for Cyprus from 1990 to 2017. We calculated the percentage change of a...
Individuals with lower childhood SES were more likely to suffer poor sleep quality during old age... more Individuals with lower childhood SES were more likely to suffer poor sleep quality during old age without developing depressive symptoms. Social policies tackling economic disparity between children may be beneficial in reducing poor sleep quality during old age.
Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initi... more Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initiation, duration and exclusivity. The use of valid measurement tools of BSES is important in clinical and community practice. Thus, we aimed to assess the properties of the Breastfeeding Self-Efficacy Scale (BSES-SF) to measure the self-efficacy of mothers in Cyprus and its association with BF and EBF up to the sixth month.Methods: A cross-sectional and longitudinal descriptive study with a nationwide consecutive sample of 586 mother-infant dyads, recruited from all state maternity wards and 24 (of 30) private clinics within 24-48 hours of birth and followed up by telephone up to the 6 th month postpartum. BSES was assessed at the clinic and at the first month with the Greek version of the 14-item 5-point Likert BSES-SF scale. Information on infant feeding practices was collected at all four time points. The association between self-efficacy and breastfeeding outcomes was estimated in log...
To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive b... more To assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month. Cross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers' self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall. Maternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide. Consecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month. Although 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-f...
The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool
Introduction While breastfeeding self-efficacy (BSES) is an important modifiable determinant of b... more Introduction While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month. Methods A methodological study with longitudinal design among 586 mother-infant dyads, as part of the “BrEaST Start in Life” project. BSES was assessed 24–48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis. Results With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbac...
The risk of respiratory symptoms near power stations among 15-17 year-old students in Cyprus, 2006-07
Paper presented at DISTRES Conference (Distributed Renewable Energy Sources in the Mediterranean ... more Paper presented at DISTRES Conference (Distributed Renewable Energy Sources in the Mediterranean region) Nicosia, Cyprus, 2009 Exposure to air pollutants has been repeatedly shown to be associated with a range of adverse respiratory effects. Differences in asthma prevalence on an island the size of Cyprus may reflect such environmental factors. This study assessed the geographical distribution of self-reported asthmatic symptoms in 15-17-year old participants recorded in an ISAAC survey across Cypriot schools (N=6393). Using GIS software, circular zones were constructed around each of the three power stations on the island in increments of 5km. vidence of an increased risk among participants with regards to their community’s proximity to the source of emissions was investigated in logistic regression models before and after adjusting for person-based risk factors, co-morbidity and intradistrict correlation. Adjusted odds ratio for active asthma was 1.79 (95%CI: 1.27, 2.53) among res...
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Papers by Mary Economou