Mitochondrial DNA Consensus Calling and Quality Filtering for Constructing Ancient Human Mitogenomes: Comparison of Two Widely Applied Methods.

Retrieving high-quality endogenous ancient DNA (aDNA) poses several challenges, including low molecular copy number, high rates of fragmentation, damage at read termini, and potential presence of exogenous contaminant DNA. All these factors complicate a reliable reconstruction of consensus aDNA sequences in reads from high-throughput sequencing platforms. Here, we report findings from a thorough evaluation of two alternative tools (ANGSD and schmutzi) aimed at overcoming these issues and constructing high-quality ancient mitogenomes. Raw genomic data (BAM/FASTQ) from a total of 17 previously published whole ancient human genomes ranging from the 14th to the 7th millennium BCE were retrieved and mitochondrial consensus sequences were reconstructed using different quality filters, with their accuracy measured and compared. Moreover, the influence of different sequence parameters (number of reads, sequenced bases, mean coverage, and rate of deamination and contamination) as predictors of derived sequence quality was evaluated. Complete mitogenomes were successfully reconstructed for all ancient samples, and for the majority of them, filtering substantially improved mtDNA consensus calling and haplogroup prediction. Overall, the schmutzi pipeline, which estimates and takes into consideration exogenous contamination, appeared to have the edge over the much faster and user-friendly alternative method (ANGSD) in moderate to high coverage samples (>1,000,000 reads). ANGSD, however, through its read termini trimming filter, showed better capabilities in calling the consensus sequence from low-quality samples. Among all the predictors of overall sample quality examined, the strongest correlation was found for the available number of sequence reads and bases. In the process, we report a previously unassigned haplogroup (U3b) for an Early Chalcolithic individual from Southern Anatolia/Northern Levant.

Lifestyle habits of adults during the COVID-19 pandemic lockdown in Cyprus: evidence from a cross-sectional study.

BACKGROUND: The COVID-19 pandemic and the widespread adoption of virus control measures have inevitably disrupted efforts to address lifestyle risk factors for non-communicable diseases (NCD). This study aimed to explore the effects of COVID-19 lockdown on all lifestyle medicine pillars, namely diet, physical activity, sleep, stress, social support and use of risky substances. METHODS: This was a cross-sectional study on a convenient sample of adults who resided in Cyprus during the Spring 2020 lockdown. Participants completed an anonymous online questionnaire comprised of six validated tools regarding the following lifestyle behaviours before and during lockdown: adherence to the Mediterranean diet, physical activity, stress and social support levels, sleep pattern and use of risky substances such as smoking and alcohol. Paired before and during lockdown comparisons for each lifestyle pillar were undertaken using Wilcoxon Signed-Rank test and Bowker symmetry Test where response was numerical (non-parametric data) and categorical respectively. Furthermore, stratified analyses for sociodemographic characteristics were performed. RESULTS: Out of 745 participants, 74% were female and median age was 39 years. Overall participants reported significantly higher perceived stress score (22 v 25, p <  0.01), lower social support score (71 v 68, p <  0.001), and worse sleep quality score (4 v 5, p <  0.01) during lockdown. Mediterranean diet (MD) adherence was moderate and increased significantly only in those practicing religious fasting (score of 6 v 7, p <  0.01). Total minutes spent sitting increased (120 v 180, p <  0.01) although overall physical activity score did not significantly change. Smoking intensity increased during lockdown whilst frequency of alcohol consumption decreased (ptrend = 0.03 and <  0.01, respectively). CONCLUSION: Various lifestyle factors were adversely affected by the COVID-19 lockdown in Cyprus. Evidence from this study supports development of holistic lifestyle interventions during and following the pandemic to reduce short and long-term NCD risks by building on lifestyle behaviour strengths and addressing longstanding and emerging gaps and needs.

Knowledge of mothers regarding children's vaccinations in Greece: an online cross-sectional study.

BACKGROUND: One of the main reasons that influence parental choice to postpone or avoid children's vaccination is insufficient knowledge. Mothers' knowledge can be considered as an important factor when determining childcare, as they are often the primary decision maker for their children's healthcare issues. This study aimed to assess the level of mothers' knowledge and practice on certain aspects of vaccination for their child/children in Greece. METHODS: This was an online cross-sectional survey, which collected information about mother's socio-demographic characteristics, vaccination-related information, and vaccine knowledge using a self-administered questionnaire. The survey was conducted between April 2020 and June 2020 and the study population included mothers over 18 years old with at least one child (< 18 years old), living in four broad geographical areas of Greece (Attica, Central Greece, North Greece, and Crete/Aegean Islands). RESULTS: A total of 1885 Greek mothers participated in the study. The majority stated that they vaccined their child/children (98%), and the most popular source of information about vaccination was their child's pediatrician (89%). About half of participants (52%) have delayed their child/children vaccination with their pediatrician's suggestion being the main driver. The median knowledge score was 11 which indicates a high knowledge level for childhood vaccination among Greek mothers. Multiple linear regression analysis identified an inverse association between education and knowledge score, characterized by higher knowledge scores among individuals with secondary and even higher among those with higher education. Multiple logistic regression analysis showed that the strict adherence to the prescribed dosage as indicated by the local recommendations for each vaccine, was associated with most of the knowledge items included in the study. CONCLUSIONS: Our findings show that the vast majority of mothers in Greece did vaccinate their child/children, while pediatricians appear to have a very influential role in mothers' decision making. High knowledge around vaccination was associated with mothers' educational attainment, being particularly high among those who completed higher education. Considerable attention is required from public health authorities to promote vaccination through educational programs and campaigns, particularly aimed at people with lower educational attainment. Additionally, improving communication between pediatricians and mothers to reach those women who have not decided to vaccinate or delayed vaccination for their children, may prove to be very beneficial.

Dietary glycaemic index and cognitive function: prospective associations in adults of the 1946 British birth cohort.

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.

Evaluation of Resilience and Mental Health in the "Post-Pandemic Era" among University Students: Protocol for a Mixed-Methods Study.

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).

Effectiveness of COVID-19 vaccine mandates in raising vaccination rates among the elderly and general population in Europe: Controlled interrupted time series analysis.

BACKGROUND: During the COVID-19 pandemic, three European countries (Austria, Greece, Italy) announced and/or implemented mandatory COVID-19 vaccination for high-risk groups in the general population. Besides the ethical justification for this policy, it is important to assess and quantify the effectiveness of the mandate in raising vaccination rates. METHODS: Controlled interrupted time series analysis of first-dose vaccination rates in the targeted age groups (Greece: ≥60 years; Italy: ≥50 years) relative to a control group (Greece: 50-59 years; Italy: 25-49 years) between week 35/2021 and week 50/2022. For Austria an uncontrolled analysis was performed, as the vaccine mandate targeted all adults ≥18 years. RESULTS: Announcement of mandatory vaccination substantially increased vaccination rates in the targeted age groups compared to control in both Greece (RR = 4.36, 95 % CI: 3.57-5.32) and Italy (RR = 2.90, 95 % CI: 2.37-3.56), an effect which persisted throughout the study period. There were 176,428 (95 % CI: 164,097-187,226) mandate-attributable first-dose vaccinations in Greece and 316,192 (95 % CI: 282,467-346,678) in Italy, most of which occurred before the mandate came into effect. In Austria no discernible increase in vaccination rates was observed after the announcement of mandatory vaccination. At the end of the study period, 9.5 % of ≥60 year-olds in Greece, 4.9 % of ≥50 year-olds in Italy and 13.8 % of ≥18 year-olds in Austria remained unvaccinated. CONCLUSIONS: In Greece and Italy - though not in Austria - simple announcement of a vaccine mandate rapidly increased COVID-19 vaccination rates in the targeted age groups, without fully closing the vaccination gap. Mandatory vaccination appears to effectively target complacency but not vaccine hesitancy, and its public health benefits need to be weighted against possible detrimental effects on confidence and trust.

Palaeogenomic insights into the origins of early settlers on the island of Cyprus.

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.

Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population.

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 cut-off 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 cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off 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.

Assessing improvement in disease prediction using net reclassification improvement: impact of risk cut-offs and number of risk categories.

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.

Socioeconomic Inequalities in COVID-19 Vaccine Hesitancy and Uptake in Greece and Cyprus during the Pandemic.

Despite the rigorous investigation of the phenomenon of vaccine hesitancy and refusal during the COVID-19 pandemic, the socioeconomic determinants of this phenomenon remain poorly investigated on a global scale. Following proportional quota sampling, we conducted a population-based cross-sectional study. We recruited participants on-site and online from different settings, regions, and socioeconomic strata in two Eastern Mediterranean populations, Greece and Cyprus. Our approach provided a nationwide sample (n = 576) approaching the adult population structure of the two countries, with a slight underrepresentation of men and older people. Our results indicate clear socioeconomic differences in vaccine hesitancy and vaccination coverage, consistent with wider social inequalities in health. In particular, we reveal a clear socioeconomic gradient characterized by lower vaccine hesitancy and higher vaccination coverage, with increasing educational attainment and income. Additionally, participants residing in semi-urban areas show higher vaccine hesitancy and have lower vaccination coverage than those residing in urban and rural areas. Our results could inform Public Health approaches aiming to tackle the alarming phenomenon of vaccine hesitancy by enabling the targeting of population groups who are particularly vaccine-hesitant, rendering such approaches more targeted and effective while at the same time reducing inequalities in the control and prevention of infectious diseases.

Lack of association between vaccination rates and excess mortality in Cyprus during the COVID-19 pandemic.

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.

Dairy intake, blood pressure and incident hypertension in a general British population: the 1946 birth cohort.

PURPOSE: We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors. METHODS: We studied 1,750 British men and women from the 1946 British birth cohort from 1989 to 1999 (age 43 and 53 years, respectively). Diet was assessed by 5-day food diaries using photographs in the estimation of portion size. Systolic (sbp) and diastolic (dbp) blood pressure and prevalent hypertension were assessed at age 43 and 53 years. Linear regression and logistic regression were used to examine 10-year blood pressure levels and incident hypertension by baseline dairy intake. RESULTS: There was a weak non-significant trend of a protective effect of total dairy intake on blood pressure and incident hypertension, but no evidence for a dose-response relationship (OR for incident hypertension: 0.88 (95% CI 0.68;1.14) 2nd vs. 1st tertile and 0.93 (95% CI 0.72;1.18) 3rd vs. 1st tertile). Higher intake of low-fat and fermented dairy was linked to a higher sbp but in a nonlinear manner. Adjustment for other dietary factors, health behaviours and BMI attenuated these associations. CONCLUSIONS: Total dairy intake and specific dairy subgroups were not associated with blood pressure and incident hypertension among a representative sample of British adults after adjustment for confounding factors.

Impact of the COVID-19 lockdown on lifestyle behaviors and their association with personality among adults in Qatar: A cross-sectional study.

The coronavirus pandemic (COVID-19) resulted in lockdowns and social distancing measures enforced by governments around the world. This study aimed to identify changes in adherence to the Mediterranean diet (MD) and physical activity (PA) and associations with personality during lockdown. Using a cross-sectional design, a convenient sample of 543 adults in Qatar completed an online questionnaire consisting of validated tools to measure adherence to MD (MEDAS questionnaire, score ranges 0-13), PA (IPAQ, assessing light, moderate high intensity PA) and personality (BFI-10, categorizing individuals' personalities). The majority of the participants were female (89%), aged between 21 and 29 years (45%). The overall MD adherence decreased during lockdown (5.9 vs. 6.1, p < 0.001). There was an increase in olive oil (9% vs. 12%; p < 0.001), vegetables (54.3% vs. 58.7%; p = 0.005), legumes (11.8% vs. 15.3%; p = 0.007), sofrito (70.9% vs. 77.3%; p < 0.001) and fat (45.9% vs. 53.8%; p < 0.001) consumption and a decrease in fresh fruit (39.4% vs. 15.8%; p < 0.001) and fish/seafood (5.9% vs. 3.9%; p = 0.0035) consumption during lockdown. Met-min/week values of total PA (1330.5 vs. 1836.7), vigorous activity (711.5 vs. 867.4), moderate activity (208.3 vs. 301.3), and walking (410.7 vs. 668.0) all decreased during lockdown (p < 0.001, p = 0.010, p = 0.010 p < 0.001, respectively), while sitting increased (3837.3 vs. 2896.4 p < 0.001). The extraversion personality dimension had a higher MD adherence (p = 0.039) compared to agreeableness before lockdown. No changes in MEDAS scores were observed during lockdown in those with high levels of openness. Openness was positively associated with all PA (p = 0.027), including walking (p = 0.026), and negatively associated with sitting (p = 0.038) before lockdown, while participants with high scores for neuroticism were less likely to be sitting during lockdown (p = 0.042). The findings can be used to guide the development of appropriate personality-tailored lifestyle interventions.

Attitudes and Determinants of Mandatory Vaccination against COVID-19 among the General Population of Cyprus: A Nationwide Cross-Sectional Study.

Vaccinations for the prevention of coronavirus disease (COVID-19) are important to control the ongoing pandemic. A much-discussed strategy to increase vaccination coverage is mandatory vaccination; however, its legitimacy and effectiveness as a measure are doubtful. This study aims to investigate the attitudes of the general population of Cyprus towards COVID-19 mandatory vaccination and to identify the factors influencing individuals' attitudes towards such policy. An online cross-sectional study was conducted, using a self-administered, anonymous questionnaire to collect information on sociodemographic and health-related characteristics, trust, and satisfaction about the healthcare system and utilization of preventive healthcare services, COVID-19 vaccination information, general vaccination knowledge, and attitudes towards mandatory vaccination. A total of 2140 participants completed the survey, with 27.8% being in favor of mandatory vaccination. We found that as the age increases by one year, the odds of supporting mandatory vaccination increase by 1.04 units (OR 1.04, 95% CI: 1.02-1.05). In addition, those who reported increased trust in national healthcare authorities' guidelines and recommendations (OR 3.74, 95% CI: 3.11-4.49) and those satisfied with the healthcare system (OR 1.38, 95% CI: 1.16-1.65) and follow doctor's instructions (OR 1.29, 95% CI: 1.03-1.61), were significantly more likely to support mandatory vaccination while those who had underage children living in the household were significantly less likely to support mandatory vaccination (OR 0.69, 95% CI: 0.50-0.94). Public health authorities need to develop well-organized vaccination campaigns in which accurate evidence-based information would be disseminated with respect to individuals' autonomy.

The Effect of Personality on Chrononutrition during the COVID-19 Lockdown in Qatar.

The COVID-19 lockdown has had a significant impact on people's lives worldwide. This study aimed to investigate the effect of personality on chrononutrition during the COVID-19 lockdown. Using a cross-sectional design, a convenient sample of 543 adults in Qatar completed an online questionnaire using validated tools to assess personality and chrononutrition behaviors during the first COVID-19 lockdown. Participants scoring high in openness were more likely to eat at night (mean difference (MD) = 0.41, 95% confidence interval (CI): 0.10, 0.72) compared to those scoring high in agreeableness, while those scoring high in extraversion and openness had a shorter eating window (MD = -76.6, 95%CI: -146.3, -6.93 and MD = -29.8, 95%CI: -56.5, -3.01, respectively). Participants high in extraversion had longer evening latency (MD = 66.3, 95%CI: 25.4, 107.3) and evening eating (MD = -62.0, 95%CI: -114.0, -9.0) compared those high in agreeableness. Participants high in conscientiousness showed evidence of first eating event misalignment during the weekend (MD = 22.0, 95%CI: 0.15, 43.9) and last eating event misalignment during weekdays (MD = -27.8, 95%CI: -47.3, -8.41) compared to those high in agreeableness. Lastly, participants high in openness showed evidence of eating window misalignment during the weekend (MD = 30.6, 95%CI: 5.01, 56.2). This study suggests that personality traits can inform personalized nutritional approaches when aiming for healthy habits during unexpected periods, such as the COVID-19 pandemic.

Excess all-cause mortality and COVID-19-related mortality: a temporal analysis in 22 countries, from January until August 2020.

BACKGROUND: This study aimed to investigate overall and sex-specific excess all-cause mortality since the inception of the COVID-19 pandemic until August 2020 among 22 countries. METHODS: Countries reported weekly or monthly all-cause mortality from January 2015 until the end of June or August 2020. Weekly or monthly COVID-19 deaths were reported for 2020. Excess mortality for 2020 was calculated by comparing weekly or monthly 2020 mortality (observed deaths) against a baseline mortality obtained from 2015-2019 data for the same week or month using two methods: (i) difference in observed mortality rates between 2020 and the 2015-2019 average and (ii) difference between observed and expected 2020 deaths. RESULTS: Brazil, France, Italy, Spain, Sweden, the UK (England, Wales, Northern Ireland and Scotland) and the USA demonstrated excess all-cause mortality, whereas Australia, Denmark and Georgia experienced a decrease in all-cause mortality. Israel, Ukraine and Ireland demonstrated sex-specific changes in all-cause mortality. CONCLUSIONS: All-cause mortality up to August 2020 was higher than in previous years in some, but not all, participating countries. Geographical location and seasonality of each country, as well as the prompt application of high-stringency control measures, may explain the observed variability in mortality changes.

Gaps in Knowledge About SARS-CoV-2 & COVID-19 Among University Students Are Associated With Negative Attitudes Toward People With COVID-19: A Cross-Sectional Study in Cyprus.

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 knowledge-related questions. Misconceptions were identified in 30%. Only 29.1% expressed a 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.

Personality, Chrono-nutrition and Cardiometabolic Health: A Narrative Review of the Evidence.

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 chrono-nutrition 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.

Developing a holistic contingency plan: Challenges and dilemmas for cancer patients during the COVID-19.

During the first quarter of 2020 the world is experiencing a pandemic of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), a novel beta coronavirus that is responsible for the 2019 novel coronavirus disease (COVID-19). The COVID-19 pandemic revealed that healthcare systems around the world were not prepared to deal with either the direct effects of the pandemic or with the indirect effects that are imposed on the health of patients with chronic disorders such as cancer patients. Some challenges and dilemmas currently faced during the pandemic include the management of cancer patients during the treatment and follow-up phases, the assessment of the safety of treatments currently used for the management of SARS-CoV-2 for use in cancer patients, the development of psychoeducation and emotional support for cancer patients and the safe conduct of clinical trials involving participation of cancer patients. Evidence from the literature supports the need for the urgent development of a holistic contingency plan which will include clear guidelines for the protection and comprehensive care of cancer patients. The implementation of such a plan is expected to have many beneficial effects by mainly minimizing the increased morbidity and mortality of cancer patients that could result as an adverse consequence of the COVID-19 or future pandemics.