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.

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.

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.

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.

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.

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.

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.

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.

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.