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PubMed2006

Sales of systemic anti-infective agents in Cyprus in comparison with four other European countries.

OBJECTIVE: To determine the pattern of systemic antibiotic sales in Cyprus during the years 1990-1993 and 1996 and make a comparison with other four European countries. METHOD: The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology according to the WHO (World Health Organization) guidelines were employed and data in wholesales were used. The results were presented as DDD/1000 inhabitants/day and were compared with similar results from Sweden, Norway, Denmark and Greece. Data from two independent surveys (1990 and 2001/2002), which covered a total sample of 166,979 persons regarding medicine taking in Cyprus were also used. RESULTS: The overall sales of systemic anti-infective agents in Cyprus were 22.1, 20.6, 24.5 and 24.2 DDD/1000 inhabitants/day for 1990, 1991, 1992 and 1993 respectively. The sales number increased to 30.2 by 1996. Penicillins, cephalosporins and tetracyclines had the greatest share. The above numbers were higher than the respective ones in the reference countries. The first independent survey conducted in 1990 showed that 4.2% of the population reported to take antibiotics without prescription. The second survey provided evidence about the kind of antibiotics taken by the sample (mainly amoxicillin and ciprofloxacin). CONCLUSION: These data reveal that the sales of antibiotics in Cyprus are higher than in Sweden, Norway, Denmark and Greece. The broad-spectrum antibiotics in Cyprus have higher sales than the other antibiotics. This study describes for the first time the pattern of systemic anti-infective agent sales in Cyprus. Further investigations are needed in order to determine the possible factors that might be implicated or explain the high antibiotic sales in Cyprus.

Anti-Infective Agents↗

PubMed2001

Baseline susceptibility to bacterial insecticides in populations of Culex pipiens complex (Diptera: Culicidae) from California and from the Mediterranean Island of Cyprus.

Bacterial insecticides play an increasingly important role in mosquito control. To establish guidelines for detecting resistance at an early stage, information on natural variation in susceptibility of insect populations to these insecticides is needed. Between 1990 and 1993, the susceptibility of Culex pipiens L. complex to Bacillus thuringiensis subsp. israelensis de Barjac and/or Bacillus sphaericus Neide was determined in 31 collections from California. These collections were undertaken before the widespread use of B. thuringiensis subsp. israelensis and before the registration of B. sphaericus in California. Seven collections from the Mediterranean island of Cyprus, where no microbial insecticides have been used, also were tested. The 1990-1991 California collections exhibited limited variation in susceptibility to B. thuringiensis subsp. israelensis. LC50 and LC95 values spanned about a three-fold and four-fold range, respectively. The 1993 Cyprus collections exhibited both higher mean LC values, and greater variability in those values, than the California collections. The LC50s for the Cyprus collections varied over a 10-fold range, whereas the LC50s varied over a 12.5-fold range. Variation in susceptibility to B. sphaericus among the 1991 California collections was about five-fold at the LC50 and LC95. No significant geographic variation in susceptibility to B. thuringiensis subsp. israelensis was observed among regions within California. Although variation in susceptibility was limited among California collections, the greater variability observed among the Cyprus collections and between the Cyprus and California collections illustrates the importance of establishing regional baselines to monitor accurately for changes in susceptibility.

Animals↗

PubMed2006

Seroprevalence and genotyping of hepatitis B, hepatitis C and HIV among healthy population and Turkish soldiers in Northern Cyprus.

AIM: To compare the prevalence of hepatitis viral markers among soldiers from Turkey, blood donors from Northern Cyprus, and soldiers from Northern Cyprus. METHODS: Hepatitis B surface antigen (HBsAg), anti-HCV and anti-human immunodeficiency virus (HIV) seroprevalence, HBV DNA, HCV RNA and HCV genotyping among soldiers from Turkey (group I), civil blood donors from Northern Cyprus (group II), and soldier candidates from Northern Cyprus (group III) were studied and compared to one another. In total, 17545 cases (13546 males and 3999 females with a mean age of 34.5 +/- 10.3 year, group I = 11234, group II = 5057, and group III = 1254) were included into the study. RESULTS: Among all cases, HBsAg positivity rates were 2.46%, anti-HCV was 0.46% and anti-HIV was 0.00%. HBV DNA was 2.25%, HCV RNA was 0.33% in all groups. HBsAg positivity rates were 2.16% in group I, 3.00% in group II and 2.71% in group III. There was a significant difference between group I and group II (c2 = 6.11, P = 0.047 < 0.05). Anti-HCV positivity rates were 0.45% in group I, 0.45% in group II, and 0.56% in group III. Genotypes of HCV were 1b and 1a in group I, 1b, 1a and 2 in group II, and 1b, 1a in group III. HBsAg carrier rates were 2.20% in females and 2.53% in males. Anti-HCV prevalence was 0.38% in females and 0.48% in males. HBsAg positivity rates were 2.53% in individuals younger than 50, and 1.47% in older than 50. There was a significant difference between the two groups (c2 = 23.48, P = 0.001). CONCLUSION: Prevalences of HBsAg, HCV and HIV infections in Northern Cyprus population are similar to those of Turkey.

Adult↗

PubMed2005

Suicide in cyprus 1988-1999.

Suicide is a universally observed human behavior related to bio-psychological, social and cultural factors. The aim of the present study was to examine suicide in Cyprus, an island that has known many civilizations and cultures. All completed suicide cases in the Christian population of Cyprus during the years 1988-1999 were included in the study and they were analyzed according to age, gender, reported reasons for suicide and suicide methods. The main results indicate that: 1. The mean age-standardized suicide rate is the lowest in Europe, in males (3.08/100,000) and also in females (1.05/100,000). 2. Mean suicide rates increase significantly with age in males only. 3. Female suicide rates are highest in the 15-24 age group. 4. Statistically significant rising trends of male and female suicide rates in the all-ages group. 5. Suicide methods were mostly violent. Among males, the most common methods were poisoning, firearms-explosives, and hanging, while in females, jumping, hanging and poisoning. 6. Mental disorders, physical illness, interpersonal and financial problems were the main reported reasons for suicide. The epidemiological characteristics of suicide in Cyprus might be attributed to a combined effect of social and cultural factors and probably reflect influences from countries to which Cyprus is ethnically, historically or geographically related.

Adolescent↗

PubMed2006

A pricing policy towards the sourcing of cheaper drugs in Cyprus.

In contrast to other EU countries, Cyprus lacks comprehensive health care coverage for its population, thus a significant portion of the population lacks insurance for medicines. Due to the small size of the country and small indigenous pharmaceutical industry, pharmaceuticals are mainly imported. Prices in the private sector are determined based on the ex-factory price from the country of origin. Distribution margins are calculated as a percentage of the import price, which creates perverse incentives for wholesalers to import products from high price countries, or import very expensive products, to maximize their income. In this article, we compare pharmaceutical prices in Cyprus to other EU counties with higher or similar GDP per capita and found Cyprus to be a high price country. We then propose a new pricing system to change wholesaler incentives, which would encourage them to shop around for the best buy in Europe. Prices can be set based on average prices from a basket of European countries, and adjusted to reflect the GDP per capita level in Cyprus. This will establish the wholesale price that the government will accept, and wholesalers can procure products from any country at a lower rate. Thus, wholesalers would be encouraged to go for the lowest prices and the authorities would be indifferent to the actual price they obtain, so long as the necessary criteria (good manufacturing practice, safety, effectiveness and efficacy) are met. Our proposal has implications for low and middle income countries where this system of pharmaceutical pricing and wholesaler incentives can be used.

Commerce↗

PubMed1996

Heat illness in the army in Cyprus.

Heat illness in the British Armed Forces is a significant occupational risk. This paper analyzes reports of heat casualties occurring in Episkopi, Cyprus from January 1990 through December 1994. A total of 96 casualties were reported from 48 separate incidents. On seven occasions, three or more casualties occurred concurrently (maximum 19). There were 20 incidents causing 32 casualties from Cyprus-based units and 28 incidents causing 64 casualties from units visiting Cyprus. There was a clear seasonal variation of reports with the maximum number of reports occurring from May to August. The majority of reported casualties occurred when the Wet Bulb Globe Temperature was between 26 degrees C and 29 degrees C. Cyprus-based units had most casualties occurring as a consequence of forced marching whereas most casualties from visiting units occurred during military field exercise training. Visiting Territorial Army units had the highest incidence of heat casualties for visiting units. The majority of heat casualties were mild; there were only ten severe cases. It was not possible to identify any particular risk factors applicable to individuals except incomplete acclimatization. The study showed that the current guidelines used by the British Armed Forces do not prevent all heat casualties. It is not possible to estimate how many casualties are prevented by the guidelines. All incidents involving a serious casualty or multiple casualties should be investigated to determine whether the guidelines should be further amended.

Cohort Studies↗

PubMed1996

Heat illness: a comparison between UK and Cyprus reports.

This paper presents an analysis of the reports of heat casualties to Medical Branch, United Kingdom Land Forces (UKLF) for the period 1986-1994. There was a marked reduction in reports for 1990-1993 compared to the remaining period studied. This may have been the result of improved prevention or under-reporting. This data has been compared to the reports of heat casualties occurring in Cyprus from 1990-1994. Forced marches and military runs were the primary activities causing heat casualties in UK compared to military exercises in Cyprus. There were many more severe casualties in UK than in Cyprus. If it is necessary to reduce the annual rate of heat casualties in the Army then changes in policy should be focused on the problem in UK. This should consider the generation of metabolic heat as the primary cause of heat illness as opposed to environmental factors. In overseas commands (eg Cyprus) the relative effects are reversed.

Cyprus↗

PubMed2006

Active surveillance of Q fever in human and animal population of Cyprus.

BACKGROUND: A long-term active surveillance of Q fever was conducted in Cyprus organized in two phases. METHODS: Following serological tests and identification of seropositive humans and animals for C. burnetii in two villages (VIL1 and VIL2), all seronegative individuals were followed up for one year on a monthly basis by trained physicians to detect possible seroconversion for Q fever. In the second phase of the study, active surveillance for one year was conducted in the entire Cyprus. Physicians were following specific case definition criteria for Q fever. Standardized questionnaires, a geographical information system on a regional level, Immunofluorescence Assay (IFA) examinations and shell vial technique were used. RESULTS: Eighty-one seronegative humans and 239 seronegative animals from both villages participated in the first phase surveillance period of Q fever. Despite the small number of confirmed clinical cases (2 humans and 1 goat), a significant percentage of new seropositives for C. burnetii (44.4% of human participants and 13.8% of animals) was detected at the end of the year. During the second phase of surveillance, 82 humans, 100 goats, and 76 sheep were considered suspected cases of Q fever. However, only 9 human, 8 goat, and 4 sheep cases were serologically confirmed, while C. burnetii was isolated from three human and two animal samples. The human incidence rate was estimated at 1.2 per 100,000 population per year. CONCLUSION: A small number of confirmed clinical cases of Q fever were observed despite the high seroprevalence for C. burnetii in human and animal population of Cyprus. Most of the cases in the local population of Cyprus appear to be subclinical. Moreover further studies should investigate the role of ticks in the epidemiology of Q fever and their relation to human seropositivity.

Animals↗

PubMed2006

An ethnobotanical survey of wild edible plants of Paphos and Larnaca countryside of Cyprus.

An ethnobotanical survey of wild edible plants of Cyprus was carried out in two sites, Paphos vine zone and Larnaca mixed farming zone. These are among the areas in Cyprus whose inhabitants subsisted primarily on pastoralism and agriculture and therefore still preserve the traditional knowledge on wild edible plants. The information was collected for three-year period, in the framework of the EU-funded RUBIA Project. Four hundred and thirteen interviews have been administered to 89 informants of various ages and background categories in 29 villages of Paphos site, and 8 in Larnaca site. A total of 78 species were recorded. Ethnographic data related to vernacular names, traditional tools and recipes have also been recorded. A comparison of the data collected from the two sites is undertaken. During this ethnobotanical research it was verified that wild edibles play an important role in Cyprus in rural people, however, it was realized that the transmission of folk uses of plants decreased in the last generations. The research of ethnobotany should be extended to other areas of Cyprus in order not only to preserve the traditional knowledge related to plants but to make it available to future generations as well.

Adult↗

PubMed2002

Healthcare telematic applications in Cyprus.

OBJECTIVES: a) To present a review of ongoing health telematic applications in Cyprus. b) To promote the use of these health telematic applications in the Cyprus region. c) To help in the spin off of other health telematic applications thus enabling the offering of a better health service to the citizens. METHODS AND RESULTS: The health telematics applications include a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a system for the evaluation of the risk of stroke by telemedicine (EROS), a diagnostic telepathology network in gynaecological cancer (TELEGYN), a collaborative virtual medical team for home healthcare of cancer patients (DITIS), and a health telematics training network (HEALTHNET). The paper refers to the set-up and characteristics of these applications and tries to relate them with the health policies that should be applied in Cyprus. CONCLUSIONS: It is anticipated that this paper will promote the importance of health telematics applications for Cyprus and increase the awareness on the possibilities that these applications offer for health policies in all levels of health related human resources.

Ambulances↗

PubMed2007

Organophosphate resistance in olive fruit fly, Bactrocera oleae, populations in Greece and Cyprus.

The olive fruit fly Bactrocera oleae (Gmelin) (Diptera: Tephritidae) is the most important pest of olives in countries around the Mediterranean basin. Its control has been based mostly on bait sprays with organophosphate insecticides (usually dimethoate or fenthion) for about 40 years. In the present study, the resistance status of olive fruit fly populations to dimethoate was examined in Greece and Cyprus over 2 years. Thirty-one populations from various regions of Greece, nine from Cyprus and one laboratory susceptible strain, which served as a control, were assayed by topical application of dimethoate. Considerable variation in the resistance levels to dimethoate was recorded in the populations of B. oleae, with resistance ratios ranging from 6.3 to 64.4 (ED(50) values 12.5-128.7 ng dimethoate per insect). The highest resistance ratios were found in populations from Crete, and the lowest in those from Cyprus. This variation could be attributed to different selection pressures from insecticidal applications among populations from the various regions. Migration of resistant genotypes, either autonomous or via commerce, may also be involved.

Animals↗

PubMed1978

Enterotoxin-producing bacteria stools from Swedish United Nations soldiers in Cyprus.

A study was designed to establish the role of heat-labile enterotoxin producing Escherichia coli and other intestinal pathogens in diarrhoeal disease in Swedish soldiers of the United Nations' Force in Cyprus. Before leaving Sweden for Cyprus, no enteropathogens were isolated from the soldiers. The study was performed from October 1975 through January 1976 and in August 1976. Enterotoxigenic strains of E. coli, Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae were the intestinal pathogens most frequently isolated from the cases of diarrhoea. Such strains were found in 14 of 79 diarrhoeal cases (18%) but also in 6 of 66 (9%) of next-bed-fellow controls and in 7 of 139 (5%) of healthy Cypriotic civilians. Few other pathogens were identified in the soldiers, but 9 of 139 (6%) of the Cypriots were carriers of cysts of Giardia lamblia. The results indicate that enterotoxigenic bacteria were probably the most important cause of diarrhoea of those agents identified among the Swedish UN soldiers on Cyprus. Several soldiers were colonized with these strains without contracting diarrhoea.

Bacteria↗

PubMed2000

Sandhoff disease in Cyprus: population screening by biochemical and DNA analysis indicates a high frequency of carriers in the Maronite community.

In the last 15 years, four patients with the infantile form of Sandhoff disease were diagnosed in four different families in Cyprus (population 703,000, birth rate 1.7%). Three of these cases came from the Christian Maronite community (less than 1% of the population) and one from the Greek community (84% of the population). This relatively large number of patients prompted us to initiate an epidemiological study in order to establish the frequency of the mutant allele in Cyprus. Carrier detection was initially based on the measurement of beta-hexosaminidase A and B in both leucocytes and serum. Using the enzyme test, 35 carriers were identified among 244 random Maronite samples and 15 among 28 Maronites with a family history of Sandhoff disease, but only one carrier was found out of 115 random samples from the Greek community. In parallel to the biochemical screening, DNA studies were undertaken in one of the three Maronite patients and in a Greek carrier related to the Greek patient. These studies resulted in the identification of two novel mutations, a deletion of A at nt76 and a G to C transversion at position 5 of the 5'-splice site of intron 8, which have been published. We subsequently screened the carriers detected in the biochemical study for these two mutations using PCR-based tests. Of 50 Maronite carriers examined, 42 were found to have the nt76 deletion. Eight Maronite samples, designated carriers from the biochemical results, were negative for both mutations. It is possible that these individuals were incorrectly classified as carriers since their enzyme values are equivocal, although the presence of another mutation has not been excluded. Two Greek Cypriot carriers and two obligate Lebanese carriers were negative for both mutations. We conclude that there is a high frequency of Sandhoff disease carriers in the Maronite community of Cyprus, approximately 1 in 7, and that a single mutation predominates in this population.

Cyprus↗

PubMed2006

Organochlorine and organophosphoric insecticides, herbicides and heavy metals residue in industrial wastewaters in Cyprus.

Most industries in Cyprus possess permits either for disposal at central wastewater treatment plants (the treated effluent of which is reused or disposed into the sea), or discharge on soil, or reuse either for irrigation or groundwater recharge or discharge into the sea. A preliminary investigation undertaken by the University of Cyprus in regards to dangerous substances was the first step towards establishing a new licensing and monitoring system. Liquid-liquid extraction was used for the extraction of the selected pesticides from wastewaters. Gas chromatography with two different detection methods (ECD and FTD) was applied for the determination of 17 pesticides (12 organochlorine insecticides, 3 organophosphoric insecticides and 2 herbicides). In addition ICP and a mercury evaporation unit were used to determine the concentrations of heavy metals in the samples. The results revealed the presence of several priority substances in wastewaters, in most cases at concentrations well below the regulatory limits. Non-compliance was observed for a limited number of metals. Sixteen out of 17 organic substances that were monitored for 1-year period time were traced in different wastewater streams. What was found out is that there is a need to expand the analytical determinations and the monitoring to more wastewater streams and more priority substances, in order to safeguard the water resources in Cyprus.

Cyprus↗

PubMed2002

Screening of dogs for Echinococcus granulosus coproantigen in a low endemic situation in Cyprus.

In the framework of an echinococcosis surveillance and control programme in Cyprus, a commercial enzyme-linked immunosorbent assay (ELISA) (CHEKIT ECHINOTEST) designed for the detection of Echinococcus granulosus and E. multilocularis coproantigens was used in 1997-2000 for the investigation of large numbers of dogs. Most of the animals originated from areas where approximately 0.2% of the dogs had been found to be infected with E. granulosus in previous (1993-1996) arecoline surveys. The sensitivity of the coproantigen test was 83%, as determined in 35 dogs naturally infected with this cestode species. The specificity was 98% in 97 randomly selected dogs from Cyprus, but it was reduced to 80% in a group of 50 dogs, infected with Taenia spp. A total of 6551 dogs (mainly of rural origin) was examined, including three large groups (N: 2928, 1761 and 1800) from the Government Control Area (GCA) in southern Cyprus and a small group (N: 62) from the Non-Government Control Area (NonGCA) in the northern part of the island. Among the dogs from the GCA, 184 (2.8%) tested positive for coproantigen; coproantigen prevalences were 2.6, 4.9 and 1.1% in these three groups, and of 62 dogs from the NonGCA 8.1% were positive. The calculated true prevalences of E. granulosus in the dog population of the GCA ranged between 0.0 and 3.58%. The predictive values of the test, based on a 0.2% prevalence, was >99.9% for negative results, but very low (7%) for coproantigen-positive results. However, the relatively small number of coproantigen-positive dogs can be treated with praziquantel or the results can further be confirmed by arecoline purging.

Animals↗

PubMed2003

Development of guidelines on best practices for the slaughter of animals in Cyprus.

Cyprus is one of the candidate countries to become a full member of the European Union. In order to access formally to the EU, Cyprus has to follow an implementation process and take into account all the obligations that the fifteen Member States have to respect. A large number of obligations derive from the European Integrated Pollution Prevention and Control (IPPC) Directive 96/61/EC, which intends to result in the protection of the environment as a whole and the public health as well. This will be the outcome of determining ways of pollution prevention and control for several industrial sectors, which are covered by the IPPC Directive and then taking action so that all operators act according to the Directive's demands. In this framework, the National Technical University of Athens, after thorough examination of a large number of documents relevant to the Best Available Techniques (BATs), developed guidelines for the application of BATs for 14 categories of the industry of Cyprus. This paper concerns the developed guidelines for slaughterhouses.

Abattoirs↗

PubMed2005

Evaluation of the support services provided to deaf children attending secondary general schools in Cyprus.

Deaf children have been integrated into secondary schools in Cyprus since 1990. This article reports the results of a major study carried out in Cyprus, the aim of which was to evaluate for the first time the support services available for deaf children receiving their education in secondary general schools. For the purposes of our study, four types of questionnaires were designed and administered to all deaf children integrated into secondary general schools, as well as to their parents, teachers, and head teachers. All participants stressed that the support services are vital for the children's academic success and social integration. The main support services identified by the participants in our study were: one-to-one and group sessions; presence of co-coordinators (special teachers of the deaf); "acoustical treatment" of the classrooms; provision and management of personal amplification, psychological support, and counseling; and in-service training for designated teachers. The majority of the participants expressed satisfaction with the support services offered to them. They also made some suggestions for the improvement of the integration of deaf children into secondary schools in Cyprus.

Adolescent↗

PubMed2002

Surveillance of HIV in the army of the Republic of Cyprus (SHARC); rationale, design, and implementation of an inexpensive system.

OBJECTIVES: To design and implement an HIV surveillance system using periodic cross sectional prevalence surveys in National Guard recruits of the Republic of Cyprus. METHODS: HIV infection surveillance used unlinked anonymous screening (UAS) methodology, which tested residual blood originally collected for other purposes. Residual blood from samples collected for ABO blood group typing at intake and samples from blood collected for hepatitis testing at discharge was used. Screening was unlinked and anonymous. RESULTS: The system operated for four semiannual recruitment seasons: summer 1998 to the end of winter 2000. No recruits screened at entry into the ranks tested positive. CONCLUSIONS: This was the first large scale HIV surveillance project in Cyprus. Without nationwide HIV surveys, periodic measurements of prevalence could lead to estimates of HIV incidence and provide insights on temporal changes in HIV infection rates. The prevalence data collected provide useful epidemiological information about the status of the HIV epidemic in this segment of the population in Cyprus.

Adult↗