Cyprus: The Island still divided between Turkey and Greece's influences.

openThe Cyprus problem represents one of the few still open conflicts within the European borders. At the same time, it corresponds to the only island divided into two different parties in which the capital, Nicosia, is known to be “the last divided capital” in Europe. This situation has seen only tiny improvements since the escalation of this issue, at the beginning of the 1960s. But the problem does not find its origin uniquely within the island’s border, rather it is the result of the foreign policy preferences and practices that external countries, neighbours and not, implemented towards the island: starting from the Ottoman Empire, the British Empire, to the modern relations between Greece and Turkey. And despite the official independence of the island from the United Kingdom obtained in 1960, Cyprus is located at the heart of one of the most unstable and precarious region, the MENA area, in which every country influences the actions of all the others, more than it happens in other regions. For Cyprus, these persuasive and affecting decisions come mainly from other two countries, Greece and Turkey, whose relationship has presented many complications since the establishment of the two independent nations. The rivalry between them, however, has not seen any improvements and, today, it can still be judged as one of the factors responsible for the non-resolution of the Cyprus problem. This primordial antagonism, nevertheless, is difficult to be solved in the first place as it is composed of many intersecting aspects, from the oldest struggle for supremacy in the Aegean to the most recent rivalry for the control of energy resources, each of which contributes to the non-resolution of the Cyprus problem.The Cyprus problem represents one of the few still open conflicts within the European borders. At the same time, it corresponds to the only island divided into two different parties in which the capital, Nicosia, is known to be “the last divided capital” in Europe. This situation has seen only tiny improvements since the escalation of this issue, at the beginning of the 1960s. But the problem does not find its origin uniquely within the island’s border, rather it is the result of the foreign policy preferences and practices that external countries, neighbours and not, implemented towards the island: starting from the Ottoman Empire, the British Empire, to the modern relations between Greece and Turkey. And despite the official independence of the island from the United Kingdom obtained in 1960, Cyprus is located at the heart of one of the most unstable and precarious region, the MENA area, in which every country influences the actions of all the others, more than it happens in other regions. For Cyprus, these persuasive and affecting decisions come mainly from other two countries, Greece and Turkey, whose relationship has presented many complications since the establishment of the two independent nations. The rivalry between them, however, has not seen any improvements and, today, it can still be judged as one of the factors responsible for the non-resolution of the Cyprus problem. This primordial antagonism, nevertheless, is difficult to be solved in the first place as it is composed of many intersecting aspects, from the oldest struggle for supremacy in the Aegean to the most recent rivalry for the control of energy resources, each of which contributes to the non-resolution of the Cyprus problem

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors