Levels of physical dependence on tobacco among adolescent smokers in Cyprus

PURPOSE: The purpose of this study is to assess tobacco dependence among Cypriot adolescents and examine its association to cigarette consumption and attitudes towards smoking. METHODS: The current study used cross-sectional data from the 2011 Cyprus Global Youth Tobacco Survey which adopted multistage cluster sampling methods to select adolescents registered in middle and high schools in Cyprus. Tobacco use, physical dependence on tobacco, and attitudes towards tobacco use were measured in 187 adolescents aged 13-18years old who reported that they had smoked at least once in the preceding 30 days. Physical dependence was assessed using the Levels of Physical Dependence scale. RESULTS: Physical dependence was present in 86% of the adolescent smokers. The mean latency to needing among smokers in the highest dependence group was 101h. Significant associations were observed between physical dependence and the perceived difficulty in quitting (OR=13.1, 95% CI: 4.0, 43.0) as well as the expectation to continue smoking for the next five years (OR=3.3, 95% CI: 1.3, 8.4). Significant associations were also observed between physical dependence and the number of smoking days per month, daily smoking, daily cigarette consumption, lifetime cigarette consumption, and perceived difficulty in abstaining from smoking for one week. CONCLUSIONS: Physical dependence provides a symptom-based approach to assess dependence and it is a strong predictor of adolescents\u27 perceptions of their ability to quit or to refrain from smoking for a week. Physical dependence on tobacco was highly prevalent among adolescent smokers in Cyprus and it was associated with greater perceived difficulty in quitting. Interventions targeting adolescent smoking must account for the high prevalence of physical dependence

Antenatal and Postnatal Depressive symptoms in Kuwait: results from the TRACER Study

Εισαγωγή: Η περιγεννητική περίοδος χαρακτηρίζεται από ορμονικές και νευροβιολογικές αλλαγές που μπορεί να οδηγήσουν σε μεταβολές της διάθεσης, καθιστώντας τις γυναίκες πιο ευάλωτες στην κατάθλιψη. Η κατάθλιψη κατά τη διάρκεια της εγκυμοσύνης και η επιλόχεια κατάθλιψη συναντούνται συχνά και έχουν συσχετιστεί με ανεπιθύμητα αποτελέσματα τόσο στη μητέρα όσο και στο παιδί. Στις χώρες του Αραβικού Κόλπου τα στοιχεία για τον επιπολασμό τους καθώς και για τους παράγοντες που σχετίζονται με αυτά είναι περιορισμένα. Οι στόχοι της παρούσας διδακτορικής διατριβής ήταν: α) να υπολογιστεί ο επιπολασμός των συμπτωμάτων κατάθλιψης στην εγκυμοσύνη και να διερευνηθούν οι παράγοντες κινδύνου τους, β) να εξεταστεί εάν τα συμπτώματα κατάθλιψης στην εγκυμοσύνη σχετίζονται με τον πρόωρο τοκετό και με την γέννηση νεογνών μικρότερων ή μεγαλύτερων με βάση την ηλικία κύησης τους και να διερευνηθούν περαιτέρω παράγοντες κινδύνου με αυτές τις δυσμενείς εκβάσεις, και γ) να εκτιμήσει τον επιπολασμό των συμπτωμάτων επιλόχειας κατάθλιψης, να προσδιορίσει τους παράγοντες που αυξάνουν τον κίνδυνο εκδήλωσής τους και να εξετάσει τη σχέση τους με τα συμπτώματα κατάθλιψης στην εγκυμοσύνη. Μέθοδοι: Έγινε μία δευτερογενής ανάλυση των δεδομένων που συλλέχθηκαν από 1938 γυναίκες στο Κουβέιτ οι οποίες συμμετείχαν στην προοπτική μελέτη κοορτής TRansgenerational Assessment of Children's Environmental Risk (TRACER). Ένα αρχικό ερωτηματολόγιο με βασικές πληροφορίες είχε δοθεί στους συμμετέχοντες κατά την εγγραφή τους στην μελέτη ενώ ένα εκτενές ερωτηματολόγιο που είχε ως κύριο σκοπό να αξιολογήσει την ψυχική υγεία των εγκύων και το οποίο περιλάμβανε και την κλίμακα επιλόχειας κατάθλιψης του Εδιμβούργου (EPDS) διεξήχθη σε μεταγενέστερη επίσκεψη κατά την διάρκεια της εγκυμοσύνης. Τέλος, διεξήχθη μια τηλεφωνική συνέντευξη των μητέρων μετά τον τοκετό για να ληφθούν πληροφορίες σχετικά με την ημερομηνία και το βάρος γέννησης του βρέφους, δυσμενείς εκβάσεις κατά τη διάρκεια της εγκυμοσύνης και του τοκετού, και συμπτώματα επιλόχειας κατάθλιψης χρησιμοποιώντας το EPDS. Εάν η βαθμολογία στο EPDS ήταν μεγαλύτερη ή ίση με το 10, τότε θεωρούμε ότι υπήρχαν συμπτώματα κατάθλιψης. Οι στατιστικές αναλύσεις έγιναν με τη χρήση απλών και πολλαπλών μοντέλων λογιστικής παλινδρόμησης καθώς και με τη χρήση της δοκιμασίας χ². Αποτελέσματα: Ο επιπολασμός συμπτωμάτων κατάθλιψης κατά την διάρκεια της εγκυμοσύνης ήταν 20,2% (95% CI: 18,4-22,1) ενώ των συμπτωμάτων επιλόχειας κατάθλιψης ήταν 11,7% (95% CI: 10,1-13,5). Τα συμπτώματα κατάθλιψης ήταν πιο συχνά σε γυναίκες στο τρίτο τρίμηνο της εγκυμοσύνης τους σε σύγκριση με εκείνες του δευτέρου τριμήνου, σε γυναίκες με χαμηλότερο οικογενειακό εισόδημα, σε αυτές που είχαν βιώσει περισσότερα από πέντε τραυματικά γεγονότα κατά τη διάρκεια της ζωής τους και σε αυτές που είχαν ιστορικό κατάθλιψης (αυτό-αναφορές). Το άγχος που σχετίζεται με την εγκυμοσύνη, περισσότερο αντιληπτό στρες, συμπτώματα Συνδρόμου Μετατραυματικού Στρες, η κακή ποιότητα ψυχικής υγείας και η κακή ποιότητα σωματικής υγείας κατά τη διάρκεια της εγκυμοσύνης συσχετίζονταν επίσης με την παρουσία συμπτωμάτων κατάθλιψης. Στο δείγμα μας, τα συμπτώματα κατάθλιψης στην εγκυμοσύνη δεν συνδέονταν με δυσμενή αποτελέσματα στη γέννηση -- ο πρόωρος τοκετός συσχετίζεται με την εξωσωματική γονιμοποίηση και με το ιστορικό πρόωρου τοκετού σε προηγούμενη εγκυμοσύνη, η γέννηση μικρότερου για την ηλικία κύησης νεογνού συσχετίζεται με ένα χαμηλότερο οικογενειακό εισόδημα και το φύλο του νεογνού (θηλυκό), ενώ αυτό της γέννησης μεγαλύτερου για την ηλικία κύησης νεογνού συσχετίζεται με την εθνικότητα (εκτός Κουβέιτ) και με το φύλο του νεογνού (αρσενικό). Τα συμπτώματα κατάθλιψης στην εγκυμοσύνη ήταν ο ισχυρότερος παράγοντας κινδύνου για την ανάπτυξη συμπτωμάτων επιλόχειας κατάθλιψης. Άλλοι καθοριστικοί παράγοντες για την επιλόχεια κατάθλιψη ήταν το χαμηλότερο οικογενειακό εισόδημα, η εθνικότητα (Κουβέιτ) και τα συμπτώματα Συνδρόμου Μετατραυματικού Στρες κατά την εγκυμοσύνη. Η ψυχική ευεξία της μητέρας και η υποστήριξη από το κοινωνικό της δίκτυο ήταν επίσης σημαντικοί παράγοντες κινδύνου για τα συμπτώματα επιλόχειας κατάθλιψης στην ομάδα των γυναικών που δεν είχαν συμπτώματα κατάθλιψης κατά την εγκυμοσύνη. Συμπεράσματα: Σύμφωνα με τα αποτελέσματα μας, στο Κουβέιτ 1 στις 5 γυναίκες παρουσιάζει συμπτώματα κατάθλιψης πριν τον τοκετό και 1 στις 9 παρουσιάζει συμπτώματα κατάθλιψης μετά τον τοκετό. Συνιστούμε όπως μια διαδικασία διαλογής για την κατάθλιψη πριν και μετά τον τοκετό πραγματοποιείται ως εξέταση ρουτίνας, ειδικά σε γυναίκες που διατρέχουν μεγαλύτερο κίνδυνο να παρουσιάσουν κατάθλιψη κατά την περιγεννητική περίοδο. Η βελτίωση της ψυχικής ευεξίας των γυναικών κατά τη διάρκεια της εγκυμοσύνης, βοηθώντας τις να μειώσουν το άγχος που σχετίζεται με την εγκυμοσύνη και να νιώσουν λιγότερο απομονωμένες, θα μπορούσε επίσης να μειώσει την πιθανότητα κατάθλιψης και τα επακόλουθα της.Introduction: The perinatal period is characterized by hormonal and neurobiological changes which may result in mood changes, making women more susceptible to depression. Prenatal depression and postnatal depression are common in women and have been associated with adverse outcomes of both the child and the mother. Limited evidence exists in the Gulf countries about depression during and after pregnancy, as well as for their correlates. The aims of this PhD dissertation work were: a) to provide an estimate of the prevalence of antenatal depressive symptoms in Kuwait, as an indicator of depression, and identify the risk factors associated with it; b) to examine whether antenatal depressive symptoms and other potential risk factors are associated with adverse perinatal outcomes, such as preterm birth, small for gestational age, and large for gestational age; and c) to estimate the prevalence of postnatal depressive symptoms and identify the risk factors associated with it as well as examine the link with antenatal depressive symptoms. Methods: This was a secondary analysis of data collected from 1938 women who participated in the TRansgenerational Assessment of Children's Environmental Risk (TRACER) Study - a longitudinal prospective birth cohort study in Kuwait. A baseline questionnaire was administered to all participants at enrollment while a stress questionnaire, that also included the Edinburgh Postnatal Depression Scale (EPDS), was administered at a later visit in person or through a phone-interview. A postnatal phone interview was conducted to obtain information about the birth date, birth weight, adverse outcomes during pregnancy, and postnatal depressive symptoms using the EPDS. A score of 10 or greater in the EPDS was used as a cut-off point to determine the presence of depressive symptoms antenatally and postnatally. Chi-square tests, crude and multiple logistic regression models were used to identify the risk factors of antenatal and postnatal depressive symptoms, preterm birth, small and large for gestational age babies and assess their effect. Results: The prevalence of antenatal depressive symptoms was 20.2% (95% CI: 18.4-22.1) while that of postnatal depressive symptoms was 11.7% (95% CI: 10.1-13.5). Antenatal depressive symptoms were reported more by women in the third trimester compared to those in the second trimester, women of lower family income, those who had experienced more than five traumatic events during their lifetime, and those women that had self-reported history of depression prior to pregnancy. Pregnancy-related anxiety, moderate and higher perceived stress, post-traumatic stress disorder symptoms, and fair or poor quality of mental health, as well as poor quality of physical health during pregnancy were also associated with the presence of antenatal depressive symptoms. In our sample, antenatal depressive symptoms did not predict adverse birth outcomes; preterm birth was associated with in vitro fertilization and previous preterm delivery, small for gestational age was associated with lower family income and a female baby, while large for gestational age was associated with a non-Kuwaiti nationality, parity, and a male baby. Antenatal depressive symptoms were the strongest risk factor for developing postnatal depressive symptoms. Other determinants of postnatal depressive symptoms included lower family income, being Kuwaiti, and reporting post-traumatic stress disorder symptoms in pregnancy. In the group of women with no depressive symptoms in pregnancy the mother’s mental well-being and social support from her network were also significant risks factors for postnatal depressive symptoms. Conclusions: Our results showed that in Kuwait, 1 in 5 women experiences depressive symptoms antenatally and 1 in 9 women postnatally. We recommend that antenatal and postnatal depression screening is performed as a routine test, especially among women who are at a higher risk of experiencing depression during the perinatal period. Improving the mental well-being of women during pregnancy, helping them reduce their anxiety related to pregnancy, and making them feel less isolated, could also potentially lower the risk for postnatal depressive symptoms and their sequelae.Complete

Adipose tissue, metabolic syndrome, and non-alcoholic fatty liver disease – a short review

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease globally, and it is expected to rise even further as a result of the increase in obesity and related risk factors. This short review summarises current evidence on the role of adipose tissue and insulin resistance in NAFLD and the interrelationship between NAFLD and the metabolic syndrome (MetS), considering central adiposity is a major feature of both the MetS and NAFLD, and that NAFLD has been previously described as the hepatic manifestation of the MetS. In addition, genetic studies of NAFLD with relation to adiposity and insulin resistance are reviewed, and up-to-date diagnostic and therapeutic tools are also discussed

Design of a 3D interactive simulator for driver behavior analysis

Diagnosing the causes of road accidents and the development of effective countermeasures to reduce accident rates is of key importance in road safety. Human error is one of the principal influencing factors that lead to road accidents, and is attributed to increased mental workload induced by distractions. Workload, however, is characterized by intrinsic properties that are difficult to observe. Hence, phenotype behaviors, such as lane deviations, could act as good predictors of driver workload. Driving simulators emerged as a promising technology for the analysis of driving conditions and road users' behavior in an attempt to tackle the problem of road accidents. However, the cost of designing or owning a simulator to conduct a safety analysis is prohibitive for many government agencies. The work presented herein demonstrates the design and development of a driving simulator, using a 3D game engine that aims to contribute towards evaluating black spots in road networks by promoting rapid design of realistic models and facilitating the specification of test scenarios. The developed simulator was employed to conduct a set of preliminary experiments that analyzed driving behaviors of local road users for a chosen black spot in a road network in Limassol-Cyprus. Data collected from the experiments are analyzed, results are presented and conclusions are drawn

Design of a 3D interactive simulator for driver behavior analysis

Diagnosing the causes of road accidents and the development of effective countermeasures to reduce accident rates is of key importance in road safety. Human error is one of the principal influencing factors that lead to road accidents, and is attributed to increased mental workload induced by distractions. Workload, however, is characterized by intrinsic properties that are difficult to observe. Hence, phenotype behaviors, such as lane deviations, could act as good predictors of driver workload. Driving simulators emerged as a promising technology for the analysis of driving conditions and road users' behavior in an attempt to tackle the problem of road accidents. However, the cost of designing or owning a simulator to conduct a safety analysis is prohibitive for many government agencies. The work presented herein demonstrates the design and development of a driving simulator, using a 3D game engine that aims to contribute towards evaluating black spots in road networks by promoting rapid design of realistic models and facilitating the specification of test scenarios. The developed simulator was employed to conduct a set of preliminary experiments that analyzed driving behaviors of local road users for a chosen black spot in a road network in Limassol-Cyprus. Data collected from the experiments are analyzed, results are presented and conclusions are drawn

Impact of immersion and realism in driving simulator studies

Driving simulators emerged as a promising technology for the analysis of driving conditions and road users’ behaviour in an attempt to tackle the problem of road accidents. The work presented herein demonstrates the design and development of a driving simulator that aims to contribute towards evaluating black spots in road networks by promoting rapid design of realistic models and facilitating the specification of test scenarios. A reliable driving simulator should be able to reproduce the driver’s behaviour in a realistic way. In this study we examine different setups of the simulator to define the one that achieves highest levels of reliability. The chosen setup is then used to evaluate the impact of distractors (e.g. billboards) on driving behaviour of local road users for a chosen black spot in Limassol, Cyprus. Data collected from the experiments are analysed, and the main findings are presented and discussed

The impact of the Cyprus comprehensive smoking ban on air quality and economic business of hospitality venues

Several countries, including Cyprus, have passed smoke-free legislations in recent years. The goal of this study was to assess the indoor levels of particulate matter in hospitality venues in Cyprus before and after the implementation of the law on 1/1/2010, evaluate the role of enforcement, and examine the legislation's effect on revenue and employment. Several hospitality venues (n = 35) were sampled between April 2007 and January 2008, and 21 of those were re-sampled after the introduction of the smoking ban, between March and May 2010. Data on enforcement was provided by the Cyprus Police whereas data on revenue and employment within the hospitality industry of Cyprus were obtained from the Cyprus Statistical Service; comparisons were made between the corresponding figures before and after the implementation of the law. The median level of PM2.5 associated with secondhand smoking was 161 μg/m3 pre-ban and dropped to 3 μg/m3 post-ban (98% decrease, p < 0.0001). Furthermore, in the year following the ban, the hotel turnover rate increased by 4.1% and the restaurant revenue by 6.4%; employment increased that same year by 7.2% and 1.0%, respectively. Smoke free legislations, when enforced, are highly effective in improving the air quality and reducing the levels of indoor PM2.5. Strict enforcement plays a key role in the successful implementation of smoking bans. Even in nations with high smoking prevalence comprehensive smoking laws can be effectively implemented and have no negative effect on accommodation, food, and beverage services