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Stoffel S, Kioupi S, Ioannou D, Kerrison RS, von Wagner C, Herrmann B. Testing messages from behavioral economics to improve participation in a population-based colorectal cancer screening program in Cyprus: Results from two randomized controlled trials. Prev Med Rep 2021; 24:101499. [PMID: 34430189 PMCID: PMC8371188 DOI: 10.1016/j.pmedr.2021.101499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
Abstract
•Behavioral economic-based interventions have been suggested to increase uptake in CRC screening programmes.•This study tested the effectiveness of six behavioral economic-based messages in two field trials.•None of the messages increased screening participation.
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Affiliation(s)
- Sandro Stoffel
- Joint Research Centre, European Commission, Ispra, Italy
- Research Department of Behavioural Science and Health, University College London, London, UK
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Stala Kioupi
- Ministry of Health, Government of the Republic of Cyprus, Nicosia, Cyprus
| | - Despina Ioannou
- Ministry of Health, Government of the Republic of Cyprus, Nicosia, Cyprus
| | - Robert S. Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Health Science, University of Surrey, Surrey, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Cardoso R, Guo F, Heisser T, Hoffmeister M, Brenner H. Utilisation of Colorectal Cancer Screening Tests in European Countries by Type of Screening Offer: Results from the European Health Interview Survey. Cancers (Basel) 2020; 12:cancers12061409. [PMID: 32486077 PMCID: PMC7352919 DOI: 10.3390/cancers12061409] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
In the past two decades, an extensive rollout of colorectal cancer (CRC) screening programmes has been initiated in European countries with a large heterogeneity of screening offers. Using data from a population-based cross-sectional survey conducted between 2013 and 2016 in all European Union countries, we analysed the utilisation of faecal tests and colonoscopy among people aged 50–74 years and the factors associated with uptake by type of screening offer. We observed the highest utilisation of either test for countries with fully rolled out organised programmes with faecal tests (ranging from 29.7% in Croatia to 66.7% in the UK) and countries offering both faecal tests and colonoscopy (from 22.7% in Greece to 70.9% in Germany). Utilisation was very low for countries with no programme (from 6.3% in Romania to 30.5% in Norway). Younger age (50–54 years), longer time since last consultation with a doctor and a lifestyle score associated with increased CRC risk were significantly associated with lower test use, a pattern observed across all types of screening offers. Our results suggest that more countries should implement organised programmes with faecal immunochemical tests, in combination with alternative endoscopy offers where resources allow. Furthermore, there is a large potential for increasing screening use in Europe by better reaching the younger eligible individuals, those who have not been to the doctor recently and those at increased risk for CRC.
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Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany; (F.G.); (T.H.)
- Correspondence: ; Tel.: +49-6221-42-3033
| | - Feng Guo
- Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany; (F.G.); (T.H.)
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Thomas Heisser
- Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany; (F.G.); (T.H.)
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Papaioannou C, Lamnisos D, Kyriacou K, Lyssiotis T, Constantinides V, Frangos S, Economides A, Economides PA. Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected. J Thyroid Res 2020; 2020:3567658. [PMID: 32351678 PMCID: PMC7128046 DOI: 10.1155/2020/3567658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the prevalence of lymph node (LN) metastasis and extrathyroidal extension (ETE) in patients with papillary thyroid microcarcinoma (PTMC) in Cyprus and to evaluate the role of preoperative ultrasound (U/S) examination. METHODS A retrospective study of 102 patients who underwent thyroidectomy for PTMC in a 2-year period. Preoperatively, all patients had a thyroid and neck U/S examination with LN mapping. Tumor size according to the largest diameter, number of foci, LN metastasis, and ETE data was collected from the histopathological report and was compared to the preoperative U/S reports. RESULTS LN metastasis was present in 23.5% of patients. 15.7% had central, 3.9% had lateral, and 3.9% had both central and lateral LN metastasis. ETE was present in 27.5% of patients. 21.6% had multifocal disease, and in this group, 40.9% had LN metastasis and 36.4% had ETE. Multifocality (p = 0.03), size of tumor (p = 0.05), and ETE (p ≤ 0.001) were significantly associated with LN metastasis. The prevalence of LN metastasis in multifocal PTMC ≤5 mm was the same with multifocal PTMC >5 mm. The preoperative U/S sensitivity for the suspicious lateral neck and central LN was 100%, and the specificity was 100%. The preoperative U/S sensitivity for nodules suspicious for ETE was 53.6%, and the specificity was 100%. CONCLUSION The presence of LN metastasis and ETE in our PTMC patients in Cyprus is frequent. Neck U/S mapping is a highly reliable and accurate tool in identifying metastatic nodes. LN metastasis is associated with ETE and multifocality. Suspicious subcentimeter nodules should undergo FNA irrespective of size when multifocality is suspected.
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Affiliation(s)
- Christos Papaioannou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | - Savvas Frangos
- Bank of Cyprus Oncology Center, Strovolos, Nicosia, Cyprus
| | - Aliki Economides
- European University Cyprus, Engomi, Nicosia, Cyprus
- Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus
| | - Panayiotis A. Economides
- European University Cyprus, Engomi, Nicosia, Cyprus
- Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus
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Celikgun S, Nur N. Cancer Incidence Rates by Age and Gender in Sivas Province of Turkey,
2004-2014. Oman Med J 2019; 34:126-130. [PMID: 30918606 PMCID: PMC6425054 DOI: 10.5001/omj.2019.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to evaluate the trends in age-standardized incidence rates of cancer by gender, age, and types in the Sivas province of Turkey from 2004 to 2014. Methods Data were obtained from the Sivas Public Health Department Cancer Unit and the Cumhuriyet University Hospital Cancer Record Unit for the studied period. Data were presented as incidence rates by age, gender, and cancer site using world age-standardized incidence rate (ASR-W) per 105 populations. Results Of the 13 377 registered new cases of cancer during the study period, 43.1% (5771) were female, and 56.9% (7606) were male. The ASR-W of all cancers was 205.2 per 105 in males and 168.0 per 105 in females. The ASR-W was increased for both genders over the 11-year period. The greatest incidence cancer type in males was prostate cancer (ASR-W = 35.8) followed by lung (ASR-W = 33.9), colorectal (ASR-W= 19.0), urinary (ASR-W = 18.4), and stomach (ASR-W = 17.3) cancer. Among females, thyroid (ASR-W= 37.5) was the cancer type with the greatest incidence followed by breast (ASR-W = 27.7), colorectal (ASR-W = 11.7), lymphoma (ASR-W = 10.4), and stomach (ASR-W = 10.0) cancer. Conclusions The cancer incidence rate in males has remained higher than in females from 2004 to 2014, and an increased incidence of various cancers was observed in both genders. Raising public awareness about the risk factors for cancer and the development of appropriate and effective screening programs to provide more reliable data for cancer prevention and control programs in Sivas province is necessary.
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Affiliation(s)
- Serkan Celikgun
- Department of Pathology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Naim Nur
- Department of Public Health, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:v10120729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Eser S, Chang J, Charalambous H, Silverman B, Demetriou A, Yakut C, Nimri O, Pavlou P, Özgür S, Ziogas A, Stevens L, Ward K, Anton Culver H. Incidence patterns of colorectal cancers in four countries of the Middle East Cancer Consortium (Cyprus, Jordan, Israel, and İzmir, Turkey) compared with those in the United States Surveillance, Epidemiology, and End Results Program. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:36-44. [PMID: 29391306 DOI: 10.5152/tjg.2018.17263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS There are wide variations in colorectal cancer (CRC) incidence across the world. Historically, the highest incidence rates have been reported historically in more developed countries; however, increasing trends have been seen in developing countries. Here, we present the CRC incidence pattern in Cyprus, Israel, Jordan, and İzmir, Turkey, which are countries of the Middle East Cancer Consortium (MECC). MATERIALS AND METHODS We analyzed 2005-2010 CRC data from population-based registries and calculated crude and age standardized rates for CRC, colon and rectum subsites, and annual percent changes (APCs) for trends. RESULTS The age-adjusted incidence rates (AAIRs) for CRC were the highest in Israeli Jews (IJ) (46.7 for males and 35.5 for females), which exceeded those of the USA Surveillance, Epidemiology, and End Result (SEER) program registries. In both sexes, AAIRs in Cyprus and Israeli Arabs (IA) were close to those in SEER registries. For both sexes, AAIRs in İzmir and Jordan were substantially lower than those in other registries. Statistically significant decreasing trends over time were observed in AAIRs for both sexes in the SEER program (APCs: males, -3.24% and females, -2.54%), whereas the trends varied within the MECC registries. There were decreasing AAIR trends for males in IJ and IA and for females in Cyprus and IJ; APC for females in IJ (-4.29%) was significant. Conversely, increasing trends with the significant APCs were observed in males in İzmir (2.43%) and Jordan (7.57%). CONCLUSION MECC countries comprise both high- and low-risk populations for CRCs. However, increasing trends in low-risk populations have been alarming. Thus, the need for implementing tailored primary and secondary prevention programs in the region is essential.
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Affiliation(s)
- Sultan Eser
- Department of Public Health, Balıkesir University, Balıkesir, Turkey; PI of Regional Hub for Cancer Registration in Northern Africa, Central and Western Asia, WHO/ IACR GICR, İzmir, Turkey
| | - Jenny Chang
- Department of Epidemiology, University of California Irvine, USA
| | - Haris Charalambous
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Barbara Silverman
- Israel Ministry of Health, Israel Center for Disease Control, National Cancer Registry of Israel, Israel
| | - Anna Demetriou
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Cankut Yakut
- Turkish Ministry of Health, İzmir Cancer Registry, İzmir, Turkey
| | - Omar Nimri
- Jordan Ministry of Health, NCDs-Department of Cancer Prevention, National Cancer Registry of Jordan, Jordan
| | - Pavlos Pavlou
- Cyprus Ministry of Health, Health Monitoring Unit, National Cancer Registry of Cyprus, Nicosia, Cyprus
| | - Suriye Özgür
- PI of Regional Hub for Cancer Registration in Northern Africa, Central and Western Asia, WHO/ IACR GICR, İzmir, Turkey
| | - Argyrious Ziogas
- Department of Epidemiology, University of California Irvine, USA
| | - Lisa Stevens
- U.S. National Cancer Institute, Center for Global Health, USA
| | - Kevin Ward
- Department of Epidemiology, Georgia Center for Cancer Statistics, Emory University, Georgia
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Altobelli E, Rapacchietta L, Angeletti PM, Barbante L, Profeta FV, Fagnano R. Breast Cancer Screening Programmes across the WHO European Region: Differences among Countries Based on National Income Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E452. [PMID: 28441745 PMCID: PMC5409652 DOI: 10.3390/ijerph14040452] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 12/16/2022]
Abstract
Breast cancer (BC) is the most frequent tumour affecting women all over the world. In low- and middle-income countries, where its incidence is expected to rise further, BC seems set to become a public health emergency. The aim of the present study is to provide a systematic review of current BC screening programmes in WHO European Region to identify possible patterns. Multiple correspondence analysis was performed to evaluate the association among: measures of occurrence; GNI level; type of BC screening programme; organization of public information and awareness campaigns regarding primary prevention of modifiable risk factors; type of BC screening services; year of screening institution; screening coverage and data quality. A key difference between High Income (HI) and Low and Middle Income (LMI) States, emerging from the present data, is that in the former screening programmes are well organized, with approved screening centres, the presence of mobile units to increase coverage, the offer of screening tests free of charge; the fairly high quality of occurrence data based on high-quality sources, and the adoption of accurate methods to estimate incidence and mortality. In conclusion, the governments of LMI countries should allocate sufficient resources to increase screening participation and they should improve the accuracy of incidence and mortality rates.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
- Epidemiology and Biostatistics Unit, .Local Health Unit 4, 64100 Teramo, Italy.
| | - Leonardo Rapacchietta
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Luca Barbante
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
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Colorectal Carcinoma: A General Overview and Future Perspectives in Colorectal Cancer. Int J Mol Sci 2017; 18:ijms18010197. [PMID: 28106826 PMCID: PMC5297828 DOI: 10.3390/ijms18010197] [Citation(s) in RCA: 749] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death. Most cases of CRC are detected in Western countries, with its incidence increasing year by year. The probability of suffering from colorectal cancer is about 4%–5% and the risk for developing CRC is associated with personal features or habits such as age, chronic disease history and lifestyle. In this context, the gut microbiota has a relevant role, and dysbiosis situations can induce colonic carcinogenesis through a chronic inflammation mechanism. Some of the bacteria responsible for this multiphase process include Fusobacterium spp, Bacteroides fragilis and enteropathogenic Escherichia coli. CRC is caused by mutations that target oncogenes, tumour suppressor genes and genes related to DNA repair mechanisms. Depending on the origin of the mutation, colorectal carcinomas can be classified as sporadic (70%); inherited (5%) and familial (25%). The pathogenic mechanisms leading to this situation can be included in three types, namely chromosomal instability (CIN), microsatellite instability (MSI) and CpG island methylator phenotype (CIMP). Within these types of CRC, common mutations, chromosomal changes and translocations have been reported to affect important pathways (WNT, MAPK/PI3K, TGF-β, TP53), and mutations; in particular, genes such as c-MYC, KRAS, BRAF, PIK3CA, PTEN, SMAD2 and SMAD4 can be used as predictive markers for patient outcome. In addition to gene mutations, alterations in ncRNAs, such as lncRNA or miRNA, can also contribute to different steps of the carcinogenesis process and have a predictive value when used as biomarkers. In consequence, different panels of genes and mRNA are being developed to improve prognosis and treatment selection. The choice of first-line treatment in CRC follows a multimodal approach based on tumour-related characteristics and usually comprises surgical resection followed by chemotherapy combined with monoclonal antibodies or proteins against vascular endothelial growth factor (VEGF) and epidermal growth receptor (EGFR). Besides traditional chemotherapy, alternative therapies (such as agarose tumour macrobeads, anti-inflammatory drugs, probiotics, and gold-based drugs) are currently being studied to increase treatment effectiveness and reduce side effects.
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Hadjisavva IS, Dina R, Talias MA, Economides PA. Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status. Eur Thyroid J 2015; 4:123-8. [PMID: 26279998 PMCID: PMC4521064 DOI: 10.1159/000430438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy. METHODS 322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded. RESULTS From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology. CONCLUSION The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.
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Affiliation(s)
- Irini S. Hadjisavva
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Roberto Dina
- Department of Cellular Pathology, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Panayiotis A. Economides
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
- *Dr. Panayiotis A. Economides, MD, PhD, FACE, Economides Nicosia Endocrinology Center, 9 Iona Nicolaou, Engomi 2406, Nicosia (Cyprus), E-Mail
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