Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by convincing evidence. We searched PubMed and ISI Web of Science from inception to December 2018 to identify meta-analyses examining associations between putative risk factors for GDM. For each meta-analysis we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. Thirty eligible meta-analyses were identified, providing data on 61 associations. Fifty (82%) associations had nominally statistically significant findings (P<0.05), while only 15 (25%) were significant at P35 kg/m2 vs. normal BMI, and hypothyroidism. The compilation of results from synthesis of observational studies suggests that increased BMI and hypothyroidism show the strongest consistent evidence for an association with GDM. Diet and lifestyle modifications in pregnancy should be tested in large randomized trials. Our findings suggest that women with known thyroid disease may be offered screening for GDM earlier in pregnancy.

Objective: To summarize evidence from the literature on genetic and non‐genetic risk factors associated with pre‐eclampsia (PE), assess the presence of statistical bias in the studies and identify risk factors for which there is robust evidence supporting their association with PE.Methods: PubMed and ISI Web of Science were searched from inception to October 2016, to identify systematic reviews and meta‐analyses of observational studies examining associations between genetic or non‐genetic risk factors and PE. For each meta‐analysis, the summary‐effect size was estimated using random‐effects and fixed‐effects models, along with 95% CIs and the 95% prediction interval. Between‐study heterogeneity was expressed using the I² statistic, and evidence of small‐study effects (large studies had significantly more conservative results than smaller studies) and evidence of excess significance bias (too many studies with statistically significant results) were estimated.Results: Fifty‐eight eligible meta‐analyses were identified, which included 1466 primary studies and provided data on 130 comparisons of risk factors associated with PE, covering a wide range of comorbid diseases, genetic factors, exposure to environmental agents and biomarkers. Sixty‐five (50%) associations had nominally statistically significant findings at P < 0.05, while 16 (12%) were significant at P < 10^–6. Sixty‐five (50%) associations had large or very large heterogeneity. Evidence for small‐study effects and excess significance bias was found in 10 (8%) and 26 (20%) associations, respectively. The only non‐genetic risk factor with convincing evidence for an association with PE was oocyte donation vs spontaneous conception, which had a summary odds ratio of 4.33 (95% CI, 3.11–6.03), was supported by 2712 cases with small heterogeneity (I² = 26%) and 95% prediction intervals excluding the null value, and without hints of small‐study effects (P for Egger's test > 0.10) or excess of significance (P > 0.05). Of the statistically significant (P < 0.05) genetic risk factors for PE, only PAI‐1 4G/5G (recessive model) polymorphism was supported by strong evidence for a contribution to the pathogenesis of PE. Eleven factors (serum iron level, pregnancy‐associated plasma protein‐A, chronic kidney disease, polycystic ovary syndrome, mental stress, bacterial and viral infections, cigarette smoking, oocyte donation vs assisted reproductive technology, obesity vs normal weight, severe obesity vs normal weight and primiparity) presented highly suggestive evidence for an association with PE.Conclusions: A large proportion of meta‐analyses of genetic and non‐genetic risk factors for PE have caveats that threaten their validity. Oocyte donation vs spontaneous conception and PAI‐1 4G/5G polymorphism (recessive model) showed the strongest consistent evidence for an association with risk for PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Healthcare workers are at the frontline of the COVID-19 pandemic and have been identified as a priority target group for COVID-19 vaccines. This study aimed to determine the COVID-19 vaccination intention among nurses and midwives in Cyprus and reveal the influential factors that affected their decision. An Internet-based cross-sectional survey was conducted between December 8 and 28, 2020. Data collection was accomplished using a self-administered questionnaire with questions about socio-demographic characteristics, questions assessing general vaccination-related intentions and behaviors, and the intention to accept COVID-19 vaccination. A sample of 437 responders answered the survey, with 93% being nurses and 7% midwives. A small proportion of the participants would accept a vaccine against COVID-19, while 70% could be qualified as “vaccine hesitant.” The main reasons for not receiving the COVID-19 vaccine were concerns about the vaccine's expedited development and fear of side effects. More females, individuals with a larger median age, and a higher number of years of working experience, intended to accept the COVID-19 vaccination, compared with those not intended to accept and undecided groups (p< 0.01). Having a seasonal flu vaccination in the last 5 years, receiving the vaccines recommended for health professionals, and working in the private sector were associated with a higher probability of COVID-19 vaccination acceptance. A considerable rate of nurses and midwives in Cyprus reported unwillingness to receive a COVID-19 vaccine due to vaccine-related concerns. Our findings highlight the need for forthcoming vaccination campaigns and programs to tackle coronavirus vaccine hesitancy barriers to achieve the desirable vaccination coverage.

The aim of this study is to comprehensively evaluate quantitative experimental mobile-assisted language learning (MALL) studies published between 1994 and 2019 that meet minimal conditions of research design and statistical analysis. Starting with a bibliographical database of 1,144 references to experimental MALL implementations, of which there were 700 objectively substantiated by quantitative experimental language learning outcomes, only 84 experimental MALL studies met the inclusion requirements. Their analysis addresses two critical sets of research questions. First, what are the general characteristics of the selected studies and, second, what are their language learning outcomes in terms of measured effect size. Nine general characteristics are considered: publication source, chronological distribution, country of origin, institutional environment, sample size, intervention duration, targeted language, language learner competence level, and learning focus. Effect size was calculated separately for between-group (independent, experimental) and within-group (quasi-experimental) treatment studies. In both cases, the overall results were quite large: 0.72 for the former and 1.16 for the latter. An analysis of four critical moderator variables (language learner competence level, language area focus, institutional environment, and intervention duration) revealed similarly large effect sizes. Notwithstanding, analysis of the data also confirmed obvious publication bias and a very high level of heterogeneity that frequently approached 100%. The relevance of positive language learning outcome conclusions thus needs to be tempered by these shortcomings.

Background: With an increasing aging population and a lower ratio between the active and the dependent population, population aging is considered a global social and health challenge, associated with increased demand in health care needs and social pension. This study projects the Greek and Cypriot population to guide future planning of social and health policies and services. Methods: The total population by sex and age groups, Total Fertility Rate (TFR), life-expectancies at birth and Potential Support Ratio PSR (persons aged 20–64 years per person 65+ years) are projected probabilistically by the year 2100 using Bayesian hierarchical models and United Nations’ population data for Greece and Cyprus from the period of 1950 to 2015. Results: The TFR is projected to be around 1.5 children per woman in 2050 and around 1.75 in 2100 for both countries, with all values of prediction intervals being around or below the Replacement level fertility. PSR is expected to decrease remarkably and be 2.5 in 2050 and 1.6 in 2100 for Cyprus while for Greece it will be around 1.5 for both years 2050 and 2100. Life-expectancy is expected to increase to 84 years for men and 87 years for women in 2050 and 90 years for men and 94 years for women in 2100 for both countries. The share of the population aged 65 years and over is projected to increase in both countries and be the one third of the population by 2100. Conclusions: Greece and Cyprus will acquire the characteristics of an aging population, putting a significance pressure on the social and health systems of both countries. Both countries should reform their social and health policy agenda to confront population aging and its consequence. They should adopt fertility incentives and family policies to increase fertility and migrants’ inclusiveness policies to improve the demographic structure and the economic activity. The national health systems should promote prevention strategies at the primary health sector and promote healthy aging while health research policy should aim to promote research in innovative technologies and digital health to create assistive technology for self-care and greater independence of older people.