Role of tumor necrosis factor-␣, leptin, and white blood cell count in betel nut chewing-related metabolic derangements A reca nut (Areca catechu)/betel quid (BQ) is said to be the fourth most commonly used psychoactive substance in the world and is chewed regularly by at least 10% of the world's population (1). High prevalences of BQ chewing were observed especially in South and Southeast Asia (1). High prevalences of insulin resistance and metabolic syndrome were also observed in this area (2). Specific areca alkaloids act as competitive inhibitors of ␥-aminobutyric acid receptors in the brain, cardiovascular system, and pancreas, which may promote one's appetite or altered insulin secretion (3). Moreover, BQ components have recently been shown to induce keratinocytes to secrete tumor necrosis factor-␣ (TNF-␣) and interleukin-6, as well as induce reactive oxygen species and activate nuclear factor-B expression (4), which may potentially provoke chronic inflammation. Recently, we confirmed that BQ chewing was associated with a higher risk of type 2 diabetes and central obesity in Taiwanese men (5). The detrimental effects of BQ chewing on selected components of the metabolic syndrome, and the induction of inflammatory cytokines and factors, raise the possibility that BQ chewing may increase the risk of metabolic syndrome.In this study, a total of 1,466 aboriginal subjects of Southern Taiwan, 30 -95 years of age, were enrolled. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III definition. The age-adjusted prevalence of metabolic syndrome in the aborigines studied was 41.1% in men and 42.4% in women. BQchewing subjects had significantly higher prevalences of central obesity, hypertriglyceridemia, dysglycemia, and metabolic syndrome than those of nonchewers. Peripheral leukocyte count also significantly increased in chewers of both sexes, with plasma TNF-␣ level increased in men and plasma leptin level elevated in women. All were parallel to the number of components of the metabolic syndrome. Multiple logistic regression modeling adjusted for age, educational level, socioeconomic level, exercise, drinking, and smoking status showed that BQ chewing is an independent risk factor for the metabolic syndrome. The adjusted OR (95% CI) for male BQ chewers was 1.92 (1.15-3.27) and that of female chewers was 1.60 (1.03-2.50). The study shows that chronic BQ chewing is an independent contributor of metabolic syndrome. TNF-␣, leptin, and leukocyte count are involved in BQ chewing-related metabolic derangements.

The use of prohibited substances in sport does not solely concern athletes, but it is also quite common among other categories of the population: people who do not engage in competitive sports but use doping substances for a number of other reasons. This article is based on a survey that was administered to 532 people of both sexes, aged 14 years and above, in 22 gyms around Cyprus. The respondents engaged in one or more sports with a very small percentage (6%) participating in competitive sports. The results showed that 11.6 percent of the respondents had used or were using prohibited substances in order to improve their performance. The use of prohibited substances seemed to be higher among certain interviewees sharing common characteristics, that is, gender, age, education and socio-economic status. Doping was common among body-builders. The research also examined the reasons for the use of prohibited substances in relation to: the reasons for exercising; the nature of the sport; smoking and drinking habits; and the level of use within the wider environment.

An investigation of reported attitudes and language use in Cyprus has enabled an interpretation of social conditions affording status and 'price' to products available in the linguistic market-place. It has identified boundaries of social division and provided reasons for the coexistence of multiple linguistic codes. An empirical investigation, with recourse to the theory of practice (Bourdieu, 1997), identifies and accounts for the use of national and international codes (i.e. the Greek-Cypriot dialect (GCD), Standard Modern Greek (SMG) and English), their market value and their location within the strata of the community. Simple summary scores from factor analysis groupings suggest that despite the power and hegemonic potential of international languages such as English, the strength of the national codes persist due to their dominance as purveyors of instrumental worth and collective symbolism. English exists in response to symbolic and pragmatic forces determined by modernity. Moreover, multivariate analysis of variance reveals that it is those with greatest socioeconomic power who use English as a resource, enabling the construction and exploitation of multiple social identities.

Purpose -This paper takes advantage of the closeness of two secular, separated communities on the island of Cyprus to study how controversial products and forms of offensive advertising can be related to levels of religiousness, time usage and temporality. The resulting observations are then offered as insights into the notion of ethics in the two religious groups and how these might influence marketing to multicultural communities. Design/methodology/approach -The findings are based on a small-scale survey of 530 students (211 Christians, 302 Muslims and 18 undeclared) who responded to a questionnaire distributed at two privately owned, English speaking institutions, one in the north and one in the south part of Cyprus. Findings -This study indicates a high degree of commonality between Muslim and Christian students living in the adjoining communities in Cyprus. In general, overall reactions were tolerant of most products and forms of advertising, but where there were differences occurred there were specific reactions to the forms of the advertising. Significant differences were found across the communities when devoutness was tested especially regarding products that were of a sexual nature.Research limitations/implications -The relatively small numbers studied in the special case of Cyprus and the focus on students could limit the generalisation of these results. Practical implications -The results raise some issues for marketing segmentation and image use. For instance, positive and forward-looking images would stimulate most of the group regardless of their level of faith. Originality/value -This paper identifies commonalties and also ontological differences that could have implications for global marketing campaigns.

Introduction:The Ministry of Health of the Republic of Cyprus has implemented an Integrated Health Information System (IHIS) in two hospitals. However, no evaluation of IHIS has been conducted to assess its safety, efficiency and effectiveness. The proper utilization of IHIS is essential for the provision of quality healthcare services. Aim: The purpose of this study was to evaluate the current IHIS in public hospitals in Cyprus utilizing the DIPSA evaluation framework. Methods: A total of 309 subjects, including doctors, nurses and other healthcare professionals, participated in the study. The DIPSA evaluation framework assessed the users' perception in five categories namely, satisfaction, collaboration, system quality, safety and procedures, using Likert scale and 3 open questions. Correlation between the categories was assessed using the Pearson correlation coefficient, and multiple regression analysis was used to examine the relationship between the demographic characteristics and categories. Data analysis was done using SPSS v24. Results: All five categories were rated moderately, between 2.5 and 3, by the participants. All categories were correlated (P < 0.01). Multiple regression analysis indicated the need for improvement between the professionals (mainly doctors and nurses) and the categories. The open questions pointed out the need for improvement in all 3 factors examined (Technology, Human Factor, Organization). Discussion: The moderately rated categories, in the Cyprus IHIS, suggest that there is a lot of room for improvement. Some interventions are suggested that could positively and simultaneously affect one or more categories.

This study contributes to the limited existing research on the participation patterns of Cypriots in leisure and sports. Leisure and sport are viewed collectively while adapting the notion put forth by The Council of Europe (2007) defining leisure sports as sports activities aimed at the preservation and improvement of physical condition, health and fun. The purpose of this paper is to examine the leisure sport participation patterns of Cypriots, specifically: (1) participation patterns in leisure sports, (2) reasons for participating in leisure sports, (3) cost and participation in leisure sport, (4) leisure sport spectatorship, and (5) vacationing and leisure sport experiences. Data was commissioned and collected by the Centre for Leisure, Tourism and Sports (University of Nicosia) for the Cyprus Sport Organisation. A telephone-survey of 1000 Cypriots, men and women, aged 15+, from coast-to-coast in Cyprus using stratified random sampling was employed. The sample was weighted by gender, age, district and region of residence. The results indicate that: (1) almost half of the Cypriot population participates in leisure sports, (2) participation in leisure sports decreases with age, (3) participation in leisure sports tends to be driven by health benefits, (4) most Cypriots participate in leisure sport at no cost, (5) television is the most common means reported for spectatorship, and (6) some Cypriots plan their vacations around leisure sport experiences. The results indicate the relevant importance of the leisure sport culture in Cyprus while also reflecting on age and cost related factors that may influence participation in leisure sports.

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The purpose of this study is to examine the condition of sport in Cyprus. An analysis of how and by whom sport programs are operated presents an overview of sport facilities and the operating costs of the Cyprus Sport Organization (CSO) and the national federations. Data was collected using mailed survey and desk research. Results indicated that: (1) Cyprus has the necessary infrastructure that can support social, leisure and grassroots sports, (2) the economic recession has contributed to the decrease of related funds allocation (3) willingness on behalf of the CSO to further develop leisure sport, (4) many federations do not seem to keep related records, (5) the CSO seems well organized in supporting the existing institutions. Despite lack of funds, sport continues to play a critical role in the development of society. It is recommended that sport continues to come to the forefront of decision making in Cyprus and in developing a sporting culture, offering the necessary opportunities and facilities.