COVID-19 vaccination roll-out and uptake among refugees and migrants in Greece: a retrospective analysis of national vaccination routine data.

OBJECTIVES: Refugees and migrants (R&Ms) exhibited higher risk of COVID-19 infection, and higher mortality rates during the pandemic. Acknowledging these risks, R&Ms early in the pandemic were identified by WHO as a priority vaccination group in need of protection. The aim of this study was to assess the vaccination roll-out and uptake among R&Ms residing in Reception Identification Centers (RICs) and Reception Sites (RSs) in Greece, relative to the general population. STUDY DESIGN: Nationwide observational study. METHODS: Retrospective analysis of national vaccination routine data and population census data, collected and triangulated from multiple official/governmental sources. Weekly vaccine roll-out and uptake were calculated for the general Greek population and the R&M population, through the first year of the vaccination programme in Greece (December 2020-December 2021). RESULTS: Vaccine roll-out among migrants in RICs/RSs started with a 22-week delay, compared to the general population. By the end of the first year of the vaccination programme in Greece in December 2021, the national vaccination uptake among registered R&Ms residing in official reception facilities was 27.3 % for 1st dose and 4.7 % for booster dose; considerably lower compared to the general population (69.5 % uptake for 1st dose, 64.7 % for 2nd dose, and 32.0 % for 3rd dose). CONCLUSION: Delayed vaccine roll-out and low vaccine uptake among R&Ms in Greece are signs of low prioritisation and implementation failures in the R&M vaccination strategy. In face of future public health threats, lessons should be learned, and vaccine equity should be insured for all socially vulnerable and high-risk population groups.

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece.

OBJECTIVES: Ensuring access to care for all patients-especially those with life-threatening and chronic conditions-during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country. STUDY DESIGN: This is an observational study. METHODS: A retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out. RESULTS: Utilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017-19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%-28.0%), 23.1% (95% CI: 7.3%-38.9%), and 24.8% (95% CI: 13.3%-36.3%) respectively. This underutilization of essential public services-mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries-is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country. CONCLUSIONS: Greece's healthcare system, deeply wounded by the 2008-18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this "success" seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the "hidden epidemic" of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.

Clinical expression and course in patients with late onset systemic lupus erythematosus.

BACKGROUND: To analyze the pattern of clinical expression and the 5-year disease course in Caucasian patients with late onset of systemic lupus erythematosus (SLE) and to compare the findings with an early onset SLE group. METHODS: Medical records of 551 patients who presented with SLE at hospitals of the region of Thessaloniki between 1989 and 2007 were studied. Patients who developed SLE at or after the age of 50 years were classified as the late onset group, while younger patients served as the early onset group. Data on clinical manifestations and damage accrual at disease onset and at 5 years was obtained and compared between the two groups. RESULTS: In 121 patients, the disease started after the age of 50 years. Elderly patients showed less pronounced female predominance and less often presented with malar rash, nephropathy, fever and lymphadenopathy, while lung involvement, pericarditis and sicca syndrome were more frequent. Damage accrual was similar in both groups. The main causes of damage at 5 years differed, with the elderly exhibiting more cardiovascular damage. They also had a higher incidence of hypertension and osteoporosis at 5 years. CONCLUSIONS: Caucasian SLE patients with late onset of the disease present with different clinical manifestations, suggesting that age affects the expression of SLE. Damage accrual at 5 years is similar in the elderly and the younger patients. However, the causes of this damage and the occurrence of other comorbidities follow a different pattern, possibly reflecting the disease process and the effects of aging.

Clinical expression and morbidity of systemic lupus erythematosus during a post-diagnostic 5-year follow-up: a male:female comparison.

The aim of this study was to analyse the prevalence of the most relevant clinical features of the diagnosis of systemic lupus erythematosus (SLE) in a sample of male patients with lupus as well as the incidence of the main causes of morbidity in a 5-year period after the diagnosis. A further aim of this study was to investigate the impact of gender on expression and morbidity of SLE. Data were collected from the medical records of 59 male and 535 female patients with SLE who were diagnosed at the hospitals in the region of Thessaloniki. Several differences in the expression and morbidity of the disease were found in relation to the gender of the patient. Male patients had a higher prevalence of thromboses, nephropathy, strokes, gastrointestinal tract symptoms and antiphospholipid syndrome when compared with female patients, but tended to present less often with arthralgia, hair loss, Raynaud's phenomenon and photosensitivity as the initial clinical manifestations. During the 5-year follow-up, positive associations have been found between male gender and the incidence of tendonitis, myositis, nephropathy and infections, particularly of the respiratory tract. In conclusion, this study has provided information regarding the features of clinical expression and morbidity in male patients, and has shown that gender is a possible factor that can influence the clinical expression of SLE.

Analysis of fatal motor vehicle collisions: evidence from Central Macedonia, Greece.

BACKGROUND: The objective of this study was to assess the factors associated with the traffic mortality in the region of Central Macedonia in order to produce evidence in building up preventive policies. MATERIAL AND METHODS: This study is a descriptive survey covering a three-year period (from 01-01-2006 to 31-12- 2008). The data used were supplied by the regional Road Traffic Police Service in Thessaloniki. RESULTS: A total of 280 fatal vehicle collisions were recorded in three years, in which 312 people died. 266 (85.26%) of the 312 people who died were men and 46 (14.74%) were women. The victims were between 1 and 91 years of age (mean ± SD, 42.00 ± 20.36 years). More fatal vehicle collisions were recorded on weekends and holidays than weekdays. Regarding the type of the vehicle, occupants of two-wheeled motor vehicles were in greater risk for dying compared to heavy duty vehicle passengers, who are considered to be protected by the vehicle. Among the 312 fatalities, alcohol was detected in 87 (28%) of the drivers who were responsible for the collision. Most of them (56/86, 64.4%) were between 15 and 44 years of age. In 6 (1.9%) cases, all of them drivers, illicit substances were detected. Vehicle collisions with younger victims were recorded during the early morning hours, whereas older people died more frequently during daytime. CONCLUSIONS: The findings of this study are providing evidence for the design and implementation of concrete and urgently needed preventive strategies in order to control the almost completely preventable fatalities of the road crashes.

Participation rates in cervical cancer screening: experience in rural Northern Greece.

BACKGROUND AND AIM: Cervical cancer is one of the most common causes of cancer mortality among women worldwide but it is one of the most preventable cancers due to the Pap smear test. The aim of this study was to estimate the participation rate of females in screening of cervical cancer with Pap smear test. METHODS: The study took place in a hospital in Rural Northern Greece during April and May 2007. Convenience sampling was performed and questionnaires were completed by 214 eligible females aged 20-64 years. RESULTS: One hundred and twenty four (57.9%) of the participants had had a Pap-test at some point in their lifetime. 72 of them (33.65%) had the test performed for the first time according to current guidelines. 13.6% were unaware about the recommended onset age of the test, 16.4% did not know the proper intervals, while 22.4% did not know the recommended upper age limit. 32.6% were informed by mass media, family members and friends. The take-up rates, the source of information and the setting where the examination was performed were related to age, origin, income, educational status, type of occupation and place of residence. Disparities in participation rates were detected. CONCLUSIONS: Special efforts should be made by National Health Services towards enhancing secondary prevention of cervical cancer by increasing participation rates of older women, those with lower educational background, females with low income, Roma, retired or unemployed and residents of rural areas.

Time trends of female breast cancer mortality in Greece during 1980-2005: a population based study.

BACKGROUND: Changes in female breast cancer mortality trends have been observed in recent years in western countries. The aim of the present study was to analyse breast cancer mortality in Greece, between 1980 and 2005. METHODS: Time trends of breast cancer mortality were calculated per 100,000 women in the whole female population of Greece, in different age groups, and in different areas of the country. Mortality data and population age distribution were provided by the National Statistical Service of Greece. RESULTS: Overall, female breast cancer mortality in Greece had an increasing trend during 1980-2005. Subgroup analysis according to age showed that this increase was confined to women older than 70 years. In contrast, a mild decrease was noted after the mid-1990s in women 40-69 years old. There were no notable regional differences in breast cancer mortality. CONCLUSIONS: The increasing trend of breast cancer mortality in women aged 70 years and older could be attributed to limited use of secondary prevention methods and rare administration of systemic cytotoxic chemotherapy in these women. In contrast, implementation of these strategies could explain the recent reduction of breast cancer mortality in younger age groups.

The use of demographic, ultrasonographic and scintigraphic data in the diagnostic approach of thyroid nodules.

INTRODUCTION: Thyroid nodules are a common diagnostic challenge mainly because of the need to exclude thyroid malignancy. The aim of this study was to evaluate the usefulness of demographic, ultrasonographic and scintigraphic findings in differentiating benign from malignant thyroid lesions in patients presenting with thyroid nodules. MATERIALS AND METHODS: 941 patients, who presented with palpable thyroid nodules and underwent at least one fine-needle aspiration biopsy (FNAB), were retrospectively evaluated. RESULTS: The thyroid was assessed by ultrasonography (US) in 796 patients and by scintigraphy (SC) in 774 patients. The final diagnostic outcome was established after surgery (n=183) or after a minimum of one-year clinical follow-up period. Higher rates of malignancy were observed in male gender (p<0.001), in patients presenting with a solitary nodule in US (p<0.001), in nodules with maximum diameter > or =4.5 cm in US (p=0.024) and in nodules detectable by SC (p=0.006). There were no statistical differences in the rates of malignancy among cystic, solid or mixed nodules in US or among "hot", "warm" or "cold" nodules in SC. CONCLUSIONS: Male gender, solitary nodule and nodule diameter > or =4.5 cm can serve as adjuncts to FNAB in predicting the risk of thyroid malignancy in patients presenting with thyroid nodules.

Epidemiologic analysis of thyroid fine needle aspiration biopsies over a period of 18 years (1987-2004).

INTRODUCTION: Fine Needle Aspiration Biopsy (FNA) is a method widely used in the assessment of thyroid nodules. The main aim of this 18-year retrospective study was the investigation of the diagnostic value of FNA cytology in thyroid malignancy. SUBJECTS AND METHODS: We retrospectively reviewed 1376 patients who underwent 1938 FNAs from 1987 to 2004 in the Department of Endocrinology, "Hippokration" General Hospital, Thessaloniki, Greece. Of them 178 subsequently underwent total or subtotal thyroid resection and a pathology report was available. RESULTS: FNA cytology shows a sensitivity of 76.2% and a specificity of 90.5% for thyroid malignancy, with a significant agreement between FNA cytology and the histology following resection surgery (Cohen's method, p<0.05). There was a considerable improvement in the diagnostic value of FNA cytology during the sub-period 1996-2004 as compared to the sub-period 1987-1995. CONCLUSIONS: 1) FNA is a reliable diagnostic method in the assessment of thyroid malignancy, 2) a non-diagnostic FNA should always be repeated, 3) meticulous follow-up is mandatory, even after a cytological result of benign hyperplasia and 4) increased experience can improve the diagnostic value of FNA in thyroid malignancy.

Colour Doppler ultrasonography of the ophthalmic artery: flow parameters in normal subjects. The significance of the resistance index.

BACKGROUND: The aim of this study was to assess the flow characteristics in ophthalmic arteries and to detect their possible relationships to those in the common and internal carotid arteries. METHODS: Sixty healthy subjects (age range 20-74 years) with normal vascular findings, stratified by age and sex were recruited to the study. A colour Doppler ultrasound examination of the neck arteries was performed, followed by a colour Doppler ultrasound examination of the 120 ophthalmic arteries included. Peak systolic velocity, end diastolic velocity and resistance index (RI) of the common carotid, internal carotid and ophthalmic arteries, as well as the insonation depth of the ophthalmic arteries were measured. RESULTS: The mean values (standard deviation) of the measured parameters for the ophthalmic arteries were: insonation depth: 38.38 mm (2.60 mm), peak systolic velocity: 34.71 cm/sec (6.38 cm/sec), end diastolic velocity: 7.95 cm/sec (1.70 cm/sec), resistive index: 0.77 (0.04). The resistance index of the ophthalmic arteries was, in all cases, greater than that of the ipsilateral common carotid artery which in turn, was greater than that of the internal carotid. The value of the index in the ophthalmic arteries, when the circulation is normal in the extra- and intracranial arteries is rarely lower than 0.70. CONCLUSIONS: When an inversion of the ratio between the resistance index of the ophthalmic artery and that of the common carotid or an index value lower than 0.70 in the ophthalmic artery is observed, further investigation is needed as this situation cannot be considered normal. The resistance index seems to be the most reliable parameter for the estimation of normal circulation in ophthalmic arteries.

Effective treatment of secondary hyperparathyroidism in hemodialysis patients by titration of intravenous calcitriol dosage.

AIM: Effective treatment of secondary hyperparathyroidism (HPTH) with intravenous (i.v.) administration of calcitriol in hemodialysis patients. PATIENTS AND METHODS: The current study evaluates the use of i.v. calcitriol dosing in relation to the severity of the HPTH in 35 hemodialysis patients with serum phosphate < 6.5 mg/dl. Arbitrarily, patients with plasma IPTH levels (intact PTH) between 288 and 576 pg/ml (288 pg/ml = four-fold the upper normal limit) were given initially 1 microg i.v. calcitriol at the end of each dialysis (group A, n = 15). Patients with IPTH between 577 and 864 pg/ml received 2 microg i.v. calcitriol (group B, n = 10) and patients with IPTH more than 865 pg/ml were given 3 - 4 microg i.v. calcitriol (group C, n = 10). As IPTH levels decreased, the dose of i.v. calcitriol was also decreased gradually. Patients were followed-up for 4 months after the end of calcitriol treatment. RESULTS: During the i.v. calcitriol treatment period, the observed plasma IPTH concentrations compared with the baseline values were significantly lower (p < 0.01 for A and B group and p < 0.05 for C group) from the sixth month onwards in group A and C and from the third month onwards in group B. At the 12th month of follow-up, all patients being off i.v. calcitriol treatment for four months, a sharp and significant increase (p < 0.01 for group A and B and p < 0.05 for group C) of plasma IPTH was recorded in all three groups of patients. Alkaline phosphatase was also gradually decreased in all studied groups. Serum Ca and P remained unchanged in most patients. CONCLUSION: In conclusion, the study presented here demonstrates that the titration of i.v. calcitriol dosage according to the severity of HPTH is an effective and safe treatment of HPTH in chronic hemodialysis patients. It also shows that parathyroidectomy could be avoided in the majority of patients with severe HPTH, if an appropriate dose of calcitriol not aggravating hyperphosphatemia is administered.

Frequency of exfoliation syndrome in Greek cataract patients.

The frequency of exfoliation syndrome (EXS) was investigated in a group of Greek patients undergoing extracapsular cataract surgery. Five hundred and nine (509) consecutive cataract patients without any other manifest ocular abnormality were prospectively examined for the presence of EXS. Patients were clinically divided into 3 groups: group I (EXS group) consisted of patients in whom exfoliation material deposition could be seen; Group II (possible EXS group) comprised patients who demonstrated a number of pigmentary signs and group III (normal subjects) comprised patients with senile cataract and no sign of EXS. EXS was found in 140 (28%) of our patients, possible EXS in 119 (23%) and the rest (49%) had no evidence of EXS. Patients with EXS were older (mean age 73.8) when compared to the possible EXS group (70 years) and the control group (64.7 years). The IOP was significantly higher in patients with EXS (mean 15.5 mmHg versus 14.3 mmHg in the other two groups). Blue irides were significantly more common in patients with EXS (19%) than in the possible EXS group (14%) and the controls (4%). EXS is common in Greek cataract patients and this study has identified a large group of patients who may be at an early stage of development of the condition. EXS may predispose to the development of cataract in Greek patients.

Measuring the prevalence of diabetes mellitus in a Greek primary health care district.

BACKGROUND: Diabetes mellitus is a common disease in developed countries, but in Greece national figures on its prevalence are lacking. OBJECTIVES: The aim of this study was to identify the burden of known diabetes mellitus through its estimation in the area of responsibility of the Spili Health Centre, based on the health information system that had been established in Primary Health Care in rural Crete. METHOD: The diagnosis of diabetes was retrospectively documented by reviewing all medical records (n = 47151) at the Spili Health Centre and its five regional outposts during the period 1/6/1988-1/7/1993. The diagnostic criteria of WHO were used to establish the diagnosis. RESULTS: After excluding the patients who had died, we found 210 patients with diabetes mellitus. Thirty cases were evaluated with OGTT because of mild but not diagnostic elevations of fasting plasma glucose, on more than one occasion. The prevalence of diabetes after age and sex standardization of that for the European population was estimated at 1.52% (1.31% in males and 1.68 in females). CONCLUSIONS: Our study shows that: 1) the role of the GPs and one appropriate information system in measuring the prevalence of known diabetes mellitus are now considered important within the Greek context; 2) diabetes mellitus seems not to be a rare disease in rural Crete. The estimated prevalence appears to be similar to the prevalence rates reported in other areas of rural Greece.

Should medical screening of the elderly population be promoted?

This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.