Migration status and perinatal parameters in a Greek public maternity hospital: an illustration of the "healthy immigrant effect".

BACKGROUND: Although socioeconomic disparities adversely affect health, studies referring to the "healthy immigrant effect" imply more favorable health outcomes in immigrants than natives. We aimed to investigate the impact of immigration on several perinatal parameters. METHODS: Birth records (01/01/2010 - 31/12/2014) from a public maternity hospital in Athens, Greece were reviewed for maternal (ethnicity, age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Immigrants were classified by country of origin, according to Human Development Index. Comparison of results between Greeks and immigrants were made. Stratification by maternal age (< and ≥35 years) was conducted to test for confounding and interaction. RESULTS: Almost one-third of 7506 deliveries applied to immigrants; 36.3% of Greeks and 19.2% of immigrants [risk ratio (RR) = 0.53, 95% confidence interval (CI) = 0.52-0.54] delivered at ≥35 years; 10.5% of Greek and 7.0% of immigrant neonates weighted <2500 g (RR = 0.67, 95% CI = 0.61-0.74); 10.9% of Greeks and 8.1% of immigrants were born <37 wks (RR = 0.74, 95% CI = 0.67-0.82); 55.7% of Greeks and 48.2% of immigrants delivered by caesarean section (RR = 0.87, 95% CI = 0.85-0.88). CONCLUSION: We found that immigrant women deliver at a younger age, vaginally, more mature, and heavier neonates. Furthermore, we confirmed that the protective effect of immigrant status could not be explained by maternal age only.

Demographic and clinical characteristics of refugees seeking primary healthcare services in Greece in the period 2015-2016: a descriptive study.

Background: In 2015-2016, more than a million refugees entered Greece. Along with other organizations, PRAKSIS, a local non-governmental organization, deployed mobile medical units on three islands and in temporary settlements in Athens. Methods: This is a descriptive cross-sectional study aimed at analysing the demographic and clinical characteristics of the population (n=6688) that received services from PRAKSIS between October 2015 and June 2016 in different locations (islands of Samos, Kos and Leros in the southeastern Aegean Sea and on the mainland at Athens-Piraeus Port Gate E) before and after the closure of European borders in March 2016. Results: The majority (88%) of the population came from Syria, Afghanistan and Iraq. Among them, 53% were women and children. Infectious diseases decreased as the population moved from the islands to the Athens-Piraeus Port, while all other disease categories increased in relative frequency, the difference being statistically significant (p<0.05). Among all consultations, dental and oral cavity health complaints also increased in the Athens-Piraeus Port, but failed to reach statistical significance (p=0.11). Referrals from the mobile health units to specialist care rose from 4.2% of all patients clinically examined on the islands to 9.9% in the Athens-Piraeus Port, and the difference was statistically significant (p<0.05). Conclusions: More research and systematic data collection are needed to inform appropriate policies for the humanitarian challenges posed by the recent refugee and migrant waves in Europe.

Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics.

OBJECTIVES: Vertebral osteomyelitis is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study was to systematically review the clinical characteristics of pyogenic vertebral osteomyelitis (PVO). METHODS: The authors conducted a systematic review of the English literature. The inclusion criteria included studies with 10 or more subjects diagnosed with PVO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies. RESULTS: The 14 studies that met selection criteria included 1008 patients with PVO. Of them, the majority (62%) were men, with back pain and fever as the most common presenting symptoms. Diabetes mellitus was the most common underlying medical illness, while the urinary tract was the commonest source of infection. Staphylococcus aureus was the most commonly isolated organism. Computed tomographic guided or open biopsy yielded the causative organism more often than blood cultures (77% versus 58%). Plain radiography showed abnormalities in 89% of the cases, while bone scanning and computed tomography or magnetic resonance imaging were positive in 94% of the cases, revealing lumbar as the most commonly affected area. The attributable mortality was 6%, while relapses and neurological deficits were described in the 32% and 32% of the cases, respectively. CONCLUSION: PVO is an illness of middle-aged individuals with underlying medical illnesses. Although the mortality rate is low, relapses and neurological deficits are common, making early diagnosis a major challenge for the physician.