Features of public healthcare services provided to migrant patients in the Eastern Macedonia and Thrace Region (Greece).

BACKGROUND: The influx of migrants, refugees and asylum-seekers into European Union (EU) countries, especially into Greece, in the last 20 years is an issue of growing concern and requires a rational approach. The aim of this study is to chart the use of public health services by the migrants of the Eastern Macedonia and Thrace Region, which forms the northeastern border of Greece. METHODS: We collected data from five of the six public hospitals in the specified region, and we carried out a per clinic cross tabulation analysis of admission diagnosis and citizenship variables in order to establish the frequency at which the various diagnoses emerge per distinct group of migrant and non-migrant patients in each clinic. The main limitation of the study was the lack of age-standardised data. An additional analysis of frequencies per clinic focusing on migrant patients yielded hospitalisation frequencies per country of origin. We also performed a t-test to compare the average length of stay per clinic between the two groups. Finally, we utilised our available data to map the insurance status of migrant patients. RESULTS: The results have indicated that the hospitalisation rate of migrant patients due to chronic medical conditions is statistically significantly lower compared to non-migrant patients, while the opposite is true when looking at accident-related diagnoses, certain infectious diseases and medical conditions pertaining to depression and alcohol abuse. The comparisons of the average length of stay showed no overall differences between migrants and non-migrants. Only 2.04% of the migrant patients were uninsured. CONCLUSIONS: One of the key issues raised by the influx of migrants settling in host countries is concerned with health policy. The knowledge afforded by the medical parameters that characterise the provision of healthcare to them and the findings of relevant studies can lead to a more efficient identification of health risk factors and more effective prevention and treatment. This knowledge also constitutes a particularly crucial and useful tool to help authorities shape their healthcare policies and modify national health systems, which are currently based on the size and characteristics of indigenous populations, to take into account the different conditions with regard to both the number of patients treated and the epidemiological characteristics of the migrants. A greater appreciation of the particular current and potential roles of non-governmental organisations (NGOs) can help to provide appropriate healthcare services to migrants, refugees and asylum-seekers, especially when these groups are excluded from the public health system.

Management of a femoral diaphyseal fracture in a patient with Klippel-Trenaunay-Weber syndrome: a case report.

INTRODUCTION: Klippel-Trenaunay-Weber syndrome is a rare congenital disorder of the peripheral vascular system that is characterized by haemangiomas, soft tissue and/or osseous hypertrophy, venous and lymphatic anomalies as well as arterio-venous malformations. To our knowledge there are no documented cases of surgical fracture management in such patients. CASE PRESENTATION: We present the case of a 42-year-old female patient previously diagnosed with Klippel-Trenaunay-Weber syndrome, who had sustained a left femoral shaft fracture. She was treated with a closed, locked intramedullary nailing procedure. The nail was peripherally locked free-hand with a single screw due to the increased vascularity and intraoperative haemorrhage of the area. The patient was transfused with 7 units of blood intra-operatively and was subsequently transferred to the Intensive Care Unit where 3 more units of blood were transfused. Her post-operative course was uneventful. One year following the operation the fracture had united and the patient remained well. CONCLUSION: The surgical management of long bone fractures in patients with such pathology is associated with increased intra and post-operative risk, mainly due to vascular complications. It is therefore mandatory that high dependency facilities and sufficient quantities of blood products are available prior to the procedure. A less invasive fixation method should be used when possible.