The migration experience of Greece and the impact of the economic crisis on its migrant and native populations

Association of cytokine gene polymorphisms with peripheral neuropathy susceptibility in people living with HIV in Greece

Relatively little research has been done in recent years to understand what leads to the unceasingly high rates of HIV sensory neuropathy despite successful antiretroviral treatment. In vivo and in vitro studies demonstrate neuronal damage induced by HIV and increasingly identified ART neurotoxicity involving mitochondrial dysfunction and innate immune system activation in peripheral nerves, ultimately all pathways resulting in enhanced pro-inflammatory cytokine secretion. Furthermore, many infectious/autoimmune/malignant diseases are influenced by the production-profile of pro-inflammatory and anti-inflammatory cytokines, due to inter-individual allelic polymorphism within cytokine gene regulatory regions. Associations of cytokine gene polymorphisms are investigated with the aim of identifying potential genetic markers for susceptibility to HIV peripheral neuropathy including ART-dependent toxic neuropathy. One hundred seventy-one people living with HIV in Northern Greece, divided into two sub-groups according to the presence/absence of peripheral neuropathy, were studied over a 5-year period. Diagnosis was based on the Brief Peripheral Neuropathy Screening. Cytokine genotyping was performed by sequence-specific primer-polymerase chain reaction. Present study findings identify age as an important risk factor (p < 0.01) and support the idea that cytokine gene polymorphisms are at least involved in HIV peripheral-neuropathy pathogenesis. Specifically, carriers of IL1a-889/rs1800587 TT genotype and IL4-1098/rs2243250 GG genotype disclosed greater relative risk for developing HIV peripheral neuropathy (OR: 2.9 and 7.7 respectively), while conversely, carriers of IL2+166/rs2069763 TT genotype yielded lower probability (OR: 3.1), all however, with marginal statistical significance. The latter, if confirmed in a larger Greek population cohort, may offer in the future novel genetic markers to identify susceptibility, while it remains significant that further ethnicity-oriented studies continue to be conducted in a similar pursuit.

Changing Epidemiology of Tinea Capitis in Athens, Greece: The Impact of Immigration and Review of Literature

Mass population movements have altered the epidemiology of tinea capitis (TC) in countries receiving refugees. Periodic monitoring of the local pathogen profiles may serve as a basis for both the selection of appropriate empirical antifungal therapy and the implementation of preventive actions. Therefore, we investigated the impact of an unprecedented immigration wave occurring in Greece since 2015 on the epidemiological trends of TC. All microbiologically confirmed TC cases diagnosed during the period 2012-2019 in a referral academic hospital for dermatological disorders in Athens, Greece, were retrospectively reviewed. A total of 583 patients were recorded, where 348 (60%) were male, 547 (94%) were children and 160 (27%) were immigrants from Balkan, Middle Eastern, Asian as well as African countries. The overall annual incidence of TC was 0.49, with a significant increase over the years (p = 0.007). M. canis was the predominant causative agent (74%), followed by T. violaceum (12%), T. tonsurans (7%) and other rare dermatophyte species (7%). M. canis prevalence decreased from 2014 to 2019 (84% to 67%, p = 0.021) in parallel with a three-fold increase in T. violaceum plus T. tonsurans rates (10% to 32%, p = 0.002). An increasing incidence of TC with a shift towards anthropophilic Trichophyton spp. in Greece could be linked to the immigration flows from different socioeconomic backgrounds.

Firing discrimination: Selective labor market responses of firms during the COVID-19 economic crisis

The speed of the economic downturn in the wake of the COVID-19 pandemic has been exceptional, causing mass layoffs-in Germany up to 30% of the workforce in some industries. Economic rationale suggests that the decision on which workers are fired should depend on productivity-related individual factors. However, from hiring situations we know that discrimination-i.e., decisions driven by characteristics unrelated to productivity-is widespread in Western labor markets. Drawing on representative survey data on forced layoffs and short-time work collected in Germany between April and December 2020, this study highlights that discrimination against immigrants is also present in firing situations. The analysis shows that employees with a migration background are significantly more likely to lose their job than native workers when otherwise healthy firms are unexpectedly forced to let go of part of their workforce, while firms make more efforts to substitute firing with short-time working schemes for their native workers. Adjusting for detailed job-related characteristics shows that the findings are unlikely to be driven by systematic differences in productivity between migrants and natives. Moreover, using industry-specific variation in the extent of the economic downturn, I demonstrate that layoff probabilities hardly differ across the less affected industries, but that the gap between migrants and natives increases with the magnitude of the shock. In the hardest-hit industries, job loss probability among migrants is three times higher than among natives. This confirms the hypothesis that firing discrimination puts additional pressure on the immigrant workforce in times of crisis.

Dental Caries Prevalence and Experience (ICDAS II Criteria) of 5-, 12- and 15-Year-Old Children and Adolescents with an Immigrant Background in Greece, Compared with the Host Population: A Cross-Sectional Study

Evidence regarding disparities in oral health among native and immigrant child and adolescent populations in Europe is scarce. The present study aimed to determine the caries status of 5-, 12-, and 15-year-olds with an immigrant background in Greece in relation to their sociodemographic characteristics and compare their caries levels with those of their native Greek peers. A sample of 707 immigrants underwent clinical examination for caries (ICDAS II criteria), followed by a calculation of caries prevalence and experience estimates (2013-2014). Multivariable regression models assessed the effect of ethnic background on the caries experience (d_3-6mfs/D_3-6MFS) of the total (707 immigrants and 3702 Greeks) population, and the association between parental education level and the immigrants' d_3-6mfs/D_3-6MFS. Among the 5- and 12-year-olds, those with an immigrant background demonstrated higher caries rates and had unfulfilled treatment needs at higher proportions. Among 15-year-old adolescents, no considerable differences in caries status were observed according to ethnic background (native Greek or immigrant). The strength of the association between immigrant background and caries experience levels attenuated gradually with increasing age (IRR = 1.61, 1.27 and 1.10, and p = 0.001, p = 0.006 and p = 0.331 for 5-, 12- and 15-year-olds, respectively). Among the immigrants, adolescents with less educated mothers exhibited elevated caries levels. Public health strategies should prioritize immigrant children and early adolescents in order to reduce the existing ethnic disparities in oral health.

Adverse working conditions and immigrants' physical health and depression outcomes: a longitudinal study in Greece

PURPOSE

Τhe study examines whether adverse working conditions for immigrants in Greece bear an association with deteriorated physical health and increased levels of depression during 2018 and 2019.

METHODS

A panel dataset resulted from the collaboration with centers providing free Greek language courses to immigrant population groups. Random Effects models assess the determinants of physical health and depression.

RESULTS

Findings indicate that workers with no written contract of employment, receiving hourly wages lower than the national hourly minimum wages, and experiencing insults and/or threats in their present job experience worse physical health and increased levels of depression. Moreover, the study found that the inexistence of workplace contracts, underpayment, and verbal abuse in the workplace may coexist. An increased risk of underpayment and verbal abuse reveals itself when workers do not have a contract of employment and vice versa.

CONCLUSION

Immigrant workers without a job contract might experience a high degree of workplace precariousness and exclusion from health benefits and insurance. Immigrant workers receiving a wage lower than the corresponding minimum potentially do not secure a living income, resulting in unmet needs and low investments in health. Workplace abuse might correspond with vulnerability related to humiliating treatment. These conditions can negatively impact workers' physical health and foster depression. Policies should promote written employment contracts and ensure a mechanism for workers to register violations of fair practices.

Evaluation of the Direct Economic Cost per Eradication Treatment Regimen against Helicobacter pylori Infection in Greece: Do National Health Policy-Makers Need to Care?

Helicobacter pylori (Hp) management has undoubtedly resulted in a notable economic burden on healthcare systems globally, including Greece. Its cost has never been estimated so far, especially during the recent 10-year unprecedented financial crisis. Direct medical and procedural costs for one attempt "outpatient" Hp eradication treatment were estimated as the following: (I) first-line regimens: 10 and 14 days standard triple, 10 and 14 days sequential, 10 and 14 days concomitant non-bismuth quadruple, 14 days hybrid, (II) second-line salvage regimens: 10 and 14 days levofloxacin-containing triple regimens. Treatment costs using prototypes and/or generic drugs were calculated. Drug prices were collected and confirmed from two official online medical databases including all medicines approved by the Greek National Organization for Medicines. Regimens based on generics were more affordable than prototypes and those including pantoprazole yielded the lowest prices (mean: 27.84 €). Paradoxically, 10-day concomitant and 14-day hybrid regimens (currently providing good (90-94%) first-line eradication rates in Greece) cost the same (mean: 34.76 €). The expenditures for Hp eradication treatment regimens were estimated thoroughly for the first time in Greece. These data should be taken into account by Public Health policymakers both in Greece and the European Union, aiming for a better and less expensive therapeutic approach.

Health in crises. Migration, austerity and inequalities in Greece and Europe: introduction to the supplement

This introduction summarizes and discusses the main findings of the supplement 'Health in crises. Migration, austerity and inequalities in Greece and Europe' to the European Journal of Public Health. The supplement applies data from the ESS (2014) health module in combination with the MIGHEAL study, which is a new source of data on the Greek population specially designed to examine health inequalities among and between migrants and natives. This has enabled the authors of the nine articles that constitute this supplement to address several pressing issues about the distribution of health and its determinants in Greece and other European countries. The main finding of the present supplement is the exceptionally high rates of reported depressive symptoms across the whole population residing in Greece and particularly among women. Levels of unmet need for healthcare were also found to be alarmingly high in Greece compared with other European countries, suggesting that the crisis and subsequent austerity policies may have impacted the provision of healthcare services and access to healthcare for broad sections of the population, whether native or migrant.

Non-communicable diseases in Greece: inequality, gender and migration

Background

The relationship between gender, migration status and non-communicable diseases (NCDs) is rarely examined. In this study, we rely on data from the MIGHEAL Survey on health inequalities in Greece collected in 2016 comprising 1332 respondents of which 59.98% identified themselves as Greek-born, 24.02% as immigrants from Albania and 15.99% as immigrants from another country than Albania, to analyse this often neglected relationship. With the help of average risk ratios, this paper explores and explains gender inequalities in heart or circulation problems, high blood pressure, breathing problems, allergies, back or neck pain, muscular pain, stomach or digestion-related problems, skin conditions, severe headaches, and diabetes in Greece among Greek-born individuals, Albanian immigrants and among immigrants of 'other origin'. We found that both among Greek-born and among immigrant groups women report substantially higher rates of NCDs although gender inequalities are more pronounced among 'other-origin' immigrants. Further, our findings show that the observed gender inequalities are fostered by occupational factors both among Greek-born and migrants.