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Mózes N, Takács J, Ungvari Z, Feith HJ. Assessing disparities in health and living conditions: a comparative study of Hungarian-speaking Roma and non-Roma women across Hungary, Romania, and Slovakia. Front Public Health 2024; 12:1438018. [PMID: 39234083 PMCID: PMC11371694 DOI: 10.3389/fpubh.2024.1438018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
Background The Roma minority, Europe's largest ethnic minority, experiences significant disparities in living conditions and health outcomes compared to the non-Roma populations across the continent. Despite extensive documentation of the socio-economic challenges faced by the Roma, there is a notable lack of comparative research. Methods This study aims to fill this gap by examining the differences in socio-economic characteristics, living conditions, and self-reported health status between Roma (R) and non-Roma (nR) women in in Hungary (HU), Romania (RO), and Slovakia (SK), providing a cross-country comparative analysis. Utilizing simple and multiple binary logistic models, our research analysed data collected from September 2020 to March 2022, involving 322 Roma and 294 non-Roma women in Hungary, 258 Roma and 183 non-Roma women in Romania, and 146 Roma and 163 non-Roma women in Slovakia. Results Findings indicate significant associations between increased age (R:OR = 1.04[1.02,1.06], p < 0.001), (nR:OR = 1.04[1.02,1.05], p < 0.001) lower financial situation (R:OR = 2.05[1.01,4.18], p = 0.048) (nR:OR = 1.67[1.01,2.77], p = 0.047), and basic education level (R:OR = 3.60[1.29,10.08], p = 0.015) (nR:OR = 3.64[1.77,7.51], p < 0.001) with the likelihood of poor health status across both groups in Hungary. In Romania, increased age (OR = 1.04[1.02,1.06], p < 0.001) and basic education level (OR = 5.24[2.29,11.99], p < 0.001) were particularly predictive of poor health among non-Roma, while in Slovakia, age (OR = 1.05[1.02,1.07], p < 0.001) was a significant factor for Roma, and intermediate education level (OR = 2.68[1.16,6.20], p = 0.021) was for non-Roma. The study also found that a higher number of children (HU:OR = 1.35[1.12,1.63], p = 0.002), (RO:OR = 1.57[1.25,1.96], p < 0.001) and problems with housing comfort (RO:OR = 4.83[2.19,10.62], p = 0.015) and wall conditions (RO:OR = 2.81[1.22,6.46], p < 0.001) significantly impacted the health status of non-Roma women in Hungary and Romania. Conversely, an increase in household size was associated with a better health status among Roma women in Hungary (OR = 0.88[0.79,0.99]) and Slovakia (OR = 0.78[0.61,0.99]). Conclusion By offering a novel comparative analysis, this study highlights the critical need for focused attention on the health disparities faced by Roma women, particularly those in a multiply disadvantaged situation due to their ethnic and socio-economic status.
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Affiliation(s)
- Noémi Mózes
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Johanna Takács
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Helga Judit Feith
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Crișan D, Avram L, Grapă C, Nemeș A, Coman MV, Beldean-Galea MS, Coman RT, Călinici T, Donca V, Crăciun R. Unveiling Health Inequalities: Exploring Metabolic Dysfunction in Rural Roma Communities. Healthcare (Basel) 2024; 12:816. [PMID: 38667578 PMCID: PMC11050184 DOI: 10.3390/healthcare12080816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Europe's largest ethnic minority, the Roma, are often confronted with substantial obstacles that result in health disparities. Research indicates that there are elevated rates of both communicable and non-communicable diseases, such as metabolic syndrome (MetS), among Roma communities, often linked to living conditions, limited education, or poverty. This study centers on remote rural Roma settlements in Romania, evaluating the prevalence of metabolic dysfunction, obesity, and liver steatosis while considering socio-economic and lifestyle factors. METHODS Over a period of 36 months, local visits to a total of 25 rural Roma communities were conducted, where a medical team gathered information through a standardized questionnaire and conducted a physical exam on every participant. Liver steatosis was also recorded with the help of a portable wireless ultrasound device. RESULTS Our study included 343 participants, with a predominance of female subjects, representing 72.5% (n = 249) of the patients. The prevalence of obesity, defined by a body mass index (BMI) above 30 kg/m2, was 32.2% (n = 111). Arterial hypertension was found to have a prevalence of 54.1% (n = 185), with de novo hypertension being observed in 19.2% patients (n = 66). Type 2 diabetes mellitus was found in 28.9% patients (n = 99), with 19.5% being de novo cases. The prevalence of hepatic steatosis was 57.2% (n = 111/194). A positive association between metabolic features and at-risk behaviors was found. CONCLUSIONS This study underscores the transition from infectious to metabolic diseases in vulnerable communities and highlights the urgency of targeted public health strategies tailored to the unique needs of rural Roma populations, aiming to mitigate health disparities and promote equitable healthcare access.
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Affiliation(s)
- Dana Crișan
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Lucreția Avram
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Cristiana Grapă
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Andrada Nemeș
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Maria-Virginia Coman
- “Raluca Ripan” Institute for Research in Chemistry, “Babeş-Bolyai” University, 400294 Cluj-Napoca, Romania;
| | | | - Radu-Tudor Coman
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Tudor Călinici
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
| | - Valer Donca
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- Clinical Municipal Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400000 Cluj-Napoca, Romania; (D.C.); (A.N.); (R.-T.C.); (T.C.); (V.D.); (R.C.)
- “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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Ekezie W, Hopwood E, Czyznikowska B, Weidman S, Mackintosh N, Curtis F. Perinatal health outcomes of women from Gypsy, Roma and Traveller communities: A systematic review. Midwifery 2024; 129:103910. [PMID: 38113569 DOI: 10.1016/j.midw.2023.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND GRT communities are disadvantaged minority groups in Europe and experience some of the poorest health outcomes, including maternal and child health. This systematic review aimed to assess the maternal, perinatal and infant health outcomes of women from GRT communities and the factors associated with the reported outcomes. METHODS Database searches were conducted from inception to June 2023 in 4 bibliographic databases supplemented with an additional Google Scholar search. Studies with quantitative data on maternal outcomes published in English were considered. A narrative synthesis was performed, and data were presented in text, figures and tables. FINDINGS Forty-five studies from 13 European countries were included. Outcome factors related to mothers showing low healthcare engagement, high fertility rates and shorter gestation periods among GRT women. Child wantedness was also noted to influence pregnancy completeness, which included abortion and miscarriage. More negative infant outcomes were seen in GRT infants than non-GRT infants; this included higher preterm births, lower birth weight, higher rates of intrauterine growth restriction and infant mortality. Risk factors of poorer maternal outcomes were early reproduction, education, smoking, alcohol consumption, deprivation, poor nutrition and perinatal care. CONCLUSION This review provides evidence that GRT women and children experience more negative outcomes than general populations. It also highlights the gaps in ethnicity and health inequalities more broadly. The significant importance of this research is the need for increased focus on reducing health inequalities, especially among the GRT community.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; School of Social Sciences and Humanities, Aston University, Birmingham B4 7ET, United Kingdom.
| | - Ellen Hopwood
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Barbara Czyznikowska
- Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Sarah Weidman
- Leicester Institute for Advanced Studies (LIAS), University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Ffion Curtis
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; Institute of Population Health, Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool L69 3GF, United Kingdom
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Kasabji F, Vincze F, Lakatos K, Pálinkás A, Kőrösi L, Ulicska L, Kósa K, Ádány R, Sándor J. Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary. Front Public Health 2024; 12:1152555. [PMID: 38327575 PMCID: PMC10847262 DOI: 10.3389/fpubh.2024.1152555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Spatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities. Aims We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems. Methods A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI). Results Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending. Conclusion Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.
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Affiliation(s)
- Feras Kasabji
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kinga Lakatos
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - László Ulicska
- Deputy State Secretariat for Social Inclusion, Ministry of Interior, Budapest, Hungary
| | - Karolina Kósa
- Department of Behavioral Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Khalfaoui A, Garcia-Espinel T, Macías-Aranda F, Molina Roldán S. How Can the Roma Deal with the Health and Social Crisis Generated by the COVID-19 Pandemic? Inequalities, Challenges, and Successful Actions in Catalonia (Spain). J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01736-w. [PMID: 37535239 DOI: 10.1007/s40615-023-01736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
The Roma is the most excluded non-migrant ethnic minority in Europe, facing prejudice, intolerance, discrimination, and social exclusion in their daily lives. This has led to a huge gap in several social domains between the Roma and non-Roma created for centuries. The COVID-19 pandemic has only increased the social and health inequalities that the Roma faced. In this context, it is important to identify actions that have been successful in mitigating the effects that the COVID-19 has had in increasing such inequalities. This paper presents the findings of a mixed-method study carried out in Catalonia (Spain) with the participation of more than 500 Roma, who reported their experience. The study results confirm the significant vulnerability and the negative impact of the COVID-19 pandemic on the Roma communities. Our research also highlights several successful actions developed by the Integrated Plan for the Roma of the Catalan Government, such as health literacy and adult education, as having a positive impact on the quality of life of many Roma during the health and social crisis generated by the COVID-19 pandemic. This paper suggests that the lessons learned from Catalonia could be transferred to other contexts across Europe and guide decision makers to promote the social inclusion and quality of life of the Roma, protecting Roma communities during current and future pandemics.
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Affiliation(s)
- Andrea Khalfaoui
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
- Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Tania Garcia-Espinel
- Roma and Social Innovation Programme, Department of Social Rights, Government of Catalonia, Barcelona, Spain
| | - Fernando Macías-Aranda
- Department of Teaching and Learning and Educational Organization, University of Barcelona, Barcelona, Spain
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Miconi D, Ouimet S, Kafi MAH, Dervishi E, Wiium N, Rousseau C. Risk behaviors and well-being among Egyptian and Roma adolescents in Albania during the COVID-19 pandemic: Vulnerability and resilience in a positive youth development perspective. Front Psychol 2023; 14:989661. [PMID: 37599737 PMCID: PMC10433179 DOI: 10.3389/fpsyg.2023.989661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/24/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Egyptian and Roma communities represent two of the most deprived and stigmatized ethnic minorities in Albania. However, research investigating vulnerability and well-being in youth from these communities is scant. Even less is known among Egyptian and Roma adolescents who dropped-out of school. Within a Positive Youth Development framework, we investigated among Egyptian and Roma adolescents: (1) risk behaviors, well-being, and developmental assets (personal and contextual); (2) associations of developmental assets with risk behaviors and well-being; (3) specificities by ethnicity, gender, and education. Methods A total of 201 Egyptian and Roma adolescents (Mage = 16.63, SDage = 1.80; 47% girls; 53% school dropouts) completed a series of questionnaires in a community setting in August 2020 (first wave of the COVID-19 pandemic). Results Binomial, Poisson and linear regression models indicated that Egyptian and Roma adolescents reported similar and high levels of risk behaviors, with boys reporting overall more risk behaviors than girls. Low level of well-being and of personal and contextual assets were reported. Girls reported higher family assets, positive values and social competencies than boys. The situation of adolescents attending school was overall not better than that of youth who had dropped out. Higher positive identity was associated with higher well-being. Discussion Intervention and prevention efforts are urgently needed to support minority adolescents' development during and in the aftermath of the pandemic. They should address the structural factors which limit the availability of personal and contextual resources in minority youth's lives. Interventions aimed at building safer neighborhoods and providing safe access to schools for minority youth should be a priority and are essential to prevent the widening of inequalities during and after this health emergency.
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Affiliation(s)
- Diana Miconi
- Department of Educational Psychology and Andragogy, Université de Montréal, Montréal, QC, Canada
| | - Sonia Ouimet
- Department of Educational Psychology and Andragogy, Université de Montréal, Montréal, QC, Canada
| | | | - Eglantina Dervishi
- Department of Psychology and Pedagogy, Faculty of Social Sciences, University of Tirana, Tirana, Albania
| | - Nora Wiium
- Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
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Kodjebacheva GD, Hristova SG, Savov V. Development and evaluation of an intervention to promote the use of eyeglasses among Romani families in Bulgaria. Front Public Health 2023; 11:1096322. [PMID: 36761123 PMCID: PMC9902913 DOI: 10.3389/fpubh.2023.1096322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Objective Uncorrected refractive error (i.e., lack of eyeglasses for the treatment of refractive error) is one of the leading causes of visual impairment in Eastern Europe. Limited information is available on how to promote the use of eyeglasses among Romani families in Bulgaria. In step 1, the objective was to obtain suggestions by Romani mothers on how to promote the use of eyeglasses among children. In step 2, the objective was to evaluate an intervention to promote the use of eyeglasses based on suggestions received during step 1. Methods During step 1, 5 focus groups with Romani mothers took place in one neighborhood in Bulgaria. During step 2, the intervention used a one-group pre-test, post-test design. Families received eye examinations. Those who needed eyeglasses chose attractive eyeglasses. Parents received education on how to encourage their children to wear eyeglasses. Results During step 1, 54 mothers participated. Mothers suggested that the whole family should receive eye examinations and eyeglasses. During step 2, of 33 family members, 14 did not have refractive errors and 19 did. Of the 19 family members with refractive error, none had eyeglasses at pre-test. Approximately 6 months following the end of the intervention, 11 of the 19 family members (57.9%) wore eyeglasses and the remaining 8 (42.1%) did not. Conclusion Romani family members needed eyeglasses but did not have any at pre-test of the intervention. Future interventions that offer education on the importance of eye examinations may increase receipt of eye examinations and adherence to wearing eyeglasses.
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Affiliation(s)
- Gergana Damianova Kodjebacheva
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan—Flint, Flint, MI, United States,International Institute, University of Michigan—Ann Arbor, Ann Arbor, MI, United States,*Correspondence: Gergana Damianova Kodjebacheva ✉
| | - Slavka Grigorova Hristova
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan—Flint, Flint, MI, United States
| | - Ventsislav Savov
- Department of Economics and Management, College of Management, Trade, and Marketing, Sofia, Bulgaria
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Prenatal and Birth Care of Roma Women. Nurs Res 2023; 72:12-19. [PMID: 36096878 DOI: 10.1097/nnr.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal-child outcomes. OBJECTIVE The aim of this study was to examine differences in prenatal care and maternal-infant outcomes between Roma and non-Roma women. METHODS A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. RESULTS Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. DISCUSSION Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding.
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Robinson T, Oluboyede Y, Vale L, Olariu E. Differences in health-related quality of life between the Roma community and the general population in Romania. J Patient Rep Outcomes 2022; 6:127. [PMID: 36547744 PMCID: PMC9780407 DOI: 10.1186/s41687-022-00530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous research has shown that Roma people report worse health outcomes than the general population and suffer from a myriad of economic and social disadvantages. The objective of this study was to assess the differences in the health-related quality of life (HRQoL) between the Roma people and the Romanian general population. METHODS Two cross-sectional surveys were conducted face-to-face in 2018 and 2019 in two nationally representative samples of both the general population and Roma communities, recruited from all regions of Romania. Both samples completed the EQ-5D-5L and EQ-VAS questionnaires, as well as a range of sociodemographic questions. Coarsened Exact Matching and several different regression models were used to assess the differences in HRQoL between the two groups. RESULTS 2308 respondents were included in the matched sample: 1,621 general population individuals; 687 Roma people. Roma people had more problems with self-care, pain/discomfort, and anxiety/depression than the general population. They also reported a lower overall level of HRQoL than the general population of Romania, as reflected by the lower EQ-5D-5L and EQ-VAS scores. Our sensitivity analysis between Coarsened Exact Matching and other matching procedures showed consistent results across all regression models. CONCLUSIONS In Romania, the Roma community has a lower level of HRQoL than the general population. Understanding the underlying causes of this inequality should be the focus of future research. Policies aimed at reducing the level of health inequality between the Roma and the general populations should be promoted locally.
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Affiliation(s)
- Tomos Robinson
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Yemi Oluboyede
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Luke Vale
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Elena Olariu
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
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Mytton J, Bedford H, Condon L, Jackson C. Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers. J Public Health (Oxf) 2021; 43:e675-e683. [PMID: 32643752 PMCID: PMC8677431 DOI: 10.1093/pubmed/fdaa100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. METHODS We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health. RESULTS 39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services. CONCLUSIONS Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers.
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Affiliation(s)
- Julie Mytton
- Centre for Public Health and Wellbeing, University of the West of England, Coldharbour Lane, Bristol BS16 1QY UK
| | - Helen Bedford
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Louise Condon
- Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, Wales, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
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11
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Beaumont A, Durand C, Ledrans M, Schwoebel V, Noel H, Le Strat Y, Diulius D, Colombain L, Médus M, Gueudet P, Mouly D, Aumaître H. Seroprevalence of anti-SARS-CoV-2 antibodies after the first wave of the COVID-19 pandemic in a vulnerable population in France: a cross-sectional study. BMJ Open 2021; 11:e053201. [PMID: 34815286 PMCID: PMC8611237 DOI: 10.1136/bmjopen-2021-053201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to assess the level of prior SARS-CoV-2 infection in socially deprived neighbourhoods after the first wave of the pandemic, and to identify factors associated with seropositivity. DESIGN A cross-sectional study. SETTING Three socially deprived neighbourhoods of the city of Perpignan, in the south of France, where large settled Roma communities live. PARTICIPANTS People aged 6 years old or over, living in the study area. 700 people were included in the study using two-stage stratified sampling design. INTERVENTIONS The study included a questionnaire and SARS-CoV-2 antibody testing by the Roche Elecsys immunoassay between 29 June and 17 July 2020. PRIMARY AND SECONDARY OUTCOME MEASURES SARS-CoV-2 antibody seroprevalence was estimated from weighted data. Associated factors and reported symptoms were investigated using univariable and multivariable logistic regressions. RESULTS The seroprevalence of anti-SARS-CoV-2 antibodies was 35.4% (95% CI 30.2% to 41.0%). People aged 15-64 years old had increased odds of being seropositive than those aged 65 years or over. Obese people had higher odds of being seropositive (adjusted OR (aOR)=2.0, 95% CI 1.1 to 3.8). The odds of being seropositive were higher in households with clinical COVID-19 cases (one case: aOR=2.5, 95% CI 1.3 to 5.0; several cases: aOR=6.9, 95% CI 3.1 to 15.2). In the neighbourhood with the highest measured seroprevalence, people living in a dwelling with one to two rooms had higher odds of being seropositive than those living in a four-room house (aOR=2.8, 95% CI 1.2 to 6.3). Working during the lockdown was associated with lower odds of being seropositive (aOR=0.2, 95% CI 0.03 to 1.0). CONCLUSION Transmission of SARS-COV-2 in this vulnerable population was very high during the COVID-19 pandemic's first wave. Our results highlight the need to strengthen and adapt preventive measures taking into account all social determinants of health, especially housing conditions.
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Affiliation(s)
- Adeline Beaumont
- Santé publique France, Direction des régions, Occitanie, Toulouse, France
| | - Cécile Durand
- Santé publique France, Direction des régions, Occitanie, Toulouse, France
| | - Martine Ledrans
- Santé publique France, Direction des régions, Occitanie, Toulouse, France
| | - Valérie Schwoebel
- Santé publique France, Direction des régions, Occitanie, Toulouse, France
| | - Harold Noel
- Santé publique France, Direction des maladies infectieuses, Saint-Maurice, France
| | - Yann Le Strat
- Santé publique France, Direction appui traitements et analyses des données, Saint-Maurice, France
| | - Donatien Diulius
- Agence régionale de Santé Occitanie, délégation départementale Pyrénées Orientales, Perpignan, France
| | - Léa Colombain
- Infectious and Tropical Diseases Department, Perpignan Hospital Center, Perpignan, France
| | - Marie Médus
- Infectious and Tropical Diseases Department, Perpignan Hospital Center, Perpignan, France
| | - Philippe Gueudet
- Laboratory of Biochemistry and Biology, Perpignan Hospital Center, Perpignan, France
| | - Damien Mouly
- Santé publique France, Direction des régions, Occitanie, Toulouse, France
| | - Hugues Aumaître
- Infectious and Tropical Diseases Department, Perpignan Hospital Center, Perpignan, France
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12
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La Parra-Casado D, Solheim EF, Estévez JF. Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys. Scand J Public Health 2021:14034948211056210. [PMID: 34796767 DOI: 10.1177/14034948211056210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. METHODS We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. RESULTS There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. CONCLUSIONS These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.
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Affiliation(s)
| | - Erling F Solheim
- Department of Social Sciences, UiT the Arctic University of Norway, Norway
| | - Jesús F Estévez
- Institute of International Economy, University of Alicante, Spain
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Zajc Petranović M, Rizzieri AE, Sivaraj D, Smolej Narančić N, Škarić-Jurić T, Celinšćak Ž, Stojanović Marković A, Peričić Salihović M, Kalászi J, Kalászi M, Lin JQ, Mehta S, Burleson J, Rizzieri DA. CVD Risk Factors in the Ukrainian Roma and Meta-Analysis of Their Prevalence in Roma Populations Worldwide. J Pers Med 2021; 11:jpm11111138. [PMID: 34834490 PMCID: PMC8622536 DOI: 10.3390/jpm11111138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
The Roma population suffers from severe poverty, social exclusion, and some of the worst health conditions in the industrialized world. Herein, we report on cardiovascular disease (CVD) risk factors in the Ukrainian Roma and present a meta-analysis of the prevalence of CVD risk factors in 16 Roma populations worldwide. The meta-analyses of CVD risk factors in Roma (n = 16,552) vs. non-Roma majority population of the same country (n = 127,874) included publicly available data. Ukrainian field survey included 339 adults of both sexes and outcomes of interest were hypertension, body mass index (BMI), smoking, education, and employment status. Furthermore, 35.7% of the Ukrainian Roma were hypertensive, 69.3% unemployed, and 48.4% never went to school. Ukrainian Roma women were more likely to be underweight and more prone to be hypertensive, with odds of hypertension increasing with age, BMI, and positive smoking status. Meta-analyses showed that, in comparison with non-Roma worldwide, the Roma bear significantly higher risk factor loads related to smoking (OR = 2.850), diabetes (OR = 1.433), abdominal obesity (OR = 1.276), and metabolic syndrome (OR = 1.975), with lower loads for hypertension (OR = 0.607) and BMI ≥ 25 kg/m2 (OR = 0.872). To conclude, the CVD risk factors which are more common in Roma than in the majority population may reflect their poor health-related behaviors and inadequate access to health education.
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Affiliation(s)
- Matea Zajc Petranović
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
- Correspondence: (M.Z.P.); (D.A.R.)
| | - Ashley Elizabeth Rizzieri
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Dharshan Sivaraj
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Nina Smolej Narančić
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Tatjana Škarić-Jurić
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Željka Celinšćak
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Anita Stojanović Marković
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Marijana Peričić Salihović
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Julia Kalászi
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Marianna Kalászi
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - John Q. Lin
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Sanica Mehta
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Jill Burleson
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - David A. Rizzieri
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
- Correspondence: (M.Z.P.); (D.A.R.)
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Alunni L. Pathogenic camps, therapeutic city? Roma, healthcare, and the negotiation of citizenship rights in Rome. Soc Sci Med 2021; 289:114421. [PMID: 34571360 DOI: 10.1016/j.socscimed.2021.114421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
While equality in healthcare implementation constitutes one of the precepts of the European Roma inclusion programs, health disparities are still one of the most problematic areas contributing to the marginality of residents in 'Roma camps'. The implementation of the right to health and access to healthcare services and resources represents a major challenge in their everyday experience. If we consider citizenship as a set of natural and legal rights to be protected as a symbolic and material link between a nation-state and a subject either born there or formally belonging to its national community, healthcare emerges as a technology of government where such rights are challenged, limited, or denied. Based on an ethnographic work on the role of public healthcare in 'Roma camps', this contribution focuses on contemporary topographies of health in the city of Rome through the lens of Roma marginalization within its urban spaces. How do camps residents experience the city through their relationship with its healthcare resources? And how does the healthcare system become a powerful tool of exclusion? Healthcare access in an urban context is an illustration of the dialectics of political power, knowledge, and expertise as a crucial factor in the administration of marginalized groups. From this perspective, the analysis focuses on precarity in the urban healthcare landscape, and on what living in a 'Roma camp' means in terms of healthcare. Both dimensions interrogate citizenship as a set of rightful entitlements that includes access to state-provided medical services.
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Affiliation(s)
- Lorenzo Alunni
- EHESS - École des hautes études en sciences sociales, Paris, IRIS - Campus Condorcet, Bâtiment Recherche Sud, 5 cours des Humanités, 93322, Aubervilliers, Cedex, France.
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15
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Miconi D, Dervishi E, Wiium N, Johnson‐Lafleur J, Ibrahimi S, Rousseau C. Egyptian and Roma Adolescents' Perspectives on Their Developmental Assets in Albania During the COVID-19 Pandemic. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:576-594. [PMID: 34448300 PMCID: PMC8646479 DOI: 10.1111/jora.12665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 05/04/2023]
Abstract
This mixed-method study explores the accessibility of developmental assets among Egyptian and Roma minority youth in Albania during the COVID-19 pandemic. Six focus groups were conducted in August 2020 with Egyptian (n = 16) and Roma (n = 15) adolescents (14-20 years, Mage = 16.71; SDage = 2.00; 14 girls and 17 boys). In addition, adolescents rated how much they experienced each developmental asset. Descriptive and thematic analyses highlighted: (1) low developmental assets and barriers to accessing resources, (2) mental health concerns and coping strategies, (3) the role of proximal contexts of life, and (4) experiences within the society in terms of discrimination, integration, and contribution to society. Inter-sectoral community-based interventions are urgently needed to mitigate the impact of the pandemic on minority youth.
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Giampaolo R, Marotta R, Biagiarelli FS, Zampa A, Moramarco S, Buonomo E. The exacerbated prevalence of acute malnutrition and growth retardation in Roma children living in camps. Ital J Pediatr 2021; 47:173. [PMID: 34419116 PMCID: PMC8380018 DOI: 10.1186/s13052-021-01122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/29/2021] [Indexed: 05/31/2023] Open
Abstract
Background Child malnutrition is still a concern in marginalized groups of populations, such as immigrants living in very low socio-economic conditions. Roma children are within the most hard-to-reach populations, susceptible to undernutrition and growth retardation. In the city of Rome (Italy), the Hospital “Bambino Gesù”, in collaboration with the Catholic Association Community of Saint’Egidio, is dedicating free services for the health and nutritional needs of vulnerable people. Methods A retrospective analysis was conducted on immigrant children visited at different ages (0–11 years old). Records including nutritional and growth assessment were collected from 2016 up to May 2020. Malnutrition was classified following the WHO 2006 standards. Data for Roma children living in extra-urban camps and non-Roma immigrant children living in urban areas were analyzed, odds ratios and univariate binary regressions were performed to investigate the risk of malnutrition within the two groups. Results A sample of 414 children (57% under-five; 51.9% Roma), was included in the database. In the under-five children, underweight accounted for 7.6%, stunting for 11.7%, and wasting for 2.9%. The first year of life was the most crucial for nutritional status. Compared to the counterpart, Roma children accounted for nearly the total rate of malnutrition (wasting 4.8% vs. 1%; stunting 21.4% vs. 2%; underweight 14.2% vs. 1%). Univariate logistic regression confirmed under-five Roma children being at the highest risk of stunting at 12 months (OR: 16.1; CI 2–132; p = 0.01). When considering the 176 school-aged children, undernutrition affected most Roma children (13% vs 1.9%), followed by stunting (5.8% vs 0.9%). Univariate logistic regression confirmed that Roma school-aged children were more likely to be underweight (OR: 7.8; CI 1.6–37.6; p = 0.01). Conclusions Malnutrition in immigrant children is still of high concern in Italy. Its prevalence in Roma children living in extra-urban camps exceeds that of immigrant children living in urban areas and the rates of underweight, stunting and wasting of Roma children living in the Balkans. This exacerbating condition highlights the need of better assisting this fragile population that is at most risk of poverty, food insecurity and social exclusion in Italy, particularly during this pandemic crisis.
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Affiliation(s)
- Rosaria Giampaolo
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Rosaria Marotta
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ersilia Buonomo
- Community of Saint'Egidio, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Petraki I, Kalpourtzi N, Terzidis A, Gavana M, Vantarakis A, Rachiotis G, Karakosta A, Sypsa V, Touloumi G. Living in Roma Settlements in Greece: Self-Perceived Health Status, Chronic Diseases and Associated Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8403. [PMID: 34444153 PMCID: PMC8394944 DOI: 10.3390/ijerph18168403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
We aimed to assess the self-perceived health status and the presence of chronic diseases of adult Roma living in settlements in Greece, and to explore associated social determinants of health. Data were derived from the Hprolipsis Health Survey. Multivariable regression models were applied. In total, 534 adults, 287 women, and 247 men were recruited from twelve Roma settlements in four prefectures. Although 62% of the participants perceived their health status as good/very good, about half of them had been diagnosed with at least one chronic disease. Several structural and intermediary social determinants of health were found to be significantly associated with the health outcomes; prefecture, settlement type, sex, age group, living with a partner, presence of depression symptoms, food insecurity, and alcohol consumption were associated with self-perceived health status; settlement type, sex, age group, presence of anxiety symptoms, food insecurity and number of persons living in the house with the presence of a chronic disease. This is one of the few studies assessing the self-perceived health status and presence of chronic diseases in Roma settlements in Greece and investigating the associated social determinants of health in the world. Community-based participatory action research and health literacy programs are needed to mitigate health inequalities in Roma settlements.
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Affiliation(s)
- Ioanna Petraki
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Agapios Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, 1, Dilou & Mikras Asias Str., Goudi, 11527 Athens, Greece;
| | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, 54124 Thessaloniki, Greece;
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Rio Achaia, 26504 Patra, Greece;
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, 3, Panepistimiou Str., Viopolis, 41500 Larisa, Greece;
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
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Annar D, Feher P, Madarasi A, Mascie-Taylor N, Kekesi A, Kalabiska I, Muzsnai A, Zsakai A. Body structural and cellular aging of women with low socioeconomic status in Hungary: A pilot study. Am J Hum Biol 2021; 34:e23662. [PMID: 34346536 DOI: 10.1002/ajhb.23662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The health status of an individual is determined not only by their genetic background but also by their physical environment, social environment and access and use of the health care system. The Roma are one of the largest ethnic minority groups in Hungary. The majority of the Roma population live in poor conditions in segregated settlements in Hungary, with most experiencing higher exposure to environmental health hazards. The main aim of this study was to examine the biological health and aging status of Roma women living in low socioeconomic conditions in Hungary. METHODS Low SES Roma (n: 20) and high SES non-Roma women (n: 30) aged between 35 and 65 years were enrolled to the present analysis. Body mass components were estimated by body impedance analysis, bone structure was estimated by quantitative ultrasound technique. Cellular aging was assessed by X chromosome loss estimation. Data on health status, lifestyle and socioeconomic factors were collected by questionnaires. RESULTS The results revealed that low SES women are prone to be more obese, have a higher amount of abdominal body fat, and have worse bone structure than the national reference values. A positive relationship was found between aging and the rate of X chromosome loss was detected only in women with low SES. Waist to hip ratio, existence of cardiovascular diseases and the number of gravidities were predictors of the rate of X chromosome loss in women. CONCLUSIONS The results suggested that age-adjusted rate of X chromosome loss could be related to the socioeconomic status.
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Affiliation(s)
- Dorina Annar
- Department of Biological Anthropology, Eotvos Lorand University, Budapest, Hungary
| | - Piroska Feher
- Department of Biological Anthropology, Eotvos Lorand University, Budapest, Hungary
| | - Anna Madarasi
- Saint Janos Hospital and Unified Hospitals of North Buda, Budapest, Hungary
| | | | - Anna Kekesi
- Istenhegyi Gene Diagnostic Center, Budapest, Hungary
| | - Irina Kalabiska
- University of Physical Education, Research Center for Sport Physiology, Budapest, Hungary
| | - Agota Muzsnai
- Saint Janos Hospital and Unified Hospitals of North Buda, Budapest, Hungary
| | - Annamaria Zsakai
- Department of Biological Anthropology, Eotvos Lorand University, Budapest, Hungary
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Kasabji F, Alrajo A, Vincze F, Kőrösi L, Ádány R, Sándor J. Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238998. [PMID: 33287122 PMCID: PMC7730532 DOI: 10.3390/ijerph17238998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.
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Affiliation(s)
- Feras Kasabji
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - Alaa Alrajo
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, H-1139 Budapest, Hungary;
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Correspondence:
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Llanaj E, Vincze F, Kósa Z, Sándor J, Diószegi J, Ádány R. Dietary Profile and Nutritional Status of the Roma Population Living in Segregated Colonies in Northeast Hungary. Nutrients 2020; 12:nu12092836. [PMID: 32947945 PMCID: PMC7551568 DOI: 10.3390/nu12092836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
Nutrition studies among Roma are scarce and to date no quantified dietary data are available. This report provides, for the first time, quantified dietary data and comprehensive anthropometric information for the Hungarian Roma (HR) population, with Hungarian general (HG) adults as reference. Data were obtained from a complex comparative health survey, involving 387 and 410 subjects of HR and HG populations, respectively. Using corporal measurements, body composition indicators were constructed, while daily nutrient intakes were evaluated in comparison with internationally accepted guidelines on nutrient requirements and recommended intakes. Associations between Roma ethnicity and nutrient intakes, as well as odds of achieving dietary recommendations were explored using regression models, adjusted for relevant covariates (i.e., age, gender, education, marital status and perceived financial status). Results showed occasional differences for selected nutrient intakes between the groups, with HR's intake being less favorable. Total fat intake, predominantly animal-sourced, exceeded recommendations among HR (36.1 g, 95% confidence interval (CI): 35.2-37.0) and was not dissimilar to HG group (37.1 g, 95% CI: 36.3-38.0). Sodium intake among HR was significantly lower (5094.4 mg, 95% CI: 4866.0-5322.8) compared to HG (5644.0 mg, 95% CI: 5351.9-5936.0), but significantly greater than recommended intake in both groups. HR had greater estimated body fatness (25.6-35.1%) and higher average body mass index (BMI, 27.7 kg/m2, 95% CI: 26.9-28.4), compared to HG. In addition, HR had lower odds of achieving dietary recommendations (odds ratio (OR) = 0.81, 95% CI: 0.67-0.97, p < 0.05). Findings warrant further research, while highlighting the importance of establishing and integrating Roma nutrition into national surveillance and monitoring systems for key dietary risk factors.
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Affiliation(s)
- Erand Llanaj
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary; (E.L.); (F.V.); (J.S.)
- Doctoral School of Health Sciences, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary; (E.L.); (F.V.); (J.S.)
- Doctoral School of Health Sciences, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary
| | - Zsigmond Kósa
- Department of Methodology for Health Visitors and Public Health, Faculty of Health, University of Debrecen, Sóstói street 2–4, H-4400 Nyíregyháza, Hungary;
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary; (E.L.); (F.V.); (J.S.)
| | - Judit Diószegi
- MTA-DE-Public Health Research Group, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary;
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary; (E.L.); (F.V.); (J.S.)
- MTA-DE-Public Health Research Group, University of Debrecen, Kassai street 26/B, H-4028 Debrecen, Hungary;
- Correspondence: ; Tel.: +36-52-512-765 (ext. 77147)
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'Differences between the earth and the sky': migrant parents' experiences of child health services for pre-school children in the UK. Prim Health Care Res Dev 2020; 21:e29. [PMID: 32799953 PMCID: PMC7443772 DOI: 10.1017/s1463423620000213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: To explore parents’ experiences of using child health services for their pre-school children post-migration. Background: Migrating between countries necessitates movement and adjustment between systems of healthcare. Children of migrants are known to have poorer health than local children on some measures and are less likely to access primary care. In the United Kingdom (UK), children are offered a preventive Healthy Child programme in addition to reactive services; this programme consists of health reviews and immunisations with some contacts delivered in the home by public health nurses. Methods: Five focus groups were held in a city in South West England. Participants were parents of pre-school children (n = 28) who had migrated to the UK from Romania, Poland, Pakistan or Somalia within the last 10 years. Groups selected included both ‘new migrants’ (from countries which acceded to the European Union in the 2000s) and those from communities long-established in the UK (Somali and Pakistani). One focus group consisted of parents of Roma ethnicity. Interpreters co-facilitated focus groups. Findings: Participants described profound differences between child health services in the UK and in their country of origin, with the extent of difference varying according to nationality and ethnic group. All appreciated services free at the point of delivery and an equitable service offered to all children. Primary care services such as treatment of minor illness and immunisation were familiar, but most parents expected doctors rather than nurses to deliver these. Proactive child health promotion was unfamiliar, and some perceived this service as intruding on parental autonomy. Migrants are not a homogenous group, but there are commonalities in migrant parents’ experiences of UK child health services. When adjusting to a new healthcare system, migrants negotiate differences in service provision and also a changing relationship between family and state.
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Lämsä R, Castaneda AE, Weiste A, Laalo M, Koponen P, Kuusio H. The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165825. [PMID: 32806508 PMCID: PMC7460452 DOI: 10.3390/ijerph17165825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods.
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Affiliation(s)
- Riikka Lämsä
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Correspondence:
| | - Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Anneli Weiste
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Marianne Laalo
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
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Dlouhá L, Adámková V, Šedová L, Olišarová V, Hubáček JA, Tóthová V. Five genetic polymorphisms of cytochrome P450 enzymes in the Czech non-Roma and Czech Roma population samples. Drug Metab Pers Ther 2020; 35:/j/dmdi.2020.35.issue-2/dmpt-2020-0103/dmpt-2020-0103.xml. [PMID: 32681777 DOI: 10.1515/dmpt-2020-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
Objectives Cytochromes P450 play a role in human drugs metabolic pathways and their genes are among the most variable in humans. The aim of this study was to analyze genotype frequencies of five common polymorphisms of cytochromes P450 in Roma/Gypsy and Czech (non-Roma) population samples with Czech origin. Methods Roma/Gypsy (n=302) and Czech subjects (n=298) were genotyped for CYP1A2 (rs762551), CYP2A6 (rs4105144), CYP2B6 (rs3745274) and CYP2D6 (rs3892097; rs1065852) polymorphisms using PCR-RFLP or Taqman assay. Results We found significant allelic/genotype differences between ethnics in three genes. For rs3745274 polymorphism, there was increased frequency of T allele carriers in Roma in comparison with Czech population (53.1 vs. 43.7%; p=0.02). For rs4105144 (CYP2A6) there was higher frequency of T allele carriers in Roma in comparison with Czech population (68.7 vs. 49.8%; p<0.0001). For rs3892097 (CYP2D6) there was more carriers of the A allele between Roma in comparison with Czech population (39.2 vs. 38.2%; p=0.048). Genotype/allelic frequencies of CYP2D6 (rs1065852) and CYP1A2 (rs762551) variants did not significantly differ between the ethnics. Conclusions There were significant differences in allelic/genotype frequencies of some, but not all cytochromes P450 polymorphisms between the Czech Roma/Gypsies and Czech non-Roma subjects.
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Affiliation(s)
- Lucie Dlouhá
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Šedová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
| | - Věra Olišarová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
| | - Jaroslav A Hubáček
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Valérie Tóthová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
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Dlouhá L, Adámková V, Šedová L, Olišarová V, Hubáček JA, Tóthová V. Five genetic polymorphisms of cytochrome P450 enzymes in the Czech non-Roma and Czech Roma population samples. Drug Metab Pers Ther 2020; 0:/j/dmdi.ahead-of-print/dmdi-2020-0103/dmdi-2020-0103.xml. [PMID: 32609646 DOI: 10.1515/dmdi-2020-0103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 01/15/2023]
Abstract
Objectives Cytochromes P450 play a role in human drugs metabolic pathways and their genes are among the most variable in humans. The aim of this study was to analyze genotype frequencies of five common polymorphisms of cytochromes P450 in Roma/Gypsy and Czech (non-Roma) population samples with Czech origin. Methods Roma/Gypsy (n=302) and Czech subjects (n=298) were genotyped for CYP1A2 (rs762551), CYP2A6 (rs4105144), CYP2B6 (rs3745274) and CYP2D6 (rs3892097; rs1065852) polymorphisms using PCR-RFLP or Taqman assay. Results We found significant allelic/genotype differences between ethnics in three genes. For rs3745274 polymorphism, there was increased frequency of T allele carriers in Roma in comparison with Czech population (53.1 vs. 43.7%; p=0.02). For rs4105144 (CYP2A6) there was higher frequency of T allele carriers in Roma in comparison with Czech population (68.7 vs. 49.8%; p<0.0001). For rs3892097 (CYP2D6) there was more carriers of the A allele between Roma in comparison with Czech population (39.2 vs. 38.2%; p=0.048). Genotype/allelic frequencies of CYP2D6 (rs1065852) and CYP1A2 (rs762551) variants did not significantly differ between the ethnics. Conclusions There were significant differences in allelic/genotype frequencies of some, but not all cytochromes P450 polymorphisms between the Czech Roma/Gypsies and Czech non-Roma subjects.
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Affiliation(s)
- Lucie Dlouhá
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Šedová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
| | - Věra Olišarová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
| | - Jaroslav A Hubáček
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Valérie Tóthová
- Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czech Republic
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Anthonj C, Setty KE, Ezbakhe F, Manga M, Hoeser C. A systematic review of water, sanitation and hygiene among Roma communities in Europe: Situation analysis, cultural context, and obstacles to improvement. Int J Hyg Environ Health 2020; 226:113506. [DOI: 10.1016/j.ijheh.2020.113506] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/23/2023]
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Macejova Z, Kristian P, Janicko M, Halanova M, Drazilova S, Antolova D, Marekova M, Pella D, Madarasova-Geckova A, Jarcuska P. The Roma Population Living in Segregated Settlements in Eastern Slovakia Has a Higher Prevalence of Metabolic Syndrome, Kidney Disease, Viral Hepatitis B and E, and Some Parasitic Diseases Compared to the Majority Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3112. [PMID: 32365672 PMCID: PMC7246595 DOI: 10.3390/ijerph17093112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
Background: The Roma population is one of the largest marginalized population groups in Europe. The aim of our work was to summarize the morbidity of lifestyle-related diseases and infectious diseases in the Roma population living in segregated settlements. Methods: We used data from the cross-sectional study HepaMeta, in which we examined 452 Roma subjects with an average age of 34.7 ± 9.1 years, 35.2% of which were men, and 403 non-Roma subjects with an average age of 33.5 ± 7.4 years, 45.9% of which were men. We collected data by means of a questionnaire, anthropometric measures, and we analyzed blood and urine samples. Results: Roma subjects had a higher incidence of metabolic syndrome (RR: 1.478 (1.159-1.885), p < 0.0001), obesity or waist circumference >94 cm in men/80 cm in women (RR: 1.287 (1.127-1.470), p < 0.0001), and HDL-C < 1.03 mmol/L in men or <1.29 in women (RR: 2.004 (1.730-2.321), p < 0.0001) than their non-Roma counterparts. Subjects of the Roma population were more frequently diagnosed with kidney disease (RR: 1.216 (1.096-1.349), p < 0.0001), HBsAg positivity (RR: 4.468 (2.373-8.415), p < 0.0001), anti HBc IgG positivity (RR: 3.13 (2.598-4.224), p < 0.0001), and anti HEV positivity (RR: 2.972 (1.226-7.287), p < 0.0001). Serological markers of Toxoplasma gondii infection and Toxocara spp. were observed much more frequently among Roma than non-Roma subjects (RR: 1.868 (1.520-2.296), p < 0.0001, for Toxoplasma gondii; and RR: 21.812 (8.097-58.761), p < 0.0001, for Toxocara spp.). Conclusions: Poor socio-economic conditions, an unhealthy lifestyle, and barriers precluding access to healthcare are factors that affect the Roma population in settlements and lead to an increased prevalence of metabolic syndrome and its components, kidney disease, viral hepatitis B and E, and some parasitic diseases.
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Affiliation(s)
- Zelmira Macejova
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, 040 11 Kosice, Slovakia;
| | - Pavol Kristian
- Department of Infectology and Travel Medicine, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, 040 01 Kosice, Slovakia
| | - Martin Janicko
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, 040 11 Kosice, Slovakia; (M.J.); (P.J.)
| | - Monika Halanova
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Safarik University, 040 01 Kosice, Slovakia;
| | - Sylvia Drazilova
- Department of Internal Medicine, Hospital Poprad and Faculty of Medicine, Pavol Jozef Safarik University, 058 01 Poprad, Slovakia;
| | - Daniela Antolova
- Department of Parasitic Diseases, Institute of Parasitology SAS, Hlinkova 3, 040 01 Kosice, Slovakia;
| | - Maria Marekova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, 040 11 Kosice, Slovakia;
| | - Daniel Pella
- 2nd Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak, Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University, 040 11 Kosice, Slovakia;
| | - Andrea Madarasova-Geckova
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, 040 11 Kosice, Slovakia;
| | - Peter Jarcuska
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, 040 11 Kosice, Slovakia; (M.J.); (P.J.)
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Coheña-Jiménez M, Chicharro-Luna E, Algaba-Del-Castillo J, Páez-Tudela A. Foot health among the Roma population of southern Spain according to the foot health status questionnaire. BMC Public Health 2020; 20:462. [PMID: 32252719 PMCID: PMC7137201 DOI: 10.1186/s12889-020-08571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot health of the Roma population is a challenge for the health professionals where this minority is significant, as is the case in Spain. At present, little is known about foot health of the Roma population and their knowledge would promote the training of these professionals at the community level. Foot pain is common and a reason for consulting podiatry services. The purpose of this study was to determine foot health among the Roma population according to the Foot Health Status Questionnaire. METHOD An observational, cross-sectional and quantitative study conducted at the Roma population living in Spain in 2018. Self-reported data and the Foot Health Status Questionnaire were recorded. Examining the general health and foot health (foot pain, foot function, footwear and general health) and general (general health, social capacity, physical activity and vigour). This questionnaire is recommended as a valid and reliable patient-reported outcome. The obtained scores were compared. RESULTS A sample made up of 624 men and women from the Roma population took part in this study. 45% were Roma men and 55% Roma women. In the first section of the FHSQ, a lower score of values was recorded in the footwear domain (62.5) and in the general foot health domain (60). Gypsy women obtained lower scores in all the domains. In the second section, lower scores were obtained in the vigour (56) domain and in the general health (60) domain. A large effect size (r-Rosenthal) was found by gender in the footwear domain (0.334) and in the vigour domain (0.195). Roma women showed higher values in cardiac disorders, serious illnesses, doctor visits and foot problems. 67.8% reported that they had never been assisted by a podiatrist. CONCLUSIONS The studied Roma population has foot health problems, and these are more pronounced among women. They show lower values in the footwear and vigour domains. More professional training is required for health workers in this field to avoid cultural diversity stereotypes.
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Affiliation(s)
- Manuel Coheña-Jiménez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
| | - Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain
| | - José Algaba-Del-Castillo
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
| | - Amanda Páez-Tudela
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
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Chomynová P, Kozák J, Mravčík V. Substance use in Roma population in contact with social workers in the Czech Republic: A cross-sectional questionnaire survey. J Ethn Subst Abuse 2020; 20:275-294. [PMID: 31990239 DOI: 10.1080/15332640.2020.1717399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An increasing number of studies have focused on the topic of Roma communities and social exclusion in the Czech Republic, however, substance use has been surveyed only marginally. This paper brings new data on the patterns of substance use among Roma population in contact with social workers (546 respondents). Substance use, including daily smoking and regular excessive alcohol drinking, has been 2-6 times higher among Roma compared to the general population. Current illicit substance use was reported by 1/3 of the respondents (46.7% of males, 17.8% of females) with cannabis (27.1%) and methamphetamine (11.9%) being the most reported substances.
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Affiliation(s)
- Pavla Chomynová
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Department of Addictology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kozák
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Viktor Mravčík
- Czech National Monitoring Centre for Drugs and Addictions, Office of the Government of the Czech Republic, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Department of Addictology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Heaslip V, Vanceulebroeck V, Kalkan I, Kömürcü N, Solanas IA. Student nurse perceptions of Gypsy Roma Travellers; A European qualitative study. NURSE EDUCATION TODAY 2019; 82:1-7. [PMID: 31408833 DOI: 10.1016/j.nedt.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/22/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.
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Affiliation(s)
- Vanessa Heaslip
- Department of Nursing Bournemouth University, United Kingdom; Associate Professor Department of Social Sciences, University of Stavanger, Norway.
| | | | - Indrani Kalkan
- Faculty of Health Sciences, Istanbul Aydin University, Turkey.
| | - Nuran Kömürcü
- Faculty of Health Sciences, Istanbul Aydin University, Turkey.
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Todor BI, Scrobota I, Todor L, Lucan AI, Vaida LL. Environmental Factors Associated with Malocclusion in Children Population from Mining Areas, Western Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183383. [PMID: 31547435 PMCID: PMC6765924 DOI: 10.3390/ijerph16183383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/29/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022]
Abstract
Our study is based on the hypothesis that the prevalence of malocclusions in children is higher in the mining areas from North-Western (NW) Romania than in other geographic areas. We also considered that the distribution of the different types of malocclusions can be correlated with environmental factors. Therefore, the main purpose of the current study was to assess the prevalence of malocclusions in children from the mining areas in NW Romania. Another purpose was to establish the influence of certain environmental factors such as gender, geographical area of origin, and ethnicity on the distribution of malocclusions in order to provide an epidemiological reference for the planning of preventive and treatment programs adapted to the particularity of the mining areas. This cross-sectional study was performed in 2015-2016. The study batch consisted of 960 children from the mining areas, aged 7-14 years, in the period of mixed dentition and early permanent dentition. The clinical examination was conducted by a single examiner, an orthodontic specialist (TBI), in order to avoid inter-operator bias. Occlusion was registered according to Bjoerk. Occlusal clinical signs were followed for the determination of malocclusions. Most children had malocclusions (93.5%). The percentage of anomalies was significantly higher in subjects from Rosia Montana, in girls, and in the Romanians. Data showed that Angle Class I was the most prevalent malocclusion (60.21%), followed by crowding (47.5%), midline shift (43.33%), and deep bite (28.65%). The independent association between ethnicity and total malocclusions shows that the Romanian subjects presented a 3.31 higher chance of developing malocclusions than the Romani ones. The presence of malocclusions was independently influenced by all the studied environmental factors, namely gender, geographical area, and ethnicity. Our results could be relevant for oral health policy-making, i.e., planning preventive and treatment measures of malocclusions, adapted to the peculiarity of the studied mining areas.
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Affiliation(s)
- Bianca Ioana Todor
- Faculty of Medicine and Pharmacy, Department of Dentistry, University of Oradea, 410087 Oradea, Romania.
| | - Ioana Scrobota
- Faculty of Medicine and Pharmacy, Department of Dentistry, University of Oradea, 410087 Oradea, Romania.
| | - Liana Todor
- Faculty of Medicine and Pharmacy, Department of Dentistry, University of Oradea, 410087 Oradea, Romania.
| | - Alexandra Ioana Lucan
- Faculty of Medicine and Pharmacy, Department of Dentistry, University of Oradea, 410087 Oradea, Romania.
| | - Luminita Ligia Vaida
- Faculty of Medicine and Pharmacy, Department of Dentistry, University of Oradea, 410087 Oradea, Romania.
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31
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Villarroel N, Davidson E, Pereyra-Zamora P, Krasnik A, Bhopal RS. Heterogeneity/granularity in ethnicity classifications project: the need for refining assessment of health status. Eur J Public Health 2019; 29:260-266. [PMID: 30260371 DOI: 10.1093/eurpub/cky191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. METHODS We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). RESULTS Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. CONCLUSIONS (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy.
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Affiliation(s)
- Nazmy Villarroel
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK.,Graduate Entry Medical School, University of Limerick, Ireland
| | - Emma Davidson
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Spain
| | - Allan Krasnik
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Raj S Bhopal
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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32
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Condon L, Bedford H, Ireland L, Kerr S, Mytton J, Richardson Z, Jackson C. Engaging Gypsy, Roma, and Traveller Communities in Research: Maximizing Opportunities and Overcoming Challenges. QUALITATIVE HEALTH RESEARCH 2019; 29:1324-1333. [PMID: 30600758 PMCID: PMC7322935 DOI: 10.1177/1049732318813558] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Gypsy, Roma, and Traveller people are marginalized worldwide and experience severe health inequalities, even in comparison to other ethnic minority groups. While diverse and hard to categorize, these communities are highly cohesive and members have a strong sense of identity as a group apart from the majority population. Researchers commonly experience challenges in accessing, recruiting, and retaining research participants from these communities, linked to their outsider status, insular nature, and history of discrimination. In this article, the challenges and the opportunities of engaging Gypsies, Roma, and Travellers in a multicenter qualitative research project are discussed. The management of public involvement and community engagement in this U.K.-based project provides insights into conducting research effectively with ethnically and linguistically diverse communities, often considered to be "hard to reach."
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Affiliation(s)
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lana Ireland
- Glasgow Caledonian University, Glasgow, Scotland
| | - Susan Kerr
- Glasgow Caledonian University, Glasgow, Scotland
| | - Julie Mytton
- University of the West of England, Bristol, United Kingdom
| | - Zoe Richardson
- NHS Wakefield Clinical Commissioning Group, Wakefield, United Kingdom
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Hubáček JA, Šedová L, Olišarová V, Adámková V, Adámek V, Tóthová V. Distribution of ADH1B genotypes predisposed to enhanced alcohol consumption in the Czech Roma/Gypsy population. Cent Eur J Public Health 2019; 26:284-288. [PMID: 30660139 DOI: 10.21101/cejph.a5090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to analyse the frequencies of rs1229984 genotypes within the alcohol dehydrogenase (ADH1B) gene in a Gypsies/Roma population and compare them with other populations and with ethanol consumption. METHODS We analysed the ADH1B (rs1229984; Arg47→His; c.143G>A) genotype using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) in two ethnically different groups - Gypsies/Roma (N = 301) and Czechs (N = 300) where one day alcohol consumption was recorded. RESULTS ADH1B genotype/allelic frequencies did not significantly differ between the populations (p = 0.32). The frequency of minor A allele carriers was slightly higher in Gypsies/Roma (14.7%) than in Czechs (11.9%). The prevalence of subjects reporting alcohol intake on the previous day was non-significantly lower in Gypsies/Roma (10.5% vs. 16.4%), as was the amount of alcohol consumed the day before the examination in ethanol consumers (36.1 ± 18.3 g vs. 43.0 ± 27.2 g). CONCLUSIONS The frequency of rs1229984 genotypes in the ADH1B gene within the Gypsies/Roma population corresponds with frequencies obtained in North India/Central Asia, the putative country of this ethnic origin. Our results suggest that the minority Gypsies/Roma population consume slightly less alcohol than the Czech majority population.
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Affiliation(s)
- Jaroslav A Hubáček
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Šedová
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Věra Olišarová
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Václav Adámek
- Faculty of Biomedical Engineering, Czech Technical University, Kladno, Czech Republic
| | - Valérie Tóthová
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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34
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Mutumba M, Schulenberg J. Cross-national variation in the subjective wellbeing of youth in low and middle income countries: The role of structural and micro-level factors. JOURNAL OF YOUTH STUDIES 2019; 23:252-268. [PMID: 32952436 PMCID: PMC7500488 DOI: 10.1080/13676261.2019.1597257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/13/2019] [Indexed: 06/11/2023]
Abstract
Subjective wellbeing (i.e. life satisfaction and happiness) impacts youth's social, economic and political participation. Prior studies have documented cross-national variation in subjective wellbeing of adults but there is a lack of data on the prevalence and correlates of subjective wellbeing among youth in low and middle income countries. This paper utilizes data from an international dataset - Multiple Indicator Cluster Surveys to assess the influence of structural and micro-level factors on the subjective wellbeing of youth (ages 15 - 24) in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa. We find that within countries, global life satisfaction and happiness are associated with age, education attainment, place of residence, marital status, household wealth and exposure to mass media. Significant interactions between age, gender and education are observed. However, none of the country level development indicators account for cross-national variation in youth's SWB although there is some indication that income inequities between countries may influence youth's SWB. The findings underscore the need for objective measures of subjective wellbeing to understand the conditions in LMICs.
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Affiliation(s)
| | - John Schulenberg
- Institute for Social Research and Department of Psychology, Ann Arbor, MI 48106-1248
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35
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Nunes MA, Kučerová K, Lukáč O, Kvapil M, Brož J. Prevalence of Diabetes Mellitus among Roma Populations-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112607. [PMID: 30469436 PMCID: PMC6265881 DOI: 10.3390/ijerph15112607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to estimate the prevalence of diabetes mellitus in the Roma population and compare it to the prevalence in the Caucasian population. Methods: Using the words “Roma”, “Gypsies”, “Romani”, and ”traveler” in combination with “diabetes, “metabolic syndrome”, “cardiovascular disease” and “health status” we searched the MEDLINE, Pubmed and Scopus databases for articles in English that focused on the prevalence of diabetes mellitus among Roma populations published until December 2017. Results: Five studies met the inclusion criteria. The results of four of them suggested a higher prevalence of diabetes among Romani compared to Caucasians but none of them reached the standards regarding representative samples and number of cases for a conclusive result. Conclusion: Although some of the existing studies suggest a substantial prevalence of diabetes among Roma populations and even a higher risk of developing diabetes for Roma persons compared to Caucasians, the number of published literature on this topic remains very low and insufficient in design and number of participants to draw any conclusions.
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Affiliation(s)
- Marisa A Nunes
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic.
| | - Kristýna Kučerová
- Arbeitsgemeinschaft der Belegärzte am Alice-Hospital, 64287 Darmstadt, Germany.
| | - Ondřej Lukáč
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic.
| | - Milan Kvapil
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic.
| | - Jan Brož
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, 150 00 Prague 5, Czech Republic.
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36
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Roma Representation in Danish Roma Policy and Public Discourse—A Critical Analysis. SOCIETIES 2018. [DOI: 10.3390/soc8030063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Imagined stereotypes of Roma are prevailing across Europe and have an impact of discrimination and social exclusion of the Roma. In 2011, Denmark published their National Roma Inclusion Strategy as a response to the Europe 2020 Growth Strategy. This study analyses how the Roma are represented in the national policy and in ongoing discourse regarding Roma in newspaper articles published around the time of the publication of the Strategy. A critical discourse analysis was conducted, and the findings show that a profound stigmatization of the Roma was common and acceptable in both Danish nationalistic media discourse and in the paternalistic policy discourse. The Roma were represented as an alienated, non-empowered group in contrast to the majority population and lacking any useful qualities. There was a lack of Roma voices in both policy and newspapers. The discourses regarding Roma in Denmark are lacking both Roma influence and initiatives to change Roma conditions.
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37
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Condon LJ, McClean S. Maintaining pre-school children's health and wellbeing in the UK: a qualitative study of the views of migrant parents. J Public Health (Oxf) 2018; 39:455-463. [PMID: 27591301 PMCID: PMC5896591 DOI: 10.1093/pubmed/fdw083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/16/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is evidence that key health behaviours of people who migrate deteriorate over time, which has a consequent impact upon the health of dependent children. As health in the early years sets the course for lifelong health, it is important to explore parents' views on maintaining children's health following migration. Methods Five focus groups were held with parents of preschool children who had migrated to the UK within the last 10 years (n = 28). Parents originated from Romania, Poland, Somalia and Pakistan, with one group of Roma Gypsy parents. Data collection took place in January to March 2015. Results All groups, apart from the Roma, perceived barriers to maintaining optimal health and well-being for their preschool children following migration to the UK. Eastern European parents experienced difficulties in ensuring family financial security, while parents from more established communities focused on barriers to children's exercise, play and nutrition. Conclusions This study highlights aspects of public health where migrants and their children can experience adverse effects in the UK. These findings have implications for policymakers, commissioners and providers of health services who aim to promote good health among preschool children.
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Affiliation(s)
- L J Condon
- Department of Nursing, University of Swansea, SwanseaSA2 8PP, UK
| | - S McClean
- Department of Health and Social Sciences, University of the West of England, BristolBS16 1QY, UK
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38
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Taking stock of Roma health policies in Spain: Lessons for health governance. Health Policy 2018; 122:444-451. [PMID: 29548514 DOI: 10.1016/j.healthpol.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/19/2017] [Accepted: 02/28/2018] [Indexed: 11/22/2022]
Abstract
Roma health inequities are a wicked problem. Despite concerted efforts to reduce them under the Decade of Roma Inclusion initiative, the health gap between Roma and non-Roma populations in Europe persists. To address this problem, the European Commission devised the National Roma Integration Strategies (NRIS). This paper provides a critical assessment of the implementation of the NRIS' health strand (NRIS-H) in Spain and proposes an evaluation tool to monitor Roma health policies - the Roma Health Integration Policy Index (RHIPEX). It also makes recommendations to promote Roma health governance. To achieve these goals, four community forums, 33 stakeholder interviews and a scoping review were conducted. Results show that the NRIS-H implementation is hindered by lack of political commitment and poor resource allocation. This has a negative impact on Roma's entitlement to healthcare and on their participation in decision-making processes, jeopardising the elimination of the barriers that undermine their access to healthcare and potentially contributing to reproduce inequalities. These unintended effects point out the need to rethink Roma health governance by strengthening intersectional and intersectoral policies, enabling transformative Roma participation in policymaking and guaranteeing shared socio-political responsibility and accountability.
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39
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Escobar-Ballesta M, García-Ramírez M, Miranda D, Petrova-Benedict R. Shedding light on governance for Roma health inequities. J Prev Interv Community 2017; 46:84-99. [PMID: 29281603 DOI: 10.1080/10852352.2018.1386340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The health inequities suffered by the Roma population in Europe represent an alarming and unacceptable source of injustice. As the main ethnic minority in Europe, the gap between the health conditions of the Roma and the rest of the population poses a challenge to human rights and public health. Many political efforts have been deployed in Europe to tackle these inequities. However, they have fallen short, even causing paradoxical consequences. In this paper, we argue that previous political efforts have failed because they were developed from a neoliberal perspective, which perceives Roma health inequities as isolated ethnic problems for which there is no political accountability. Hence, there is a need for transformative political change that results in the protection of rights and self-governance to address health inequities experienced by Roma people. We propose a framework of health governance guided by the following principles: (a) effective involvement of multiple stakeholders by building collaborative capacity; (b) infusion of health perspectives in all policies and multisectoral actions;
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Affiliation(s)
| | | | - Daniela Miranda
- a Department of Social Psychology CESPYD , Universidad de Sevilla , Seville , Spain
| | - Roumyana Petrova-Benedict
- b International Organization for Migration , Senior Regional Migration Health Manager for Europe and Central Asia at the Regional Office in Brussels , Brussels , Belgium
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40
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Garcia-Espinel T, Aso L, Redondo-Sama G, Flecha A. Roma Never Die Alone. QUALITATIVE HEALTH RESEARCH 2017; 27:2189-2200. [PMID: 28905680 DOI: 10.1177/1049732317729138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A common characteristic of Roma as a cultural group is that they do not allow their elderly to die alone. Nevertheless, rooted in a mainstream cultural perspective of health provision services, public institutions usually do not allow Roma people to be with their loved ones in their last moments. Following the communicative methodology, we conducted a communicative case study on the death of the most relevant female Roma leader in Catalonia. She was accompanied by more than two hundred family members and friends in her room and corridor at an important hospital in Barcelona. We performed our research in the 2 years following her death to obtain the reflections of the Roma members involved. These reflections revealed the egalitarian dialogue forged between these Roma members and the hospital personnel, which enabled the former to embrace their culture and support their loved ones before death. Because this dialogue was possible and fruitful, the acknowledgment of cultural diversity and the improvement of the quality of services offered to Roma might also be possible in other health institutions.
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Affiliation(s)
| | - Laura Aso
- 1 University of Barcelona, Barcelona, Spain
| | | | - Ainhoa Flecha
- 2 Autonomous University of Barcelona, Barcelona, Spain
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41
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Powell Doherty R, Telionis PA, Müller-Demary D, Hosszu A, Duminica A, Bertke A, Lewis B, Eubank S. A survey of quality of life indicators in the Romanian Roma population following the 'Decade of Roma Inclusion'. F1000Res 2017; 6:1692. [PMID: 30774929 PMCID: PMC6357989 DOI: 10.12688/f1000research.12546.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
Background: This study explores how the Roma in Romania, the EU's most concentrated population, are faring in terms of a number of quality of life indicators, including poverty levels, healthcare, education, water, sanitation, and hygiene. It further explores the role of synthetic populations and modelling in identifying at-risk populations and delivering targeted aid. Methods: 135 surveys were conducted across five geographically diverse Romanian communities. Household participants were selected through a comprehensive random walk method. Analyses were conducted on all data using Pandas for Python. Combining land scan data, time-use survey analyses, interview data, and ArcGIS, the resulting synthetic population was analysed via classification and regression tree (CART) analysis to identify hot-spots of need, both ethnically and geographically. Results: These data indicate that the Roma in Romania face significant disparities in education, with Roma students less likely to progress beyond 8 th grade. In addition, the Roma population remains significantly disadvantaged with regard to safe and secure housing, poverty, and healthcare status, particularly in connection to diarrheal disease. In contrast, however, both Roma and non-Roma in rural areas face difficulties regarding full-time employment, sanitation, and water, sanitation, and hygiene infrastructure. In addition, the use of a synthetic population can generate information about 'hot spots' of need, based on geography, ethnicity, and type of aid required. Conclusions: These data demonstrate the challenges that remain to the Roma population in Romania, and also point to the myriad of ways in which all rural Romanians, regardless of ethnicity, are encountering hardship. This study highlights an approach that combines traditional survey data with more wide-reaching geographically based data and CART analysis to determine 'hot spot' areas of need in a given population. With the appropriate inputs, this tool can be extrapolated to any population in any country.
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Affiliation(s)
- Rebecca Powell Doherty
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA.,Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Pyrros A Telionis
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA.,Department of Geography, Virginia Tech, Blacksburg, VA, USA
| | | | | | | | - Andrea Bertke
- Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Bryan Lewis
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
| | - Stephen Eubank
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
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42
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Powell Doherty R, Telionis PA, Müller-Demary D, Hosszu A, Duminica A, Bertke A, Lewis B, Eubank S. A survey of quality of life indicators in the Romanian Roma population following the 'Decade of Roma Inclusion'. F1000Res 2017; 6:1692. [PMID: 30774929 PMCID: PMC6357989 DOI: 10.12688/f1000research.12546.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 01/10/2024] Open
Abstract
Background: This study explores how the Roma in Romania, the EU's most concentrated population, are faring in terms of a number of quality of life indicators, including poverty levels, healthcare, education, water, sanitation, and hygiene. It further explores the role of synthetic populations and modelling in identifying at-risk populations and delivering targeted aid. Methods: 135 surveys were conducted across five geographically diverse Romanian communities. Household participants were selected through a comprehensive random walk method. Analyses were conducted on all data using Pandas for Python. Combining land scan data, time-use survey analyses, interview data, and ArcGIS, the resulting synthetic population was analysed via classification and regression tree (CART) analysis to identify hot-spots of need, both ethnically and geographically. Results: These data indicate that the Roma in Romania face significant disparities in education, with Roma students less likely to progress beyond 8 th grade. In addition, the Roma population remains significantly disadvantaged with regard to safe and secure housing, poverty, and healthcare status, particularly in connection to diarrheal disease. In contrast, however, both Roma and non-Roma in rural areas face difficulties regarding full-time employment, sanitation, and water, sanitation, and hygiene infrastructure. In addition, the use of a synthetic population can generate information about 'hot spots' of need, based on geography, ethnicity, and type of aid required. Conclusions: These data demonstrate the challenges that remain to the Roma population in Romania, and also point to the myriad of ways in which all rural Romanians, regardless of ethnicity, are encountering hardship. This study highlights an approach that combines traditional survey data with more wide-reaching geographically based data and CART analysis to determine 'hot spot' areas of need in a given population. With the appropriate inputs, this tool can be extrapolated to any population in any country.
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Affiliation(s)
- Rebecca Powell Doherty
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
- Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Pyrros A. Telionis
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
- Department of Geography, Virginia Tech, Blacksburg, VA, USA
| | | | | | | | - Andrea Bertke
- Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Bryan Lewis
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
| | - Stephen Eubank
- Biocomplexity Institute of Virginia Tech, Blacksburg, VA, USA
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Chaudhuri IN. Community Mobilization for Slum Upgrading through Sanitation in Roma Informal Settlements in the Paris Region. Front Public Health 2017; 5:213. [PMID: 28871278 PMCID: PMC5566561 DOI: 10.3389/fpubh.2017.00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community-based processes addressing environment, housing, and health issues may decrease health inequities by addressing social, economic, and political health determinants more effectively. Yet little analysis of their effectiveness has been undertaken and their potential transfer to marginalized groups in rich country settings. In Europe, stark health inequalities are seen among the Roma, Europe's most impoverished community who often reside in informal settlements suffering from illiteracy, inadequate housing, and lack of water and sanitation. This paper assesses a dry sanitation project in a Roma informal settlement in the Paris region to improve their living conditions. METHODS Between 2014 and 2017, multiple stakeholders were involved in a participatory process of design, construction, and maintenance of toilets. Interviews, mapping, model construction, and facilitated discussion were used to identify design features and follow-up indicators. Field notes, videos, questionnaires, and observation provided data for monitoring and evaluation. For questionnaires delivered to women in the community, a cross section time series was conducted to due to migration. RESULTS Despite issues related to maintenance, the overall quality of life of women improved after toilet construction. This included indicators for comfort, cleanliness, practicality, privacy, security, and menstrual hygiene management. Furthermore, fewer women restrained themselves from relieving themselves or from drinking less water to avoid urinating. Odors continued to be an issue. Self-reporting of illnesses, such as diarrhea and urinary tract infections, were not reliable due to the vague description of these illnesses and the potential recall bias. Appropriate sanitation in informal settlements is a necessity as shown by feedback from Roma women and the literature. However, a more sustainable toilet project would have required an adequate budget, good quality materials, accountability, and buy in from all inhabitants as well as good relationships between the chief and all stakeholders in the settlement. Furthermore, provision should have been made for vulnerable and less autonomous inhabitants to ensure proper follow-up and maintenance. CONCLUSION/RECOMMENDATIONS Safe water and sanitation is essential to decrease health inequities. Formative research, identifying natural leaders, sanitation committee formation, outcome indicator and baseline questionnaire development, appropriate messages and toilet design and placement, long-term follow-up, and political support are elements for effective interventions with the Roma. Potential attrition and reporting bias should be considered in monitoring and evaluation.
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Andreassen T, Weiderpass E, Nicula F, Suteu O, Itu A, Bumbu M, Tincu A, Ursin G, Moen K. Controversies about cervical cancer screening: A qualitative study of Roma women's (non)participation in cervical cancer screening in Romania. Soc Sci Med 2017; 183:48-55. [PMID: 28460211 DOI: 10.1016/j.socscimed.2017.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Romania has Europe's highest incidence and mortality of cervical cancer. While a free national cervical cancer-screening programme has been in operation since 2012, participation in the programme is low, particularly in minority populations. The aim of this study was to explore Roma women's (non)participation in the programme from women's own perspectives and those of healthcare providers and policy makers. We carried out fieldwork for a period of 125 days in 2015/16 involving 144 study participants in Cluj and Bucharest counties. Fieldwork entailed participant observation, qualitative interviewing and focus group discussions. A striking finding was that screening providers and Roma women had highly different takes on the national screening programme. We identified four fundamental questions about which there was considerable disagreement between them: whether a free national screening programme existed in the first place, whether Roma women were meant to be included in the programme if it did, whether Roma women wanted to take part in screening, and to what degree screening participation would really benefit women's health. On the background of insights from actor-network theory, the article discusses to what degree the programme could be said to speak to the interest of its intended Roma public, and considers the controversies in light of the literature on patient centred care and user involvement in health care. The paper contributes to the understanding of the health and health-related circumstances of the largest minority in Europe. It also problematizes the use of the concept of "barriers" in research into participation in cancer screening, and exemplifies how user involvement can potentially help transform and improve screening programmes.
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Affiliation(s)
- Trude Andreassen
- Cancer Registry of Norway, Oslo, Norway; Institute of Health and Society, University of Oslo, Norway.
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Florian Nicula
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Ofelia Suteu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania; "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Itu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Minodora Bumbu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Aida Tincu
- "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Norway
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Papamichail D, Petraki I, Arkoudis C, Terzidis A, Smyrnakis E, Benos A, Panagiotopoulos T. Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling. Eur J Public Health 2017; 27:318-324. [PMID: 27694159 PMCID: PMC5439213 DOI: 10.1093/eurpub/ckw179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. Methods We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7-10 children aged 24-77 months were selected from each settlement using systematic sampling. Information on children's vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. Results A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35-39% of children 'minimum vaccination' (DTP3 and IPV2 and MMR1) was administered, while 34-38% had received HepB3 and 31-35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Conclusions Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies.
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Affiliation(s)
- Dimitris Papamichail
- Department of Child Health, National School of Public Health, Athens, Greece
- Laboratory of Primary Health Care, General Practice and Health Services Research, Department of Medicine, Aristotle University of Thessaloniki
| | - Ioanna Petraki
- Programme “Education of Roma children”, Centre for Intercultural Studies, Faculty of Philosophy, Pedagogy and Psychology, University of Athens
- Programme of Postgraduate Education “International Medicine - Health Crisis Management”, Medical School, University of Athens
| | - Chrisoula Arkoudis
- Programme “Education of Roma children”, Centre for Intercultural Studies, Faculty of Philosophy, Pedagogy and Psychology, University of Athens
| | - Agis Terzidis
- Programme of Postgraduate Education “International Medicine - Health Crisis Management”, Medical School, University of Athens
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Department of Medicine, Aristotle University of Thessaloniki
| | - Alexis Benos
- Laboratory of Primary Health Care, General Practice and Health Services Research, Department of Medicine, Aristotle University of Thessaloniki
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Nagy K, Fiatal S, Sándor JS, Ádány R. Distinct Penetrance of Obesity-Associated Susceptibility Alleles in the Hungarian General and Roma Populations. Obes Facts 2017; 10:444-457. [PMID: 28988247 PMCID: PMC5741168 DOI: 10.1159/000478094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/08/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of our study was to explore differences in genetic predisposition to obesity between the Hungarian general and Roma populations. METHODS A total of 1,152 samples from the Hungarian Roma population and 1,743 samples from the Hungarian general population were genotyped for 20 single nucleotide polymorphisms (SNPs) associated with the risk of obesity. Two types of multilocus genetic risk scores were constructed to estimate the combined effect of selected SNPs. RESULTS Risk allele frequencies differed significantly between the two populations for 11 SNPs, with no enrichment in any of the two study groups. Variants (rs1558902, rs1121980, rs9939609, and rs9941349) in the fat mass and obesity-associated (FTO) gene exhibited strong but ethnicity-independent association with obesity. Genetic risk scores showed stronger associations with obesity in the Roma population compared with the Hungarian general population; however, without significant gene-population interaction. CONCLUSION Differences in obesity prevalence between the Hungarian general and Hungarian Roma populations could not be explained by their distinct genetic susceptibility, rather by ethnicity-related environmental and behavioral factors. Nonetheless, particular gene-environment interactions might contribute to the distinct penetrance of the obesity-associated genetic factors in populations of different ethnic backgrounds.
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Affiliation(s)
- Károly Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- *Károly Nagy, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 26 Kassai Street, Debrecen H 4012, Hungary,
| | - Szilvia Fiatal
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Center on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - JSános Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Center on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Center on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, University of Debrecen, Debrecen, Hungary
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McFadden A, Atkin K, Bell K, Innes N, Jackson C, Jones H, MacGillivray S, Siebelt L. Community engagement to enhance trust between Gypsy/Travellers, and maternity, early years' and child dental health services: protocol for a multi-method exploratory study. Int J Equity Health 2016; 15:183. [PMID: 27842597 PMCID: PMC5109772 DOI: 10.1186/s12939-016-0475-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/08/2016] [Indexed: 11/12/2022] Open
Abstract
Background Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. Methods This multi-method 30-month study, commenced in June 2015, and comprises four stages.Three related reviews: a) systematic review of Gypsy/Travellers’ access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers’ participation in health services. The reviews will consider any economic literature; Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice; Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32–48 mothers of pre-school children, 32–40 healthcare providers and 8–12 informants from third sector organisations. Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable.
Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one. The main outputs will be: a) an evaluative framework of Gypsy/Travellers’ engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs. Discussion Our novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy/Travellers. The findings may have wider resonance for other marginalised populations. Strengths and limitations of the study are discussed. Trial registration Prospero registration for literature reviews: CRD42015021955 and CRD42015021950 UKCRN reference: 20036
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Affiliation(s)
- Alison McFadden
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK.
| | - Karl Atkin
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Kerry Bell
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Nicola Innes
- Dental Hospital and School, University of Dundee, Park Place, Dundee, DD1 4HR, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Helen Jones
- Leeds Gypsy and Traveller Exchange, Crown Point House, 167-169 Cross Green Lane, Leeds, LS9 0BD, UK
| | - Steve MacGillivray
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK
| | - Lindsay Siebelt
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK
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Duval L, Wolff FC, McKee M, Roberts B. The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe. Vaccine 2016; 34:5524-5530. [PMID: 27727032 DOI: 10.1016/j.vaccine.2016.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
Abstract
AIM To investigate differences in vaccination coverage between Roma and otherwise comparable non-Roma children, including factors associated with the vaccination gap, health care access and discrimination faced by Roma. METHODS We analyse data from the Roma Regional Survey 2011 implemented in twelve countries of Central and South-East Europe. Our sample comprises 8233 children aged up to 6 with 7072 Roma children and 1161 non-Roma children. Estimates of the Roma vaccination gap are estimated using Logit regressions. RESULTS We find that the Roma children have a lower probability of being vaccinated compared to non-Roma (odds ratio=0.325). The odds of being vaccinated for a Roma child is 33.9% that of a non-Roma child for DPT, 34.4% for Polio, 38.6% for MMR and 45.7% for BCG. These differences do not appear to be explained entirely by their worse socio-economic status. The ethnic gap narrows by about 50% once individual characteristics are controlled for, with odds ratios of 0.548 for DPT, 0.559 for Polio, 0.598 for MMR and 0.704 for BCG. The probability of being vaccinated increases with access to health care, especially when Roma have a doctor to approach when needed. CONCLUSIONS Our findings point out a large difference in vaccination coverage between Roma and non-Roma and support the need for better understanding of factors influencing vaccination among Roma as well as policies that might improve services for Roma in Central and South-East Europe.
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Affiliation(s)
- Laetitia Duval
- School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom.
| | - François-Charles Wolff
- LEMNA, Université de Nantes, BP 52231 Chemin de la Censive du Tertre, 44322 Nantes Cedex, France; INED, Paris, France.
| | - Martin McKee
- ECOHOST - The Centre for Health and Social Change, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Bayard Roberts
- ECOHOST - The Centre for Health and Social Change, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Condon LJ, Salmon D. 'You likes your way, we got our own way': Gypsies and Travellers' views on infant feeding and health professional support. Health Expect 2015; 18:784-95. [PMID: 24890123 PMCID: PMC5060882 DOI: 10.1111/hex.12214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gypsies and Travellers are known to have poor health status and access to health services, even in comparison with other ethnic minority groups. People from this stigmatized ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve lifelong health. OBJECTIVE The aim of this study was to explore mothers and grandmothers' views on feeding in the first year of life, including the support provided by health professionals. METHODS Semi-structured interviews were conducted with a purposively selected sample of 22 mothers and grandmothers of English Gypsy, Irish Traveller and Romanian Roma ethnicity between November 2011 and February 2012 in a city in south-west England. RESULTS Few women perceived themselves as requiring help from health professionals in infant feeding, as acceptable and accessible support was available from within their own communities. Roma mothers described a tradition of breast-feeding and appropriately timed weaning, while English Gypsies and Irish Travellers customarily practised less healthy infant feeding. When mothers requested support, health service provision was often found inadequate. CONCLUSION Exploring the views of Gypsies and Travellers is important to gain insight into the provision of health services for this marginalized ethnic group. This study has implications for policy and the practice of health professionals, in indicating the customary feeding behaviours of some Gypsy and Travellers, and highlighting areas meriting culturally sensitive health promotion.
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Affiliation(s)
- Louise J Condon
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Debra Salmon
- Department of Health and Social Science, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Pappa E, Chatzikonstantinidou S, Chalkiopoulos G, Papadopoulos A, Niakas D. Health-Related Quality of Life of the Roma in Greece: The Role of Socio-Economic Characteristics and Housing Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6669-81. [PMID: 26075724 PMCID: PMC4483723 DOI: 10.3390/ijerph120606669] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
The aim was to assess the health-related quality of life (HRQL) of the Roma and further to detect the significant determinants that are associated with their HRQL. The cross-sectional study involved 1068 Roma adults living in settlements (mean age 36). HRQL was measured by the Greek version of SF-36 Health Survey and further socio-demographic characteristics (sex, age, marital status, education, permanent occupation etc.) and housing conditions (stable housing, access to basic amenities such as drinkable water, drainage, electricity which compose material deprivation) were involved. Non parametric tests and multiple linear regression models were applied to identify the factors that have significant association with HRQL. After controlling for socio-demographic characteristics, health status and housing conditions, sex, age, education, chronic diseases, stable housing and material deprivation were found to be significant determinants of the Roma’s HRQL. Men reported significantly better health than women as well as those who attended school compared to the illiterate. Chronic diseases were remarkably associated with poor HRQL from 10 units in MH (Mental Health) to 34 units in RP (Role Physical). Material deprivation was related to lower GH (General Health), and VT (Vitality) scores and higher RP (Role Physical) and RE (Role Emotional) scores. Chronic conditions and illiteracy are two key areas that contribute significantly to worse HRQL. Policies should be part of a comprehensive and holistic strategy for the Roma through intervention to education, housing and public health.
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Affiliation(s)
- Evelina Pappa
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece.
| | | | - George Chalkiopoulos
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece.
| | - Angelos Papadopoulos
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece.
- Department of Internal Medicine, "Attikon" University Hospital, 1 Rimini Street, Athens 12462, Greece.
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece.
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