PREVALENCE OF OVERWEIGHT AND OBESITY IN A ROMA POPULATION FROM SOUTHERN ROMANIA - CALARASI COUNTY

Diabetes Distress Among the Roma Population From a Tertiary Care Center in Romania

Background Distress in patients with diabetes is a condition that has received significant attention in recent years; however, data regarding the psychological assessment and the impact of the emotional burden of diabetes among the Roma population are still scarce in the medical literature. Material and methods We conducted an observational, transversal study that included 310 adult patients with diabetes mellitus, aged between 18 and 85 years old, of which the majority (61%) were women; patients were selected from a tertiary hospital providing diabetes care; diabetes distress was evaluated using a standardized questionnaire, the diabetes distress scale (DDS), validated on Romanian patients. Results In the study population, a great proportion of patients showed diabetes distress, with 24.8% (N=82) having moderate distress and 29.7% (N=121) having severe distress. In the Caucasian group, there were significantly more patients without distress than in the Roma patients,while on the contrary, more Roma patients experienced severe distress compared to the opposite group (64.5%, N=78 versus 35.5%, N=43). In the Caucasian group, a statistical significance was observed regarding interpersonal distress, with Caucasian women having a higher score than men. Concerning the Roma patients, total DDS and all subscales´ scores were statistically significant, with Roma women having higher scores than men. A statistical significance was observed between ethnicity and diabetes distress scores, with the Roma population having higher median values than Caucasian patients. It was also demonstrated that the lack of education, a higher diabetes evolution, and a higher glycated hemoglobin (HbA1c) level (above 8%) have influenced the risk of severe DDS in the Caucasian group, while in the Roma patients, employment status (being unemployed) represents a risk factor for severe DDS. Conclusion The Roma patients included in our study experienced higher distress scores compared to Caucasians. These results are substantial as they emphasize the need to include the evaluation of diabetes distress in clinical practice to facilitate the early initiation of intervention measures. There is nevertheless limited data regarding this particular ethnic group; therefore, further research is still needed.

Unveiling Health Inequalities: Exploring Metabolic Dysfunction in Rural Roma Communities

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.

A Retrospective Assessment of Laboratory Findings and Cytokine Markers in Severe SARS-CoV-2 Infection among Patients of Roma Population

Growing research data suggests that the severity of COVID-19 is linked with higher levels of inflammatory mediators, such as cytokines, chemokines, tumor necrosis factor, C-reactive protein, ferritin, and D-dimers. In addition, it was evident from the existing research data that the severity of SARS-CoV-2 infection differs according to independent risk factors such as race and ethnicity. Some scarce evidence shows that the European Roma community is likely to be at an elevated risk of illness and death during the pandemic due to their lifestyle, social factors, and economics. Assuming that precautions must be taken to protect this population from coronavirus infections and from widening existing disparities in comparison with the Romanian ethnic population, the current study aimed to observe the clinical evolution of the Roma patients with severe SARS-CoV-2 infection in correlation with the laboratory findings and inflammatory markers involved. After calculating the sample size requirements, we included 83 Roma patients admitted to the hospital with severe COVID-19 and 236 patients of Romanian ethnicity with the same inclusion criteria. Patients were selected from the period stretching from March 2020 to December 2021, before COVID-19 vaccines were introduced. Compared with the general population, the Roma patients with severe SARS-CoV-2 infection had a higher unemployment rate (39.8%), and most of them were residing in rural regions (65.4%). There were significantly more overweight patients in the Roma group than in the control group (57.8% vs. 40.7%), and it was also observed that high blood pressure and diabetes mellitus were significantly more prevalent in the Roma patients. They had significantly longer mean duration of hospitalization was significantly longer in the group of Roma patients (18.1 days vs. 16.3 days). IL-6 and CRP levels were significantly more elevated during admission in the group of Roma patients (43.4% vs. 28.4%); however, IL-6 levels normalized at discharge, but ESR remained high. Although ICU admissions were significantly more frequent in this group, the mortality rate was not significantly higher than in the general population. It is necessary to plan different healthcare strategies aimed at special populations, such as the Roma ethnicity to prevent disparities in negative outcomes reflected in this study. The results imply that community-health collaborations between organizations of minority groups and healthcare professionals can mitigate the disproportionate consequences of the pandemic on Roma.

Physical Activity Pattern Characterized by Domains and Dimensions of the Roma Population in Comparison with That of the General Population in Northeast Hungary

Our study focuses on examining physical activity, as one of the most influential health determinants by domains and dimensions among Roma, the largest vulnerable ethnic minority in Europe. The study was carried out on a sample representative of the Hungarian Roma (HR) population (n = 350) living in segregated colonies in Northeast Hungary in comparison with the Hungarian general (HG) population sample (n = 343) from the same region. Data were collected using the International Physical Activity Questionnaire (IPAQ) long-form and physical activity was quantified as MET-min/week. Scores were calculated for walking, moderate and vigorous-intensity activities for each domain (work, transport, domestic and gardening, leisure) and as an overall total. The HR population—similarly to the HG—is characterized by moderate or high physical activity; however, this level is achieved by work and housework/gardening instead of leisure time activities, which is worryingly low among HR females, but its prevalence is significantly (p < 0.001) lower in both sexes than among the HG population in the vigorous activity category. HR men move (walk and cycle) significantly more during transport than HG men. Our results may direct the attention of decision-makers to improve the health of Roma by increasing leisure-time physical activity.

Demographic, anthropometric, and metabolic characteristics of obstructive sleep apnea patients from Romania before the COVID-19 pandemic

Obstructive sleep apnea (OSA) syndrome is one of the major pathologies of modern life, with multiple etiologies intertwining: the increase in life expectancy, facial and dental changes, metabolic syndrome, and others. The current diagnosis is based on sleep studies, flexible endoscopy, imaging studies and a complete differential diagnosis from other possible pathologies. We present a retrospective study of 80 cases with OSA managed in 2019 prior to the beginning of the COVID-19 pandemic. We analyzed various demographic, anthropometric and metabolic data recorded in our study group. Some of the results, such as high levels of cholesterol and triglycerides, were consistent with worldwide literature. However, regarding the anthropometric data, we underline a general decrease in height in the Romanian population. In addition, demographic data have changed in the last decade due to the work immigration in the European Union. This data will be used in a future analysis for comparison with variables recorded from cases with OSA during the COVID-19 pandemic. Current cases with OSA are not a priority for healthcare systems, and patients avoid referral to a specialist as much as possible.

Solanum melongena allergy (A comprehensive review)

The Solanaceae family, including, among other, eggplants, represents the sixth most widely cultivated crops around the globe. We review the current data regarding allergies to Solanum melongena (eggplants), generating symptoms that range from gastrointestinal to respiratory allergic reactions. Currently, there are more than 4 mechanisms and molecules presumably involved in triggering allergic reactions to Solanum melongena: The lipid transfer protein (LTP) pathway, the profilin pathway, polyphenol oxidase (PPO) mechanism and other molecules. Allergies may be triggered both by pollen respiratory reactions and fruit intake. There is also an important cross-reactivity mechanism revealed by recent studies. Our literature review revealed many case series studies, some with in-depth molecular analysis of the triggering mechanism. However, wide population studies are still scarce. Current geographical distribution of the crops and population migrations should enhance the awareness of allergy and immunology specialists, ENT specialists, emergency physicians and pediatricians to the need for proper routine laboratory testing for possible Solanum allergy.

Ultrasonography used in the diagnosis of chronic rhinosinusitis: From experimental imaging to clinical practice

There is an increasing incidence of sinusitis cases in outpatient clinics; therefore, new methods for screening and triage are required. Performance of sinus sonography in our outpatient protocol was assessed in order to ascertain the specificity and sensitivity of this imaging method to detect rhinosinusitis. A total of 81 consecutive cases with clinical signs of sinusitis were collected and clinical data compared with sinus sonography results. Moreover, sinus sonography enhanced referral for further computed tomography scans. The results showed that sonography may be a screening method in sinus pathology, with a high sensitivity of 78.3% and a specificity of 93.1%. In the context of the COVID-19 pandemic, the use of ultrasound for paranasal sinus imaging should be reconsidered as in the case of lung sonography. According to data of the present study, sinus ultrasound may be implemented in the emergency departments with no access to standard ENT services and it could be efficient in managing sinusitis in pregnant women and pediatric cases.

Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

Cardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5-3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2-3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

Low Level of Physical Activity in Two Roma Subgroups Compared to Non-Roma Population in Niraj Valley, Transylvania

Objective: A low level of physical activity is a cardiovascular risk factor. Physical activity patterns may differ among different ethnic groups.

Aim of the study: Our aim was to evaluate the physical activity patterns of two different Roma populations compared to non-Roma.

Material and Methods: The study population included 231 Gabor Roma, 111 Băieși Roma, and 183 non-Roma. A 70-item questionnaire was administered, including also the short form of the International Physical Activity Questionnaire, evaluating daily physical activity in minutes and physical activity categories such as walking, gardening, household activity, and sports. Anthropometric parameters (weight, height, waist and hip circumference) were measured.

Results: The level of physical activity was the lowest among Gabor Roma and was lower in both Roma groups than in non-Roma (Gabor Roma 118.6 ± 91.1 min/day, Băieși Roma 207.55 ± 172.1 min/day, and non-Roma 234.12 ± 167.3 min/day). Both Roma groups had significantly lower percentages of gardening and sport activities compared to non-Roma. Women had a higher level of daily physical activity than men in the Gabor Roma population (144.22 ± 109.4 min/day vs. 79.71 ± 58.2 min/day, p = 0.001). In the two other groups the differences were not statistically significant.

Conclusions: Both Roma groups had significantly lower levels of daily physical activity, with differences between genders. Both Roma groups were lesser engaged in sports and gardening than non-Roma subjects.