Search Results (121)

Background/Objectives: As part of the human adaptation to dairy consumption, the presence of the rs4988235-T variant in the MCM6 gene primarily determines lactase persistence in adult European populations, increasing the expression of the lactase-encoding LCT gene. Carriers of the C/C variant are lactose intolerant, while carriers of the T/T or T/C variant have persistent lactase enzyme activity and are able to digest lactose in adulthood. While the association between lactose intolerance and increased cardiovascular risk (CVR) is well-known, the underlying causes have only been partly explored. The present study aimed to investigate the association of rs4988235 polymorphism with significant lipids affecting cardiovascular health and estimated CVR. Methods: The rs4988235 polymorphism was genotyped in 397 subjects from the general Hungarian population and 368 individuals from the Roma population. To characterize the overall lipid profile, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), apolipoprotein AI (ApoAI), and apolipoprotein B100 (ApoB100) levels were measured, and their ratios (TG/HDL-C, LDL-C/HDL-C, and ApoB100/ApoAI) were calculated. Cardiovascular risk was estimated using the Framingham Risk Score (FRS), Pooled Cohort Equations (PCE), Revised Pooled Cohort Equations (RPCE), and the Systematic Coronary Risk Evaluations (SCORE and SCORE2) algorithms. Adjusted linear and logistic regression analyses were performed, with p < 0.05 considered significant. Results: The Roma population had a significantly higher prevalence of the C/C genotype than the general population (65.5% vs. 40.3%, respectively). The results of the adjusted linear regression analysis showed a significant association between the C/C genotype and higher LDL-C level (B = 0.126, p = 0.047) and ApoB100 level (B = 0.046, p = 0.013), as well as a higher LDL-C/HDL-C ratio (B = 0.174, p = 0.021) and a higher ApoB100/ApoAI ratio (B = 0.045, p = 0.002), as well as a lower HDL-C level (B = −0.041, p = 0.049). The C/C genotype was also significantly associated with an increased cardiovascular risk (CVR) as estimated by the SCORE (B = 0.235, p = 0.034), SCORE2 (B = 0.414, p = 0.009), PCE (B = 0.536, p = 0.008), and RPCE (B = 0.289, p = 0.045) but not the FRS. After adjusting the statistical model further for ApoAI and ApoB100 levels, the significant correlation with the risk estimation algorithms disappeared (SCORE: p = 0.099; SCORE2: p = 0.283; PCE: p = 0.255; and RPCE: p = 0.370). Conclusions: Our results suggest that the C/C genotype of rs4988235 is associated with significantly higher ApoB100 and lower ApoAI levels and consequently higher ApoB100/ApoAI ratios, potentially contributing to an increased risk of cardiovascular disease. The results of the statistical analyses suggest that the association between lactose intolerant genotype and cardiovascular risk may be mediated indirectly via modification of the apolipoprotein profile. Full article

The article examines the support structures available to Roma women faced with domestic violence, focusing on the role of the church as a sanctuary. The research includes a case study of the Roma community in Međimurje County, Croatia, which is characterized by (Catholic) religious homogenization. Analysis reveals that Roma women who fear the perpetrator prefer confidentiality, anticipate disbelief, or feel they are themselves to blame are more likely to seek support from the church. The findings show that Roma women who report domestic violence to the police are also likely to turn to the church for help. The research further examines the correlation between different types of violence and the likelihood of Roma women contacting the church for support. Full article

Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health behavior and care factors associated with its occurrence. In our study, preterm birth was defined as delivery before 37 completed weeks of gestation (i.e., <259 days). Data were collected from 231 Roma women living in three municipalities of Szabolcs-Szatmár-Bereg County, one of Hungary’s most disadvantaged regions, using a structured interview questionnaire. The participants were women aged 18–65 years. Of these, 209 had been pregnant at least once in their lifetime. The questionnaire covered socio-demographic characteristics (age, level of education, employment status, housing conditions, marital status), health behaviors (smoking, alcohol consumption, drug use, vitamin supplementation, other substance use), antenatal care attendance, and birth outcomes (preterm birth, gestational age, low birth weight, newborn status). Statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression with significance set at p < 0.05. Preterm birth was significantly more common among women who smoked, consumed alcohol or drugs during pregnancy, or had vaginal infections. Drug use showed the strongest association with a 22-fold increase in risk, followed by alcohol (nearly fivefold), smoking (over threefold), and infections (threefold). Although non-attendance at antenatal care was associated with increased risk, this relationship was not statistically significant. In the multivariate logistic regression model, alcohol consumption (OR = 1.744, p < 0.01), smoking (OR = 2.495, p < 0.01), drug use (OR = 25.500, p < 0.001), and vaginal infections (OR = 4.014, p < 0.01) during pregnancy were independently associated with an increased risk of preterm birth, whereas folic acid supplementation (OR = 0.448, p < 0.05) showed a significant protective effect. These findings highlight that preterm birth is intricately linked to socioeconomic disadvantage and adverse health behaviors. Culture-specific, community-based prevention strategies are essential to reduce perinatal risks in marginalized populations. Full article

Background/Objectives: Policy implementers play a crucial role in the effective delivery of policies aiming at promoting a healthy lifestyle in the most vulnerable populations. This study aimed to explore (a) policy implementers’ knowledge and perceptions of the policy framework promoting physical activity and healthy nutrition among children in need in Greece, and (b) self-perceived barriers and facilitators of the framework implementation. The term children in need refers to children who are at risk of poverty and/or social exclusion. Methods: A qualitative study design was employed consisting of semi-structured interviews with 25 policy implementers, who represented four delivery systems (health, social protection, food, and education sectors) from three geographical regions in Greece. Interviews were completed between November and December 2023. Thematic analysis was conducted using inductive and deductive approaches to identify key themes, following data management in the N-VIVO 14 software. Results: Commonly mentioned policies that study participants were involved in included school- and/or community-level-based behavioral interventions. Participants perceived policy implementation efforts that often relied on individual initiatives as inconsistent. Most participants argued that existing policies were not tailored to the needs of children in need. Major self-perceived barriers included limited personnel training, limited facilities and infrastructure, and lack of incentives or opportunities to encourage active participation. Major self-perceived facilitators included personnel motivation, integration of nutrition and physical education into school curricula, and provision of free school meals, which was associated with regular school attendance of children from the Roma communities. Conclusions: Individual, sociocultural, and structural issues are shown to persist across different delivery systems indicating the complexity of tackling obesogenic environments, especially among children in need. This is the first study in Greece to provide evidence on self-perceived barriers and facilitators and could inform ongoing national and European efforts to address obesogenic environments in children in need. Full article

Background/Objectives: Alport syndrome (AS) predominantly presents with X-linked inheritance worldwide. However, the epidemiological landscape remains poorly characterized, particularly among ethnic minority groups like the Roma minority in Slovakia. Our study aimed to investigate the inheritance patterns of AS in this region and determine whether a distinct pattern predominates. Methods: Selective genetic screening for pathogenic variants previously occurring in Slovakia was performed. Samples from patients with persistent (familial) hematuria ± hearing loss who had not yet undergone biopsy or genetic testing were analyzed by high-resolution melting analysis. The prevalence of AS per million (pm) population was calculated by adding information on patients with previously confirmed AS. Results: Twenty-five new cases of ARAS, one digenic form, and two cases of XLAS were identified by screening. In total, we collected information on 46 patients with genetically or bioptically confirmed AS in the region of eastern Slovakia, corresponding to a prevalence of 29 pm population. The c.1598G>A (p.Gly533Asp) pathogenic variant of the collagen type IV alpha 4 chain, which follows an autosomal recessive inheritance pattern, was the most prevalent variant that was exclusively confirmed in Roma patients (n = 35), suggesting a founder effect. Within the Roma community, the prevalence of ARAS (the most prevalent inheritance pattern) corresponds to 133 pm of the Roma population, based on midpoint population estimates. Conclusions: Our findings demonstrate a unique genetic profile of AS in the Roma population, characterized by a high prevalence of ARAS, with implications for genetic counseling and screening strategies. Full article

The article is aimed at building on the existing studies devoted to the last stage of the assimilation policy directed at the Muslim population in Communist Bulgaria during the second half of the 1980s. The 40th anniversary of the forced change of the given Turkish–Arabic and Persian names of this population is an occasion to revisit this dark period of the recent past. This study focuses on the short- and long-term consequences of the political measures, which became known as the ‘Revival process’ (1984/1985–1989). For the first time, the author presents new written sources, including analytical and field reports commissioned by the Central Committee of the Bulgarian Communist Party and prepared by Bulgarian scholars during the second half of the 1980s, as well as later collected biographical data related to Muslims affected by the events, derived through an (auto)ethnographic method of research among Turks, Crimean Tatars and Muslim Roma. Full article

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and to identify possible interventions to increase their use. Methods: Our research was conducted on Pubmed, Google Scholar, and the Trip Database. We selected articles written in English, Spanish, and Italian published since 2015. Results: Studies have shown that the health status of Roma and Sinti populations is generally worse than that of the rest of the population. Limited access to care is due to several specific factors, such as beliefs, traditions, and the lack of awareness of widespread direct and indirect discrimination against these groups by healthcare professionals. The studies reviewed have shown how mistrust can be broken down through multi-centered interventions linked to information, education, and communication through mediators able to interact with these populations, as well as through appropriate training of the health workers in charge. Conclusions: The health of the Roma and Sinti populations is commonly worse than that of the rest of the population. This is particularly true for the large proportion of people confined to suburban camps. However, the available evidence signals the low quality of life they experience and the need for interventions involving the communities and the establishment of ad hoc orientation or initial care contact points in the segregated areas. This could lead to an improvement in the integration of this population into the National Health Systems’ activities. Full article

The Roma population is one of Europe’s largest ethnic minorities, often living in inadequate living conditions, worse than those of the majority population. They frequently lack access to essential services, even in high-income countries. This lack of basic services—particularly in combination with proximity to (stray) animals and human and solid waste—significantly increases environmental health risks, and leads to a higher rate of endoparasitic infections. Our study sheds light on the living conditions and health situation in Roma communities in Slovakia, focusing on the prevalence of intestinal endoparasitic infections across various settlement localisations. It highlights disparities and challenges in access to safe drinking water, sanitation, and hygiene (WASH) and other potentially disease-exposing factors among these marginalised populations. This study combines a comprehensive review of living conditions as per national data provided through the Atlas of Roma communities with an analysis of empirical data on parasitological infection rates in humans, animals, and the environment in settlements, applying descriptive statistical methods. It is the first study in Europe to provide detailed insights into how living conditions vary and cause health risks across Roma settlements, ranging from those integrated within villages (inside, urban), to those isolated on the outskirts (edge, sub-urban) or outside villages (natural/rural). Our study shows clear disparities in access to services, and in health outcomes, based on where people live. Our findings underscore the fact that (i) place—geographical centrality in particular—in an already challenged population group plays a major role in health inequalities and disease exposure, as well as (ii) the urgent need for more current and comprehensive data. Our study highlights persistent disparities in living conditions within high-income countries and stresses the need for greater attention and more sensitive targeted health-promoting approaches with marginalised communities in Europe that take into consideration any and all of the humans, ecology, and animals affected (=One Health). Full article

Background/Objectives: Inappropriate use of emergency department (ED) services is widely acknowledged to have a negative impact on health systems as a whole. A minor portion of Frequent User (FU) patients are often responsible for the disproportionate use of ED services. Methods: A retrospective population study was conducted on the attendances of pediatric EDs from 1 January 2022 to 31 December 2022 at the Roma 1 Local Health Authority in Rome, a territory served by more than 13 EDs. Nested logistic regression analysis was used to investigate patient characteristics in predicting inappropriate use of EDs. Results: In 2022, 35,691 pediatric ED attendances were recorded, with 24,824 patients distributed among 904 PCP/GPs in the six districts. A total of 71.8% of patients had only one attendance in 2022. A total of 3.5% of the patients were FUs, who were responsible for more than 10% of the attendances. However, most of the attendances were not appropriate. FUs, younger age (<2 yo), and more severe clinical presentations were more likely to be associated with appropriate ED attendance. PCPs/GPs and districts do not have a role in determining a higher number of ED attendances. The single patient’s characteristics have a greater influence on this phenomenon. Conclusions: Frequent use of the ED is not associated with inappropriate use among children, mainly due to the characteristics and needs of specific patients. However, parents’ education for a more rational use of health system resources and the provision of local solutions to children’s health needs may allow for a more appropriate use of health service resources. Full article

Background/Objectives: Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The availability of an increasing number of new molecules approved for IBD treatment has increased our ability and aspirations to change the trajectory of the disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) II consensus (2018) is the current suggested strategy for IBD management, which recommends a treat-to-target approach. The primary objective of this study is to describe the clinical history of IBD in the post-STRIDE II era and to quantify the burden of IBD in terms of hospitalisation rate. The secondary objective is to estimate the 6-year risk of intestinal resection among IBD patients. Methods: A population-based time series analysis was conducted on administrative data; retrospective data from January 2011 to December 2021 were collected for the Local Health Authority “Roma 1” population (∼1.5 million residents). Hospitalisation and surgical events were prospectively recorded for patients newly diagnosed between January 2018 and February 2022 (n = 556), with follow-up throughout May 2024. A Kaplan–Mayer survivor analysis was performed to estimate the cumulative surgery risk. Results: In 2021, the IBD prevalence was 218.3 cases/100,000 people (77.2 CD, 141.1 UC). The incidence trend slowly increased during the last decade, up to 5.3 (CD) and 9.4 (UC) cases/100,000 ppl/year. The yearly hospitalisation rate remained stable, near 16.5%. The 6-year cumulative risk of surgery was 36% for CD and 20% for UC. Conclusions: The incidence of IBD has increased in the last few decades, with substantial stability in regard to the incidence of surgery and hospitalisations. Thus, the current IBD management approach has only had a small effect on changing the natural history of the disease. Full article

Background: Providing midwifery care to Roma women is a significant public health issue due to their status as a vulnerable population, often facing unique challenges and discrimination in accessing healthcare. Cultural competence refers to the ability of maternity providers to understand and incorporate cultural factors within the broader healthcare system. Objective: This study aimed to investigate the cultural competence of obstetricians/gynecologists and midwives working in Western Greece who provide midwifery care to Roma women. Methods: A cross-sectional quantitative study was conducted using a questionnaire from the Roma Women’s Empowerment and Fight against discrimination in Access to Health (REACH) project, which focuses on empowering Roma women and combating healthcare access discrimination. The questionnaire covered three areas: the cultural competence of maternity professionals, their knowledge of Roma women’s lifestyle, and participants’ demographics. The sample included 100 maternity professionals from hospitals and health centers in Western Greece. Results: Cultural competence was found to be moderate to high, with a mean score of 6.9 (SD = 2.2) for the ability to provide adequate care. In the past six months, 33% had provided care to 1–5 Roma women with communication issues, and 53% frequently faced challenges in service delivery. Common problems included Roma women not understanding the information provided (72.9%), and not having necessary documents (41.7%). Obstetricians/gynecologists had higher knowledge scores compared to midwives, and higher educational attainment correlated with better knowledge. Older age was associated with higher cultural competence (p = 0.048). Conclusions: Cultural competence was positively correlated with knowledge levels, with obstetricians/gynecologists exhibiting higher competence than midwives. Enhancing cultural competence among perinatal care providers is crucial to addressing health disparities faced by Roma women. The study’s cross-sectional design and reliance on self-reported data may limit the generalizability and introduce bias. Enhancing cultural competence through targeted training programs can help address healthcare disparities faced by Roma women. Full article

Background: Hepatitis B (HBV) and Delta (HDV) virus infections pose critical public health challenges, particularly in Romania, where HDV co-infection is underdiagnosed. Methods: This study investigates the epidemiology, risk factors, and clinical outcomes of HBV/HDV co-infection in vulnerable populations, leveraging data from the LIVE(RO2) program. Conducted between July 2021 and November 2023, the program screened 320,000 individuals across 24 counties, targeting socially disadvantaged groups such as rural residents, the Roma community, and those lacking health insurance. Results: Among 6813 hepatitis B surface antigen (HBsAg)-positive individuals, HDV antibody prevalence was 4.87%, with active replication confirmed in 75.6% of HDV-positive cases. Regional disparities emerged, with higher HDV prevalence and replication rates in the Eastern region compared to the South. HDV-positive individuals were more likely to be younger, male, and from rural or socioeconomically disadvantaged backgrounds. Clinically, HDV co-infection correlated with increased liver stiffness, advanced fibrosis stages, and lower steatosis levels compared to HBV mono-infection. Psychiatric comorbidities were more prevalent among HDV-positive patients, highlighting the need for integrated care. Conclusions: This study underscores the urgent need for targeted public health interventions, including enhanced screening, education, and access to novel antiviral therapies like bulevirtide to address the significant burden of HBV/HDV co-infection in Romania. Full article

The Roma population is one of the most discriminated social groups. Ignorance of their culture, traditions, etc. generates prejudices and stereotypes that hinder the processes of intercultural coexistence. The aim is to make the Roma people visible and to intervene in the university population, promoting intercultural and inclusive learning spaces to reduce behaviors that generate inequalities. Students from the University of Valladolid were involved, 1255 students in particular, distributed in control and experimental groups. The instrument consists of 40 closed questions and one open-ended. A quantitative analysis was carried out in the anti-Gypsy attitudes categories with t-tests. Item to item differences were not significant in categories A, B and C, but there were differences in D between the experimental and the control groups, which confirms important trends in the target population. Prejudices towards the Roma population continue to exist. University students who receive training have fewer prejudices than students who do not, although other variables can influence the process. Of the students, 72.2% are disturbed by the same negative behaviors, regardless of the ethnic group, and half of them are disturbed by behaviors based on prejudices. It is confirmed the need for preventive interventions to avoid the establishment of erroneous beliefs about the Roma community. Full article

Background: The Roma are a socioeconomically disadvantaged, marginalized community with reduced access to education, social services, and healthcare. Despite the known health risks they are exposed to, we have limited data about a wide range of health outcomes in this population, including vitamin D deficiency. The aim of this study was to investigate prevalence of vitamin D deficiency and its impact on the anthropometric outcomes of newborns in a group of Roma mothers and their infants in Romania. Methods: In total, 131 Roma women and 131 newborns were included in the study. Vitamin D levels in both mothers and newborns, as well as the birth weight, length, and head circumference of newborns, were recorded at birth. We also assessed socioeconomic factors, including education, employment status, income, and living conditions, as well as factors that influence vitamin D status, including sun exposure, use of sunscreen, fish consumption, and skin type. Results: All mothers and almost all newborns had vitamin D insufficiency or deficiency, with 25-hydroxivitamin D levels below 30 ng/mL. Maternal vitamin D status was significantly correlated with neonatal vitamin D levels (p < 0.01) but not with anthropometric outcomes such as birth weight (p = 0.57), birth length (p = 0.53), or head circumference (p = 0.96). Most study participants had a low socioeconomic status, reporting severe deficiencies in education, employment status, household income, and living conditions. Conclusions: Vitamin D deficiency is a significant public health issue among Roma women and their newborns, which may be compounded by the socioeconomic challenges of this vulnerable population. Full article

The Roma population—with a unique history marked by migration, settlement issues, and ongoing resilience—has always faced significant social marginalization and has often been subjected to forced migration. Despite being one of the largest and most diverse ethnic groups in Europe, Roma continue to face systemic discrimination and social exclusion, leading to poor outcomes in education, employment, health, and housing. This article analyses the migration pathways, settlement experiences, and persistent obstacles faced by Roma. We argue that removing historical and systemic barriers to create a more equitable and welcoming environment for the Roma community is their right. The resilience of the Roma community in the face of adversity is a testament to their cultural strength and adaptability. This research aims to document these aspects and thus provide a basis for policies that promote social inclusion, equality, and respect for cultural diversity. Full article