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Special Issue "Roma Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (15 December 2017)

Special Issue Editor

Guest Editor
Assoc. Prof. Jitse P. Van Dijk

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands
Website | E-Mail
Interests: Roma health; Roma health disadvantage; chronic disease; adolescents and health

Special Issue Information

Dear Colleagues,

The Roma ethnicity, in a society where more than 5% of the population affiliates with this ethnic minority, provides a good opportunity for studying several health outcomes of such an ethnicity. Studies might focus on comparisons, history, natural experiments, (social) epidemiology, and on time-trend analyses. As the Special Issue is called Roma health, we are, most of all, interested in the health outcomes of all these approaches.

Roma are a rather large minority in many Eastern and Central European countries, and generally report poorer health than majority populations. However, Roma health has never been well studied, or outcomes are contradictory. For us, this is the main reason to put together this Special issue.

This Special Issue seeks papers on topics related to Roma health, including comparisons over time and with non-Roma, the prevalence of chronic disease/non-communicable diseases, whether unemployment worsens health and mortality, and adherence to preventive measures, such as vaccination.

By learning more about the opportunities presented by Roma health, we can better target interventions to improve Roma lives.

Assoc. Prof. Jitse P van Dijk, MD PhD
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Roma health
  • Comparison over time
  • Comparison with non-Roma
  • Chronic disease
  • Non-communicable diseases
  • (Un-)employment
  • Mortality
  • Vaccination
  • Prevention

Published Papers (16 papers)

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Research

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Open AccessArticle Serum Uric Acid in Roma and Non-Roma—Its Correlation with Metabolic Syndrome and Other Variables
Int. J. Environ. Res. Public Health 2018, 15(7), 1412; https://doi.org/10.3390/ijerph15071412
Received: 24 March 2018 / Revised: 22 June 2018 / Accepted: 28 June 2018 / Published: 4 July 2018
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Abstract
Background: The Roma population is one of the major marginalized groups in Europe, having higher incidence of all spectrums of disease and a shorter life expectancy. Yet, the reasons for higher morbidity and its exact prevalence were not properly studied. Objectives: [...] Read more.
Background: The Roma population is one of the major marginalized groups in Europe, having higher incidence of all spectrums of disease and a shorter life expectancy. Yet, the reasons for higher morbidity and its exact prevalence were not properly studied. Objectives: The objective of our study was to compare the frequency of metabolic syndrome (MetS) in Roma people to the non-Roma population in Slovakia, and to compare levels of uric acid and its correlation with components of metabolic syndrome. Methods: A group of 452 Roma people aged 18–55 years, was compared to a control group of 403 non-Roma people. The data were obtained by questionnaire, anthropometric measures, and analyzed blood and urine samples Results: The prevalence of MetS was significantly higher among Roma participants (131; 29.6%) compared with non-Roma participants (80; 20.1%), p = 0.001. Roma people significantly more often fulfilled obesity and low high-density lipoprotein (HDL) criteria of MetS (257, 58.9% vs. 180, 45.8%, p < 0.0001, and 312, 70.0% vs. 140, 34.9%, p < 0.0001). There was no difference in the triacylglycerols (TG), glycemia or blood pressure (BP) criteria of MetS. The Roma also presented with greater levels of high sensitivity C-reactive protein (hs-CRP). Baseline levels of uric acid (UA) among the Roma population were significantly lower compared with the majority population (226.54 ± 79.8 vs. 259.11 ± 84.53) (p < 0.001). The levels of UA significantly correlated with fulfilled criteria of MetS. Univariate regression showed that UA is a significant predictor of MetS in the whole cohort (unadjusted odds ratio (OR) 1.005; 95% CI 1.004–1.007; p < 0.0001) also after the adjustment for age, sex, and ethnicity (adjusted OR 1.008; 95% CI 1.005–1.010; p < 0.0001). Conclusions: We were able to show that prevalence of MetS among the Roma is higher than in the majority population. Moreover, the uric acid levels are significantly lower in the Roma group as well as when it comes to a cohort with MetS. Levels of UA, besides others, depend on ethnicity, age, and sex. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle Prevalence and Risk Factors for Hepatitis B Virus Infection in Roma and Non-Roma People in Slovakia
Int. J. Environ. Res. Public Health 2018, 15(5), 1047; https://doi.org/10.3390/ijerph15051047
Received: 21 March 2018 / Revised: 9 May 2018 / Accepted: 15 May 2018 / Published: 22 May 2018
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Abstract
Prevalence of Hepatitis B is relatively low in developed European countries. However specific subpopulations may exist within each country with markedly different Hepatitis B burden. Roma minority is very numerous in Slovakia and their lifestyle is completely different to non-Roma population. The aim [...] Read more.
Prevalence of Hepatitis B is relatively low in developed European countries. However specific subpopulations may exist within each country with markedly different Hepatitis B burden. Roma minority is very numerous in Slovakia and their lifestyle is completely different to non-Roma population. The aim of this study is to map Hepatitis B prevalence in Roma and compare it to non-Roma population and to explore potential socio-economic and health related risk factors. Cross-sectional epidemiology study was performed in Slovakia that included randomly sampled Roma population and geographically corresponding random sampled non-Roma population. Comprehensive questionnaire about risk factors was administered and blood samples were drawn for Hepatitis B serology and virology tests. Altogether 855 participants were included. Global Hepatitis B surface Antigen (HBsAg) positivity rate was 7.7% (i.e., active Hepatitis B) and anti Hepatitis B core IgG antibody (antiHBcIgG) positivity rate was 34.6%. Roma population had significantly higher prevalence of Hepatitis B, both active chronic infection (12.4%; 95% Confidence Interval (CI) 9.58%–15.97% versus 2.8%; 95% CI 1.56%–4.91%; p < 0.0001) and antiHBcIgG positivity (52.8%; 95% CI 48.17%–57.44% versus 25.9%; 95% CI 12.56%–20.02%; p < 0.0001) Main risk factors for HBsAg positivity were Roma ethnicity, male sex and tattoo. Conclusion: There is a very high prevalence of Hepatitis B in Roma communities in Slovakia, with potential for grave medical consequences. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Seroprevalence of Hepatitis E Virus in Roma Settlements: A Comparison with the General Population in Slovakia
Int. J. Environ. Res. Public Health 2018, 15(5), 904; https://doi.org/10.3390/ijerph15050904
Received: 15 March 2018 / Revised: 25 April 2018 / Accepted: 28 April 2018 / Published: 3 May 2018
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Abstract
Hepatitis E infection is one of the most frequent causes of acute hepatitis in the world. Currently five human genotypes with different geographical distributions and distinct epidemiologic patterns are identified. In Slovakia, only rare cases of hepatitis E have been reported in past [...] Read more.
Hepatitis E infection is one of the most frequent causes of acute hepatitis in the world. Currently five human genotypes with different geographical distributions and distinct epidemiologic patterns are identified. In Slovakia, only rare cases of hepatitis E have been reported in past years. Because the most important risk factors associated with HEV infection include consumption of contaminated pork meat and poor hygienic standards, the aim of the study was to evaluate the prevalence of anti-HEV total antibodies and the main risk factors for HEV in the population living in separated and segregated Roma settlements (n = 195), which represent places with increased risk of infection in Slovakia and to compare it with the prevalence in the general population (n = 69). Of 264 respondents included in the study, 47 (17.8%) showed positivity for anti-HEV antibodies, 42 of whom were Roma (21.5%, n = 195) and 5 (7.2%, n = 69) non-Roma. The population living in Roma settlements lives in poorer conditions and are at higher risk of HEV in comparison to the general population. However, differences in living conditions within the settlements do not contributed to lower risk of HEV antibody prevalence between Roma living in settlements. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Roma Housing and Eating in 1775 and 2013: A Comparison
Int. J. Environ. Res. Public Health 2018, 15(4), 588; https://doi.org/10.3390/ijerph15040588
Received: 15 February 2018 / Revised: 14 March 2018 / Accepted: 22 March 2018 / Published: 25 March 2018
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Abstract
We compared housing and the eating habits of Roma. Contemporary findings (2013) were compared with those from the first monothematic work on Roma (1775), which depicts their housing and eating habits, especially regarding the differences between social classes. Data were obtained from a [...] Read more.
We compared housing and the eating habits of Roma. Contemporary findings (2013) were compared with those from the first monothematic work on Roma (1775), which depicts their housing and eating habits, especially regarding the differences between social classes. Data were obtained from a journal (1775) and from semi-structured interviews (2013) with more than 70 Roma women and men who live in segregated and excluded settlements at the edges of villages or scattered among the majority. Data were collected in two villages and one district town in the Tatra region, where the data from the 1775 measurements originated. We used classical sociological theory to interpret the obtained data. The main findings showed differences between specific social classes then and now regarding housing, as well as the eating habits related to both conditions among the Roma in the Tatra region. The houses of rich Roma families did not differ from the houses of the majority population. The huts of the poorest inhabitants of settlements did not meet any hygiene standards. Typical Roma foods such as gója or marikľa were the traditional foods of Slovak peasants living in poverty in the country. We concluded that the housing and eating habits of the citizens of poor settlements located in the eastern parts of Slovakia are still similar to those of two centuries ago. The existing social exclusion may be explained partly from this finding. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle Exposure to Toxoplasma gondii in the Roma and Non-Roma Inhabitants of Slovakia: A Cross-Sectional Seroprevalence Study
Int. J. Environ. Res. Public Health 2018, 15(3), 408; https://doi.org/10.3390/ijerph15030408
Received: 29 December 2017 / Revised: 19 February 2018 / Accepted: 20 February 2018 / Published: 27 February 2018
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Abstract
The lifestyle, health and social status of the Roma are generally below the standards characteristic for the non-Roma population. This study aimed to find out the seropositivity to Toxoplasma gondii (T. gondii) in the population of Roma living in segregated settlements [...] Read more.
The lifestyle, health and social status of the Roma are generally below the standards characteristic for the non-Roma population. This study aimed to find out the seropositivity to Toxoplasma gondii (T. gondii) in the population of Roma living in segregated settlements and to compare it with the prevalence of antibodies in the non-Roma population from the catchment area of eastern Slovakia. The seroprevalence of antibodies to T. gondii was significantly higher in the Roma group (45.0%) than in non-Roma inhabitants (24.1%). A statistically significant difference was also recorded between the two non-Roma groups in the study, 30.4% of those from the catchment area and 19.7% from the non-catchment area were seropositive. Univariate logistic regression confirmed poverty and higher age to be significant risk factors influencing the seropositivity to T. gondii. Of the clinical symptoms analyzed in the study, only muscle and back pain were associated with seropositivity to T. gondii. The close contact of Roma with an environment contaminated by different infectious agents and the insufficient hygiene, lower level of education, poverty, lack of water and household equipment and high number of domestic animals increase the risk of infectious diseases in the Roma settlements and subsequently the spread of communicable diseases at the national or even international level. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Qualification of Food Intake by the Roma Population in the Region of South Bohemia
Int. J. Environ. Res. Public Health 2018, 15(2), 386; https://doi.org/10.3390/ijerph15020386
Received: 10 December 2017 / Revised: 17 February 2018 / Accepted: 20 February 2018 / Published: 23 February 2018
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Abstract
The article presents the results of a correlation study, aimed at quantifying the food intake of the Roma population in the South Bohemian Region. To achieve the goal, we applied the method of one-day dietary recall and frequency food analysis (non-standardized). The quantification [...] Read more.
The article presents the results of a correlation study, aimed at quantifying the food intake of the Roma population in the South Bohemian Region. To achieve the goal, we applied the method of one-day dietary recall and frequency food analysis (non-standardized). The quantification was carried out by analysis in the Nutridan program. The study involved 302 Roma persons and 298 persons in the control group. Both groups had the same representation of males and females (50:50). The age categories of both sets differed; the average age of the Roma was lower (39.2 years) (p < 0.001). The probands from the Roma population were chosen with the help of the snowball method through known respondents. The statistical analysis shows differences in nutritional estimate between the Roma population and the control sample. The Roma differ in their energy intake. Both groups showed lower intake of sugars, below 50% total energy intake (TEI) and higher intake of fats, above 30% TEI. The respondents from both groups consume little fruits and vegetables, which may be connected with their low dietary fiber intake. In addition to the differences in the nutritional estimates, we recorded statistically significant differences in body mass index (BMI; p < 0.001), in age (p < 0.001), regular alimentation (p = 0) and demanding physical activities (p = 0). In spite of the fact our groups differed in age (the Roma are younger), it can be assumed that the obesity of the Roma may be caused by unbalanced alimentation and lack of physical activities. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System
Int. J. Environ. Res. Public Health 2018, 15(2), 377; https://doi.org/10.3390/ijerph15020377
Received: 15 December 2017 / Revised: 2 February 2018 / Accepted: 7 February 2018 / Published: 22 February 2018
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Abstract
Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted [...] Read more.
Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population
Int. J. Environ. Res. Public Health 2018, 15(2), 360; https://doi.org/10.3390/ijerph15020360
Received: 18 December 2017 / Revised: 12 February 2018 / Accepted: 14 February 2018 / Published: 18 February 2018
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Abstract
Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding [...] Read more.
Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population (p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis (p = 0.965, variance of the model—adjusted R2 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey
Int. J. Environ. Res. Public Health 2018, 15(2), 353; https://doi.org/10.3390/ijerph15020353
Received: 14 December 2017 / Revised: 10 February 2018 / Accepted: 12 February 2018 / Published: 16 February 2018
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Abstract
The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting [...] Read more.
The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting and observer-reporting of Roma ethnicity were applied in a population-based health interview survey. A questionnaire was completed by 1849 people aged 18–64 years; this questionnaire provided information on 52 indicators (morbidity, functionality, lifestyle, social capital, accidents, healthcare use) indicators. Multivariate logistic regression models controlling for age, sex, education and employment were used to produce indicators for differences between the self-reported Roma (N = 124) and non-Roma (N = 1725) populations, as well as between observer-reported Roma (N = 179) and non-Roma populations (N = 1670). Differences between interviewer-reported and self-reported individuals of Roma ethnicity in statistical inferences were observed for only seven indicators. The self-reporting approach was more sensitive for two indicators, and the observer-reported assessment for five indicators. Based on our results, the self-reported identity can be considered as a useful approach, and the application of observer-reporting cannot considerably increase the usefulness of a survey, because the differences between Roma and non-Roma individuals are much bigger than the differences between indicators produced by self-reported or observer-reported data on individuals of Roma ethnicity. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle Drugs and Mental Health Problems among the Roma: Protective Factors Promoted by the Iglesia Evangélica Filadelfia
Int. J. Environ. Res. Public Health 2018, 15(2), 335; https://doi.org/10.3390/ijerph15020335
Received: 22 December 2017 / Revised: 29 January 2018 / Accepted: 8 February 2018 / Published: 14 February 2018
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Abstract
Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of [...] Read more.
Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of these practices. Objective: In this article, authors analyze in which ways the IEF favors processes of drug rehabilitation and mental health recovery as well as the prevention of these problems among its Roma members. Methods: A communicative qualitative approach was developed. It was communicative because new knowledge was created by dialogically contrasting the existing state of the art with study participants. It was qualitative because everyday life stories were collected, gathering the experiences, perceptions and interpretations of Roma people who are actively involved in three different IEF churches based in Barcelona. Results: This article identifies these protective factors: anti-drug discourse, a supportive environment, new social relations, role model status, the promotion of interactions, the revaluation of oneself, spiritual activities and the improvement of the feeling of belonging and the creation of meaning. Conclusion: The present research contributes new evidence to the current understanding of the role played by the IEF in improving Roma health status and how the identified protective factors can contribute to rehabilitation and recovery from such problems in other contexts. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle A Community-Based Study to Estimate the Seroprevalence of Trichinellosis and Echinococcosis in the Roma and Non-Roma Population of Slovakia
Int. J. Environ. Res. Public Health 2018, 15(2), 251; https://doi.org/10.3390/ijerph15020251
Received: 13 December 2017 / Revised: 25 January 2018 / Accepted: 30 January 2018 / Published: 2 February 2018
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Abstract
Trichinellosis and cystic and alveolar echinococcosis are serious parasitic diseases transmissible between animals and humans. Moreover, alveolar echinococcosis is considered one of the most dangerous of human helminthoses. Roma communities are particularly numerous in Central and Eastern Europe. They are often concentrated in [...] Read more.
Trichinellosis and cystic and alveolar echinococcosis are serious parasitic diseases transmissible between animals and humans. Moreover, alveolar echinococcosis is considered one of the most dangerous of human helminthoses. Roma communities are particularly numerous in Central and Eastern Europe. They are often concentrated in economically undeveloped regions and live in segregated localities with unsatisfactory housing and sanitary conditions. The study aimed to find out the seroprevalence of Trichinella and Echinococcus infections in the Roma population of segregated settlements and to compare it with the seropositivity of the non-Roma population of eastern Slovakia. Out of 823 samples, three sera showed seropositivity to Trichinella in the ELISA (Enzyme-linked immunosorbent assay) test. Subsequent Western blot reaction (WB) confirmed seropositivity in two Roma women. ELISA seropositivity to E. multilocularis was recorded in six persons (0.73%), and five (0.61%) respondents were seropositive to E. granulosus, but WB confirmed the presence of antibodies to Echinococcus spp. in one Roma participant. Positive persons suffered from unspecific clinical symptoms; Trichinella-positive persons reported headache, cough, fatigue, and muscle pain. The Echinococcus-positive participant suffered from headache and back pain. The study showed that the worse living conditions of the Roma community did not significantly influence the occurrence of Trichinella and Echinococcus infections in this minority. Full article
(This article belongs to the Special Issue Roma Health)
Open AccessArticle Lipoprotein-Cholesterol Fractions in Marginalized Roma versus Majority Population
Int. J. Environ. Res. Public Health 2018, 15(1), 81; https://doi.org/10.3390/ijerph15010081
Received: 30 November 2017 / Revised: 22 December 2017 / Accepted: 27 December 2017 / Published: 6 January 2018
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Abstract
The trend of modern clinical biochemistry is to emphasize the composition and the quality of lipoproteins over their quantity. The serum lipoprotein fractions and subfractions were analyzed by the Lipoprint Lipoprotein Subfractions Testing System, the parameters of lipid profile, as total cholesterol (TC), [...] Read more.
The trend of modern clinical biochemistry is to emphasize the composition and the quality of lipoproteins over their quantity. The serum lipoprotein fractions and subfractions were analyzed by the Lipoprint Lipoprotein Subfractions Testing System, the parameters of lipid profile, as total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triacylglycerides (TAG) were determined by an automated selective biochemical analyzer. Our results showed a significantly lower concentration of cholesterol in the LDL fractions 1 and 2 and in the HDL fractions 8 to 10 in Roma compared to the majority population. The most significant differences between Roma and the majority population when considering body mass index (BMI), waist-to-hip ratio and the index of central obesity were in very low-density lipoproteins (VLDL), intermediate-density lipoproteins, fraction A (IDL-A) and LDL-2. The last two listed were significantly higher in the majority population. VLDL was significantly higher in overweight or obese Roma men and in Roma men with central obesity compared to men from the majority population, as well as in Roma women with normal weight and physiological waist-to-hip ratio compared to the women from majority population. Our study is among the first describing the distribution of lipoprotein subfractions in different ethnic groups. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle Prevalence of Chlamydia trachomatis Infection and Its Association with Sexual Behaviour and Alcohol Use in the Population Living in Separated and Segregated Roma Settlements in Eastern Slovakia
Int. J. Environ. Res. Public Health 2017, 14(12), 1579; https://doi.org/10.3390/ijerph14121579
Received: 11 October 2017 / Revised: 4 December 2017 / Accepted: 11 December 2017 / Published: 14 December 2017
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Abstract
The aim of the study was to explore sexual behaviour and the occurrence of Chlamydia trachomatis (CT) infection in the population living in Roma settlements compared to the majority population in Slovakia and to assess the association between alcohol use and sexual behaviour [...] Read more.
The aim of the study was to explore sexual behaviour and the occurrence of Chlamydia trachomatis (CT) infection in the population living in Roma settlements compared to the majority population in Slovakia and to assess the association between alcohol use and sexual behaviour within both populations. A cross-sectional population-based Hepa-Meta study was conducted in Slovakia in 2011. The final sample comprised 452 Roma and 403 non-Roma respondents. The occurrence of CT was detected by direct proof of the pathogen by PCR. The association between alcohol use and the prevalence of risky sexual behaviour were assessed using a logistic regression. First intercourse at age 15 or younger was reported by 27.9% of Roma (vs. 4.5% of non-Roma); 93.4% of Roma (vs. 77.9% of non-Roma) used condom inconsistently, 22.8% of Roma (vs. 43.9% of non-Roma) used a condom for protection from unwanted pregnancies and only 8.8% of Roma (vs. 21.8% of non-Roma) due to protection against infectious diseases. However, Roma reported having had five or more sexual partners less often compared to the majority (11.5% of Roma vs. 20.6% of non-Roma). Binge drinking at least once a month was associated with a higher number of sexual partners in both groups, but not with condom non-use. The prevalence of CT infection in the Roma population was higher (3.8%) compared to non-Roma (2.7%); however, the difference was not statistically significant. Our study found no differences in the prevalence of CT infection between Roma and non-Roma despite differences in sexual behaviour. Roma begin their sexual life earlier and have unprotected sex more often, but on the other hand, they seem to be much more restrained in terms of the number of sexual partners compared to the majority population. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study
Int. J. Environ. Res. Public Health 2017, 14(12), 1569; https://doi.org/10.3390/ijerph14121569
Received: 8 November 2017 / Revised: 8 December 2017 / Accepted: 10 December 2017 / Published: 13 December 2017
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Abstract
In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in [...] Read more.
In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH. Full article
(This article belongs to the Special Issue Roma Health)
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Open AccessArticle Reproductive Investment and Health Costs in Roma Women
Int. J. Environ. Res. Public Health 2017, 14(11), 1337; https://doi.org/10.3390/ijerph14111337
Received: 1 August 2017 / Revised: 12 October 2017 / Accepted: 24 October 2017 / Published: 3 November 2017
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Abstract
In this paper, we examine whether variation in reproductive investment affects the health of Roma women using a dataset collected through original anthropological fieldwork among Roma women in Serbia. Data were collected in 2014–2016 in several Roma semi-urban settlements in central Serbia. The [...] Read more.
In this paper, we examine whether variation in reproductive investment affects the health of Roma women using a dataset collected through original anthropological fieldwork among Roma women in Serbia. Data were collected in 2014–2016 in several Roma semi-urban settlements in central Serbia. The sample consisted of 468 Roma women, averaging 44 years of age. We collected demographic data (age, school levels, socioeconomic status), risk behaviors (smoking and alcohol consumption), marital status, and reproductive history variables (the timing of reproduction, the intensity of reproduction, reproductive effort and investment after birth), in addition to self-reported health, height, and weight. Data analyses showed that somatic, short-term costs of reproduction were revealed in this population, while evolutionary, long-term costs were unobservable—contrariwise, Roma women in poor health contributed more to the gene pool of the next generation than their healthy counterparts. Our findings appear to be consistent with simple trade-off models that suggest inverse relationships between reproductive effort and health. Thus, personal sacrifice—poor health as an outcome—seems crucial for greater reproductive success. Full article
(This article belongs to the Special Issue Roma Health)

Review

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Open AccessReview Socioeconomic Inequalities in the Use of Healthcare Services: Comparison between the Roma and General Populations in Spain
Int. J. Environ. Res. Public Health 2018, 15(1), 121; https://doi.org/10.3390/ijerph15010121
Received: 5 December 2017 / Revised: 30 December 2017 / Accepted: 5 January 2018 / Published: 12 January 2018
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Abstract
This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 [...] Read more.
This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 National Health Survey of the Spanish Roma Population (n = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population. Full article
(This article belongs to the Special Issue Roma Health)
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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