Search Results (54)

Background/Objectives: Differentiating between benign and malignant ovarian adnexal masses before surgery is a significant diagnostic challenge. This study examined a wide range of circulating plasma molecules (immune and inflammatory) to identify potential markers to classify tumors as benign or malignant. The goal was to develop a proof-of-concept tool for preoperative risk stratification. Methods: Twenty-three plasma molecules were evaluated in women with benign lesions (n = 68) and women with malignant ovarian tumors (n = 25). To evaluate the behavior of each marker in a normal population, women without adnexal pathology were also included (n = 11). The results were compared using the Kruskal–Wallis test with Dunn post hoc pairwise comparisons, the Benjamini–Hochberg correction for multiple comparisons, and ROC analysis. TGF-β isoforms and CA125 were measured in the complete cohort (n = 104), while the remaining molecules were assessed in a reduced cohort (n = 51). Two classification approaches were developed using TGF-β3 and IL-13: a sequential two-step algorithm and an ordinal logistic regression model. Apparent performance was corrected for optimism using Harrell’s bootstrap procedure. Results: Ten molecules reached statistical significance. Among the significant molecules, TGF-β3 identified ovarian lesions regardless of malignant status (AUC = 0.983), while IL-13 showed perfect malignancy-specific separation from benign cases (AUC = 1.000). Their combination in an ordinal logistic regression model produced three non-overlapping diagnostic strata across all three groups, significantly outperforming CA125, HE4, and ROMA at the malignancy-separation boundary (DeLong p < 0.05) in our exploratory cohort. Conclusions: TGF-β3 and IL-13 represent a biologically complementary marker pair whose combined ordinal regression model shows promising performance and warrants prospective validation in larger, multicenter independent cohorts as a preoperative risk-stratification tool for ovarian adnexal masses. Full article

Background/Objectives: Measles remains a significant public health concern in Romania, with recurrent ongoing nationwide outbreaks despite the availability of the measles–mumps–rubella (MMR) vaccine. This study investigates the epidemiological, clinical, and sociocultural dimensions of measles among Romanian adults, with a particular focus on a vulnerable group, the Roma population. Methods: We conducted a retrospective cohort study using clinical data from a tertiary hospital in Bucharest, Romania. The study included adult patients hospitalized with measles between July 2023 and April 2024. In a subsequent phase, we carried out a cross-sectional survey among hospitalized measles patients to assess their perception and understanding of measles and the MMR vaccine, with particular attention to responses from Roma participants. Results: A retrospective investigation of 100 hospitalized adult patients with laboratory-confirmed diagnoses of measles demonstrated frequent complications such as hepatic involvement (85/100), pneumonia (68/100), and respiratory failure (21/100). Only 6/100 of patients were fully vaccinated. Rhabdomyolysis was significantly more common in unvaccinated individuals and women. No deaths were recorded, and no ICU admissions occurred. Among the hospitalized patients, 49 adults responded to a vaccine centered questionnaire. We report a notable vaccine hesitancy, particularly among the Roma respondents. Socioeconomic factors such as low income, limited education, and lack of health insurance were significantly associated with negative perceptions of the MMR vaccine. A statistically significant association was observed between Roma ethnicity and the belief that the MMR vaccine causes autism. Conclusions: These findings highlight the urgent need for targeted public health interventions with culturally adapted education campaigns to improve vaccination coverage and thereby protect vulnerable adult populations in Romania. Full article

Background: Data on assisted reproductive technology (ART) outcomes among Roma women are virtually absent from the literature, despite Roma being the largest and most socioeconomically marginalized ethnic minority in Europe. This study provides the first structured evaluation of IVF/ICSI outcomes among Roma women at a tertiary fertility center. Methods: A retrospective observational cohort study was conducted at the Clinic for Gynecology and Obstetrics, University Clinical Center Niš, Serbia (May 2010–September 2015). Roma (n = 88) and non-Roma women (n = 1197) undergoing IVF/ICSI were compared on baseline clinical, hormonal, and embryological parameters. Primary and secondary outcomes were clinical pregnancy and live birth, respectively. Multivariable logistic regression, propensity score matching (1:4, by age and AMH), first-cycle sensitivity analysis, and a machine learning pipeline (logistic regression, random forest, XGBoost) with SHAP interpretability analysis were applied. Results: Roma women were significantly younger (31.9 ± 4.0 vs. 34.5 ± 4.7 years; p < 0.001) and had a more favorable ovarian reserve profile (AMH 3.78 vs. 2.90 ng/mL; p = 0.004; FSH 6.87 vs. 8.23 IU/L; p < 0.001), yet had a markedly longer duration of infertility (9.3 vs. 6.3 years; p < 0.001). Clinical pregnancy rates (48.9% vs. 41.3%; p = 0.179) and live birth rates (28.4% vs. 30.9%; p = 0.720) were comparable between groups. In multivariable logistic regression and propensity score-matched analyses, Roma ethnicity was not an independent predictor of either outcome. XGBoost SHAP analysis ranked Roma ethnicity last (11th of 11) in feature importance for both clinical pregnancy (mean |SHAP| = 0.033) and live birth (mean |SHAP| = 0.009). The dominant predictors were the number of embryos transferred, AMH, and age. Only 88 Roma women accessed ART over the decade-long study period, indicating profound underutilization of fertility services. Conclusions: No independent association was detected between Roma ethnicity and IVF/ICSI outcomes within the statistical power afforded by the Roma subgroup (n = 88). An exploratory first-cycle live birth signal (adjusted OR = 0.478; 95% CI 0.249–0.920; p = 0.027), not replicated in primary or propensity-matched analyses, is interpreted as hypothesis-generating. The extreme underutilization of ART services among Roma women remains the most clinically salient observation and a priority for targeted public health intervention. Full article

Background: Women from Roma communities face considerable health inequalities, primarily due to limited access to healthcare systems, alongside broader social and structural disadvantages. Among Roma women these disparities are reflected in poorer perinatal outcomes when compared to non-Roma populations. This systematic review aims at: (a) exploring disparities in neonatal health outcomes between Roma and non-Roma populations in relation to maternal factors such as health status, lifestyle, and education; (b) summarizing key perinatal characteristics in these groups; (c) assessing the influence of prenatal care on neonatal outcomes. Comprehending these disparities is crucial for guiding effective interventions and promoting health equity. Methods: A systematic literature review was conducted in major databases, such as PubMed and Scopus, to identify studies published up to 2025. The eligible studies focused on observational research that compared perinatal outcomes, including preterm birth, low birth weight (LBW), stillbirth, and neonatal mortality, between Roma and non-Roma populations. The potential discrepancies between these populations are thoroughly discussed in the review. Results: A comprehensive search yielded a total of 157 studies. After meticulous screening, 48 relevant studies were identified, reporting substantial health disparities between Roma and non-Roma mothers and their newborns. Roma populations exhibited significantly increased rates of preterm birth, LBW, and neonatal mortality vs. non-Roma populations. Socioeconomic status, access to prenatal care, maternal education, and systemic discrimination were identified as the primary contributing factors to these disparities. Conclusions: The findings highlight the significant and enduring disparities in perinatal health between Roma and non-Roma populations. In order to effectively address these disparities, it is necessary to have a comprehensive and multi-level strategy that prioritizes the social determinants of health, ensures equitable access to high-quality maternal care, and mitigates actively systemic discrimination. Future research should prioritize the development and rigorous evaluation of targeted interventions to reduce these inequities and improve perinatal outcomes among Roma populations. Full article

Background/Objectives: Ovarian adnexal masses present diagnostic challenges due to their heterogeneous etiologies. Accurately differentiating these conditions is critical for timely and effective clinical intervention. This study evaluated circulating molecules and serum-induced apoptosis as complementary tools to conventional diagnostic methods (CA125, HE4, and the ROMA index) for distinguishing benign masses from malignant masses. Methods: A cohort of 136 participants (9 healthy controls, 87 women with benign ovarian adnexal masses and 40 with malignant ovarian adnexal masses) was analyzed. The induction of apoptosis in Jurkat cells by patient serum was assessed using flow cytometry. Serum concentrations of sFas/CD95, HE4, CA125, and additional molecules were measured by ELISA and LEGENDplex™. Clinical, ultrasonographic, and histopathological data were correlated with tumor malignancy. To improve diagnostic performance beyond individual biomarkers, we developed two multiparametric classifiers that integrate the dominant parameters identified through group divergence analysis and ROC evaluation across multiple clinical comparisons. Results: Malignant tumors were associated with older age (51.45 ± 8.35 years, p = 0.0002), postmenopausal status (61.1%, p = 0.0013), and larger tumor size (>10 cm). Ultrasonographic features of complexity were observed exclusively in malignant masses. Functional assays revealed reduced apoptosis in Jurkat cells exposed to malignant sera, suggesting tumor-mediated immune evasion. Although higher sFas levels were observed in tumors, no significant differences were identified between the groups. Among the circulating biomarkers, CA125, HE4, MRP8/14, OPN, and SAA levels were significantly higher in malignant tumors than in benign tumors and controls. Conclusions: The evaluation of CA125, HE4, MRP8/14, and apoptosis (Classifier 1) and, more prominently, the measurement of additional molecules: OPN, SAA, IL-6, IL-8, and IGFBP-4 (Classifier 2), systematically outperformed the ROMA. Both achieved superior specificity and balanced accuracy (Youden’s J index) across all clinical comparisons by capturing the biological diversity of malignancies. Full article

Background: Reduced tissue sensitivity to insulin, as well as the associated increased risk of gestational diabetes mellitus is genetically controlled and often varies racially and geographically. Roma populations constitute a genetically autonomous society with particularities in their type of sociability, and they are reported to have an increased prevalence of type 2 diabetes mellitus, which is pathophysiologically related to insulin resistance. Objectives: The aim of this study was to investigate the level of insulin sensitivity in pregnancies of Roma mothers compared to controls. Methods: A total of 65 pregnancies were studied during the third trimester, divided between 33 Roma mothers (RP) and 32 mothers of European descent to serve as control volunteers (CP). The presence of gestational diabetes was confirmed according to the WHO diagnostic criteria by a 75 mg oral glucose tolerance test and insulin resistance status by the means of HOMA-IR index. Results: The mean fasting insulin levels as well as the mean HOMA-IR index were statistically significantly higher in the Roma population (p = 0.0013) and (p < 0.001), respectively, regardless of the age and BMI of the participants. Gestational Diabetes Mellitus developed in seven women (10.7%), five of whom were Roma (15.1%) and in two controls (6.2%) (p = 0.247). Conclusions: Increased insulin resistance is observed in Roma pregnancies, so it would be beneficial to provide these women with appropriate counseling focused on healthy diet and lifestyle. Full article

The most recent scientific literature shows the effects of the COVID-19 pandemic on socially vulnerable groups such as Roma people. Non-profit social initiative organizations were active agents in overcoming the effects of the pandemic. This article shows the role that Third Sector of Social Action organizations played in alleviating the impact of the pandemic in collaboration with the Roma community itself, as part of the R&D&I research project ROM21, which studied the social agency of the Roma population in Spain regarding overcoming inequalities caused by the pandemic in relation to education, social services, and civic organizations. Based on the communicative methodology, discussion groups and interviews were conducted with Roma people and professionals from social services, civic organizations, and the health and education sectors, with 54 Roma women, 24 Roma men, 40 professionals, and 5 social activists participating. The results show the social initiative entities’ social action strategies in collaboration with the Roma community and the public administrations that responded to the needs that arose during the pandemic and in the post-pandemic context. 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: 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

Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di Roma “Tor Vergata”, following the principles of the Declaration of Helsinki. It included postmenopausal women aged over 60, with the case group receiving Romosozumab after fracture fixation, and the control group consisting of women on Romosozumab therapy without fracture fixation. Exclusion criteria included psychiatric conditions, contraindications to Romosozumab, high-energy trauma, or other bone metabolism disorders. Data on fractures, surgeries, FRAX (Fracture Risk Assessment Tool) scores, BMD (Bone Mineral Densit) values, and follow-up details were collected. Side effects, including nasopharyngitis and severe events like hypocalcemia, stroke, and myocardial infarction, were recorded. Adherence was assessed via pharmacy records and patient interviews during routine clinical follow-up visits. Statistical analysis was performed using descriptive statistics, t-tests, and chi-square tests. Results: The study included 25 patients, with 12 in the surgical group and 13 in the conservative treatment group. The surgical group had a mean age of 67.3 years and a follow-up of 374 days, while the conservative group had a mean age of 76.4 years and a follow-up of 287 days. The surgical group underwent various fracture treatments, including femoral, humeral, and distal radius fractures, while the conservative group was treated with immobilization. There were no significant differences in FRAX scores or BMD values between the two groups. Vitamin D levels increased significantly in both groups after supplementation, but parathyroid hormone levels showed no difference. No new fractures occurred, and surgical patients had no delayed union or nonunion, though two had superficial wound infections. Conclusions: Both groups adhered well to Romosozumab therapy, with no severe side effects; minor side effects included myalgia in the surgical group and shoulder arthralgia in the conservative group. Romosozumab is well-tolerated and adherent in osteoporotic patients after osteosynthesis surgery, with adverse events similar to non-fractured individuals. While the study design is appropriate, multicenter trials would improve the sample size and allow for subgroup analysis based on fracture type and demographics. 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: 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

Background: Ovarian carcinoma (OC) has an unfavorable prognosis due to lack of screening and an asymptomatic course. New diagnostic methods are being sought to enable earlier diagnosis of this condition. The purpose of this study was to determine the diagnostic utility of collagenases (MMP-1, MMP-8 and MMP-13) in the diagnosis of OC compared to HE4 and CA125 and the ROMA. Methods: The study group consisted of 120 patients with OC, the control group: 70 patients with benign ovarian lesions (BLs) and 50 healthy women (HS). MMP-1, MMP-8 and MMP-13 were determined by ELISA and HE4 and CA125 by CMIA. Results: OC patients had higher levels of MMP-1 and MMP-13 compared to the BL and HS groups. MMP-1 (SE: 81.66%; SP: 94%; PPV: 97.02%; NPV: 68.11%; AUC: 0.9625) and MMP-13 (SE: 77.50%; SP: 94%; PPV: 96.875%; NPV: 63.51%; AUC: 0.917) showed similar or higher diagnostic values to routine markers (HE4: SE:85%; SP: 92%; PPV: 96.22%; NPV: 71.875%; AUC: 0.943; CA125: SE: 80%; SP: 98%; PPV: 98.96%; NPV: 67.12%; AUC: 0.909) and the ROMA (SE: 90.83%; SP: 94%; PPV: 97.32%; NPV: 81.03%; AUC: 0.955). Performing combined analyses of individual MMPs and MMPs with ROMA was associated with further increases in diagnostic parameters. Conclusions: MMP-1 and MMP-13 have shown preliminary potential as diagnostic markers and auxiliary markers to ROMA in biochemical diagnosis of OC. Full article

Objective: We aimed to compare the clinical utility and diagnostic accuracy of the ADNEX model, ROMA score, RMI I, and RMI IV, as well as two serum markers (CA125 and HE4) in preoperative discrimination between benign and malignant adnexal masses (AMs). Methods: We conducted a retrospective study extracting all consecutive patients with AMs seen at our Institution between January 2015 and December 2020. Accuracy metrics included sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC), and their 95% confidence intervals (CI) were calculated for basic discrimination between AMs. Model performance was evaluated in terms of discrimination ability and clinical utility (net benefit, NB). Results: A total of 581 women were included; 481 (82.8%) had a benign ovarian tumor and 100 (17.2%) had a malignant tumor. The SE and SP of CA125, HE4, ROMA score, RMI I, RMI IV, and ADNEX model were 0.60 (0.54–0.66) and 0.80 (0.76–0.83); 0.39 (0.30–0.49) and 0.96 (0.94–0.98); 0.59 (0.50–0.68) and 0.92 (0.88–0.95); 0.56 (0.46–0.65) and 0.98 (0.96–0.99); 0.54 (0.44–0.63) and 0.96 (0.94–0.98); 0.82 (0.73–0.88) and 0.91 (0.89–0.94), respectively. The overall AUC was 0.76 (0.74–0.79) for CA125, 0.81 (0.78–0.83) for HE4, 0.82 (0.80–0.85) for ROMA, 0.86 (0.84–0.88) for RMI I, 0.83 (0.81–0.86) for RMI IV, and 0.92 (0.90–0.94) for ADNEX. The NB for ADNEX was higher than other biomarkers and models across all decision thresholds between 5% and 50%. Conclusions: The ADNEX model showed a better discrimination ability and clinical utility when differentiating malignant from benign Ams, compared to CA125, HE4, ROMA score, RMI I, and RMI IV. Full article