Assessing disparities in health and living conditions: a comparative study of Hungarian-speaking Roma and non-Roma women across Hungary, Romania, and Slovakia.

Background: The Roma minority, Europe's largest ethnic minority, experiences significant disparities in living conditions and health outcomes compared to the non-Roma populations across the continent. Despite extensive documentation of the socio-economic challenges faced by the Roma, there is a notable lack of comparative research. Methods: This study aims to fill this gap by examining the differences in socio-economic characteristics, living conditions, and self-reported health status between Roma (R) and non-Roma (nR) women in in Hungary (HU), Romania (RO), and Slovakia (SK), providing a cross-country comparative analysis. Utilizing simple and multiple binary logistic models, our research analysed data collected from September 2020 to March 2022, involving 322 Roma and 294 non-Roma women in Hungary, 258 Roma and 183 non-Roma women in Romania, and 146 Roma and 163 non-Roma women in Slovakia. Results: Findings indicate significant associations between increased age (R:OR = 1.04[1.02,1.06], p < 0.001), (nR:OR = 1.04[1.02,1.05], p < 0.001) lower financial situation (R:OR = 2.05[1.01,4.18], p = 0.048) (nR:OR = 1.67[1.01,2.77], p = 0.047), and basic education level (R:OR = 3.60[1.29,10.08], p = 0.015) (nR:OR = 3.64[1.77,7.51], p < 0.001) with the likelihood of poor health status across both groups in Hungary. In Romania, increased age (OR = 1.04[1.02,1.06], p < 0.001) and basic education level (OR = 5.24[2.29,11.99], p < 0.001) were particularly predictive of poor health among non-Roma, while in Slovakia, age (OR = 1.05[1.02,1.07], p < 0.001) was a significant factor for Roma, and intermediate education level (OR = 2.68[1.16,6.20], p = 0.021) was for non-Roma. The study also found that a higher number of children (HU:OR = 1.35[1.12,1.63], p = 0.002), (RO:OR = 1.57[1.25,1.96], p < 0.001) and problems with housing comfort (RO:OR = 4.83[2.19,10.62], p = 0.015) and wall conditions (RO:OR = 2.81[1.22,6.46], p < 0.001) significantly impacted the health status of non-Roma women in Hungary and Romania. Conversely, an increase in household size was associated with a better health status among Roma women in Hungary (OR = 0.88[0.79,0.99]) and Slovakia (OR = 0.78[0.61,0.99]). Conclusion: By offering a novel comparative analysis, this study highlights the critical need for focused attention on the health disparities faced by Roma women, particularly those in a multiply disadvantaged situation due to their ethnic and socio-economic status.

Mitochondrial DNA Profiles of Individuals from a 12th Century Necropolis in Feldioara (Transylvania).

The genetic signature of modern Europeans is the cumulated result of millennia of discrete small-scale exchanges between multiple distinct population groups that performed a repeated cycle of movement, settlement, and interactions with each other. In this study we aimed to highlight one such minute genetic cycle in a sea of genetic interactions by reconstructing part of the genetic story of the migration, settlement, interaction, and legacy of what is today the Transylvanian Saxon. The analysis of the mitochondrial DNA control region of 13 medieval individuals from Feldioara necropolis (Transylvania region, Romania) reveals a genetically heterogeneous group where all identified haplotypes are different. Most of the perceived maternal lineages are of Western Eurasian origin, except for the Central Asiatic haplogroup C seen in only one sample. Comparisons with historical and modern populations describe the contribution of the investigated Saxon settlers to the genetic history of this part of Europe.

The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence.

BACKGROUND: Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment - the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s -we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). METHODS: Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires. RESULTS: Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory. CONCLUSIONS: These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan - effects that are linked specifically to deprivation-related adult ADHD symptoms.

Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study.

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.

Responding to measles outbreaks in underserved Roma and Romanian populations in England: the critical role of community understanding and engagement.

Since 2016, the European Region has experienced large-scale measles outbreaks. Several measles outbreaks in England during 2017/18 specifically affected Romanian and Romanian Roma communities. In this qualitative interview study, we looked at the effectiveness of outbreak responses and efforts to promote vaccination uptake amongst these underserved communities in three English cities: Birmingham, Leeds and Liverpool. Semi-structured in-depth interviews were conducted with 33 providers involved in vaccination delivery and outbreak management in these cities. Interviews were analysed thematically and factors that influenced the effectiveness of responses were categorised into five themes: (1) the ability to identify the communities, (2) provider knowledge and understanding of the communities, (3) the co-ordination of response efforts and partnership working, (4) links to communities and approaches to community engagement and (5) resource constraints. We found that effective partnership working and community engagement were key to the prevention and management of vaccine-preventable disease outbreaks in the communities. Effective engagement was found to be compromised by cuts to public health spending and services for underserved communities. To increase uptake in under-vaccinated communities, local knowledge and engagement are vital to build trust and relationships. Local partners must work proactively to identify, understand and build connections with communities.

What have we learnt from measles outbreaks in 3 English cities? A qualitative exploration of factors influencing vaccination uptake in Romanian and Roma Romanian communities.

BACKGROUND: Since 2016, large scale measles outbreaks have heavily affected countries across Europe. In England, laboratory confirmed measles cases increased almost four-fold between 2017 and 2018, from 259 to 966 cases. Several of the 2017-18 measles outbreaks in England particularly affected Romanian and Roma Romanian communities, with the first outbreaks in these communities occurring in Birmingham, Leeds and Liverpool. This study explored factors influencing vaccination behaviours amongst Romanian and Roma Romanian communities in these three cities. METHODS: Across Birmingham, Leeds and Liverpool, we conducted semi-structured interviews with 33 key providers to explore their experience in delivering vaccinations and managing the outbreak response. We also interviewed 9 Romanian women in one of the cities to explore their vaccination attitudes and behaviours. To categorise factors affecting vaccination we applied the 5As Taxonomy for Determinants of Vaccine Uptake (Access, Affordability, Awareness, Acceptance and Activation) during data analysis. RESULTS: Factors related to access and acceptance, such as language and literacy, ease of registering with a general practice, and trust in health services, were reported as the main barriers to vaccination amongst the communities. Concerns around vaccination safety and importance were reported but these appeared to be less dominant contributing factors to vaccination uptake. The active decline of vaccinations amongst interviewed community members was linked to distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK. CONCLUSION: Access and acceptance, dominant barriers to vaccination, can be improved through the building of trust with communities. To establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve. To achieve this, cultural and linguistic barriers need to be addressed. Better provider-service user relationships are crucial to reducing vaccination inequalities and tackling broader disparities in health service access.

Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model.

BACKGROUND: Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early time-limited exposure to severe institutional deprivation is associated with early-onset and persistent neurodevelopmental problems and later-onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. METHODS: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships. RESULTS: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive. CONCLUSIONS: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.

Identification of Cultural and Transcultural Health Assets Among Moroccan, Romanian and Spanish Adolescents Through Photovoice.

The health assets model focuses on recognizing the strengths, capacities and resources of individuals and their communities to improve health control processes. This study focuses on identifying and comparing the transcultural and cultural assets in health as accounted for by 45 young Romanians, Moroccans and Spaniards living in southern Spain. The research uses a photovoice method to understand what young people consider to boost their health. Of all the photographs taken, each young person selected the six most relevant images, and individual interviews were carried out. Both images and interviews were analysed qualitatively using Atlas Ti. We identified 40 transcultural assets in health that were common among the 3 cultural groups and 7 cultural assets that were specific to cultural groups. The seven assets include religion and spirituality, cultural symbols, medicine, traditional food, thinness, freedom/autonomy and plants. The definition of transcultural and cultural health assets facilitates the development of educational health interventions that reinforce the strengths of others in a culturally sensitive manner.

Begging abroad in Sweden: An interview study.

Background: The occurrence of begging by poor people from other countries in the European Union (EU) is now common in Scandinavia. They have a challenging life, but there is little knowledge about their own perceptions of their stay abroad.Aim: To explore the experiences of EU citizens begging in Sweden.Material: A descriptive design was used. Data were gathered through individual interviews conducted in Romanian and translated into Swedish. These were analysed using conventional content analysis. Participants were 20 EU citizens aged 19-64 years with experience of begging in Sweden.Results: The identified main category, "A hard time abroad to improve one's life", contained four categories - "Endurance is required to make a living"; "Exposed to others' attitudes and kindness"; "Handling being away"; and "A better life is the driving force".Conclusions and significance: EU citizens who beg face occupational injustice, spending many hours in non-preferred activity of begging and with few leisure activities, although no generalizations can be drawn based on this study. The importance of a friendly attitude and environmental support when abroad was also shown. Since occupational justice is within the scope of occupational therapy, occupational therapists have the skills to contribute in collaboration with others.

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

Organic Consumer Choices for Nutrient Labels on Dried Strawberries among Different Health Attitude Segments in Norway, Romania, and Turkey.

Consumer interest towards healthy food is driving the growth of the organic food market because consumers perceive organic food products to improve their personal health. Berries have well-known health benefits and show increasing market shares in European markets. This manuscript investigates for the first time how health attitudes relate to organic consumers' choices for nutrient labels of organic dried strawberry products. We conducted an online survey with 614 consumers from Norway, Romania, and Turkey. All participants consumed and liked strawberries and purchased organic food at least once a month. Participants filled out attitudinal questionnaires and conducted an experimental choice task featuring paired images of packaged organic dried strawberries varying in nutrients content label and other factors. The pooled sample was split into three groups of varying health attitudes for profiling and choice analysis. The results show that broad variations exist in health attitudes among Norwegian, Romanian, and Turkish organic consumers. A non-linear effect of health attitude is revealed, where a moderate health attitude is more strongly associated with the selection of products with increased nutrients content than either a low or a high health attitude. The results highlight the complexity in targeting nutrition labels to organic consumers. Finally, implications and suggestions for organic food operators are discussed along with future research avenues.

'I don't think anybody explained to me how it works': qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England.

OBJECTIVES: This study explored vaccination attitudes and behaviours among Polish and Romanian communities, and related access to primary healthcare services. DESIGN: A qualitative study using in-depth semistructured interviews with Polish and Romanian community members (CMs) and healthcare workers (HCWs) involved in vaccination in areas with large Polish and Romanian communities. CMs discussed their vaccination attitudes and their experiences of accessing vaccinations in England. HCWs shared their experiences in vaccinating Polish and Romanian communities. SETTING: Recruitment focused on three geographical areas in England with large Polish and Romanian populations (in London, Lincolnshire and Berkshire). PARTICIPANTS: 20 Polish and 10 Romanian CMs, and 20 HCWs. Most CMs were mothers or pregnant women and were recruited from London or Lincolnshire. HCWs included practice nurses, health visitors and school nurses recruited from the targeted geographical areas. RESULTS: Although most CMs reported vaccinating according to the UK schedule, obstacles to vaccination were highlighted. CMs experienced difficulties navigating and trusting the English primary healthcare system, and challenges in accessing credible vaccination information in Polish and Romanian. CM vaccination expectations, largely built on knowledge and experiences from Poland and Romania, were often unmet. This was driven by differences in vaccination scheduling and service provision in England, such as nurses delivering vaccines instead of doctors. CMs reported lower acceptance of the influenza vaccine, largely due to perceptions around the importance and efficacy of this vaccine. HCWs reported challenges translating and understanding vaccination histories, overcoming verbal communication barriers and ensuring vaccination schedule completeness among families travelling between England and Poland or Romania. CONCLUSIONS: This study identified vaccination uptake and delivery issues and recommendations for improvement. HCWs should discuss health service expectations, highlight differences in vaccination scheduling and delivery between countries, and promote greater understanding of the English primary healthcare system in order to encourage vaccination in these communities.

Observations on Osteoporosis in Three Generations of Descendants of Holocaust Survivors.

BACKGROUND: Throughout history, studies on episodes of famine have led to the discovery of metabolic abnormalities and hormonal aberrations as well as an increased incidence of cancer and mental health conditions. Starvation during early life is thought to nfluence the programming of childhood and adult bone metabolism, which may result in poor bone health in later life. This observational case series includes a small group (with no control group) of famine-exposed Holocaust survivors and their descendants. We proposed an investigational mechanism to determine any association between starvation and osteoporosis, both in the individual survivors and in their descendants.

HLA Polymorphisms and Haplotype Diversity in Transylvania, Romania.

Transylvania is a historical region in the northwestern part of Romanian with a rather heterogeneous population. Our study is the first to determine human leukocyte antigen (HLA) profiles in a large population sample from this region and to compare them with other European population groups. HLA genes were examined in 2,794 individuals using the Single Specific Primer-Polymerase Chain Reaction (SSP-PCR) and Polymerase Chain Reaction Sequence-Specific Oligonucleotide (PCR-SSO) methods. All samples were tested for the HLA-A locus, 2,773 for HLA-B, 1,847 for HLA-C, and 2,719 for HLA-DRB1 loci. HLA gene frequency data from several European population groups (as presented in studies involving more than 1,000 individuals) served as reference in comparison with the local sample. The distribution of HLA genes in the studied population group was heterogeneous, as the Hardy-Weinberg equilibrium was statistically significant (P value < 0.01). The most common genes found in our sample group were A∗02 (0.27%), B∗35 (0.14%), C∗07 (0.25%), and DRB1∗11 (0.19%). The most common haplotype was A∗01~B∗08~C∗07~DRB1∗03 (1.26% in 1,770 individuals with complete data). This analysis confirmed the known heterogeneity of the Transylvanian population. The study indicates that the European population groups located in close vicinity (those from Serbia, Hungary, Wallachia, and Croatia) are genetically closest to the Transylvanian population.

The Winners of Socialism: Fighting Infertility in Pronatalist Romania.

Drawing from interviews and life histories, I consider the singular reproductive trajectories of women who fought infertility during the enforced pronatalist policies of the late communist era in Romania. I aim to explore the role of fine-grained ethnography in revealing both the localized mechanisms of reproductive governance and the diverse subjectivities produced by citizens' encounters with biopower. I argue that, through an analysis of these ethnographic cases, we can further conceptualize reproductive vulnerability as an intersubjective notion. In addition, women's atypical stories give us a glimpse into the typical workings of the recording and reporting practices of the pronatalist regime.

Self-Construals and Social Adjustment in Immigrant and Nonimmigrant Early Adolescents: The Moderating Role of Executive Functioning.

This study examined whether executive functions (EFs) moderate the association between independent and interdependent self-construals and social adjustment in 488 Moroccan, Romanian, and Italian preadolescents (ages 11-13) in Italy. Participants were assessed using self-report questionnaires and standardized EF tasks. Better working memory was related to increased social competence across all groups. High levels of inhibitory control were found to enhance the positive relation between interdependence and prosocial behavior for native Italian youth, and between interdependence and social competence for Moroccan preadolescents. High levels of cognitive flexibility boosted the interdependence-social competence link for the immigrant groups, whereas among native Italian preadolescents, the interdependence-social competence link was significant at low levels of flexibility. Implications for developmental theory and practice are discussed.

Accumulation by Dispossession and Public-Private Biomedical Pluralism in Romanian Health Care.

Neoliberal reforms in health care are an accumulation by dispossession. In examining this in Romania, we show that neoliberal reforms led to an uneven landscape of public and private care. We document how patients variously situated in Romanian society respond to this situation, and demonstrate the instability of their strategies-restraining from formal care, lifting-off from public care and hooking-up to private care. Public-private biomedical pluralism proves to be detrimental to vulnerable and better-off patients alike.

A transcultural health education programme led by immigrant adolescents in Southern Spain.

Immigration to western countries is a relevant phenomenon that has been linked to health inequalities. One form of inequality is ethnocentrism in health programmes. Therefore, social innovations and a new transcultural approach have been developed to culturally adapt health education interventions. This study aimed to evaluate the effects of a double transcultural health intervention, the Leader Adolescents in Transcultural Health Education (LATES) Project, which is led by high school immigrant adolescents over elementary students of multicultural contexts in southeastern Spain. This double quasi-experimental study had experimental and control groups composed of secondary students (12 health cultural brokers with 36 controls) and elementary students (26 participant students and 26 controls). The LATES Project was delivered to two high schools and two elementary schools in Almeria (Spain). A mixed evaluation method was used. Six attitudinal scales were used pre- and post-intervention to collect the data. The quantitative evaluation was completed using qualitative techniques through in-depth interviews and focal groups. Four sociocultural gradients were identified pre-intervention: a positive rural gradient, a negative gender gradient except in traditional 'female' dimensions, a negative age gradient and a dual migrant gradient that combined the health migrant effect in some behaviours and westernization in others. Specifically, the Moroccan population demonstrated better attitudes towards eating and physical activity behaviours. After the intervention, the experimental groups showed more improvement than the controls. However, the attitudinal scale increment is modest compared with the knowledge and motivation improvements. This intervention, which used a transcultural approach, has benefited young Spaniards to a greater extent than immigrants, probably due to the worse initial health conditions of the Spanish.

Discrimination and externalizing problems among Moroccan- and Romanian-origin early adolescents in Italy: Moderating role of cultural orientations and impulse control.

OBJECTIVE: Although discrimination is a common stressor in the everyday life of immigrant youth, individuals are not equally susceptible to its adverse effects. This cross-sectional study aimed to examine whether cultural orientation preferences and impulse control (IC) moderate the association between perceived discrimination and externalizing problems among Moroccan- and Romanian-origin early adolescents in Italy. METHOD: The sample included 126 Moroccan and 126 Romanian youths (46% girls, 42% first-generation) aged 11-13 years and their parents. Perceived discrimination and cultural orientations were assessed using self-report questionnaires, while IC was evaluated via a computerized version of the Iowa Gambling Task. Externalizing behaviors were assessed via parental report. RESULTS: Cluster analysis identified separated, assimilated, and integrated early adolescents. Regression analyses revealed that when facing discrimination, youths who endorsed separation and exhibited low levels of IC were more vulnerable to externalizing problems. In contrast, among assimilated adolescents the discrimination-externalizing difficulties link was significant at high levels of IC. Furthermore, low levels of IC were associated with more externalizing problems for Romanian, but not for Moroccan early adolescents. CONCLUSIONS: Findings underscore the need to consider both cultural orientation processes and early adolescents' ability to control their impulses when developing interventions aimed to reduce discrimination-related problem behaviors in immigrant youth. Implications for theory and practice are discussed. (PsycINFO Database Record