Gypsy Research Articles

Socioeconomic inequalities in the uptake of COVID-19 vaccination in Hungary; context and public health implications

Abstract Background Eastern Europe witnessed substantial life expectancy losses in 2021. COVID-19 vaccination coverage was lower, and mortality was higher than in Western Europe. Research suggests an important factor behind lower vaccination coverage is vaccine hesitancy. Our studies aimed to explore spatial inequalities in COVID-19 morbidity, mortality, and vaccination coverage in Hungary and the reasons behind vaccine hesitancy during the 3rd and 4th pandemic waves. Methods We characterized COVID-19 morbidity, mortality, and vaccination coverage by indirectly standardized ratios at the municipality level and investigated the association with deprivation. Attitudes towards vaccination were measured by a nationally representative monthly questionnaire survey. Results In Hungary, people in the most deprived municipalities had 17-58% higher relative COVID-19 mortality than the national average, although morbidity was significantly lower. COVID-19 vaccination coverage among the least deprived was 9.2% (95% CI 9-9.5%) higher, while in the most deprived areas, it was 38.2% (95% CI 38.0-38.4%) below the national average at the end of the 3rd pandemic wave. In the 10 districts with the highest proportion of the Roma population, vaccination coverage was 56.0% of the national average (95% CI 55.0-64.0%). Inequalities persisted by the end of the 4th pandemic wave. Younger age, lower education, and lower income were major determinants of vaccine refusal. Reasons for refusal mostly resulted from barriers to accessing reliable information and mistrust. Although Hungary has traditionally had high social acceptance of vaccination, the campaign failed to close the gap in COVID-19 mortality. Hungary demonstrates how social inequalities, misinformation, and mistrust can undermine a vaccination program's success. Consistent, credible communication can dispel misconceptions and build trust, which is key to the acceptance of public health measures.

10.M. Workshop: Community Health Practice and Research in Europe: Up front and centre!

Abstract Community Health (CH) is one of the most undervalued and poorly funded domains of action of health systems. Although evidence is strong on its contribution to population health, well-being and equity, national and regional health systems, and to some extent public health institutions, tend to pay little attention to its contribution. Community health encompasses the application of health promotion principles and strategies at the local level to improve equity and resilience of a community. It does so through three fundamental means: cross-sectoral collaborations, community involvement/engagement, and community health workers (CHW). It engages and works with communities in a culturally appropriate manner in order to implement effective strategies. In community health, capacity building is essential. The aim of this workshop is three-fold: 1) to generate a discussion among participants on the state of practice and research, 2) to reflect on strategies to strengthen and improve community health in Europe and, 3) to enhance the visibility of this domain within the ranks of the European Public Health Association (EUPHA). The workshop will provide a space for reflections and discussions. Each of our speakers, who are researchers from 5 different countries (Belgium, Czech Republic, Germany, Spain, and UK), will have 5 minutes to provide some elements of answers to the two following questions: • What is the state of community health practice and research in your country? • What difference does it make for health systems to implement community health strategies? Eric Breton (France) will briefly introduce the workshop providing a conceptual framework for community health and an overview of the different perspectives that drive practices and policies. Manfred Cassens (Germany) and Caroline Masquillier (Belgium) will discuss how the COVID-19 pandemic has enhanced the shortfalls of health systems and lead their countries to experiment community health strategies. Camila Picchio (Spain) will demonstrate how CHWs are essential in reaching out marginalised communities as will Ekaterina Volevach (Czech Republic) drawing lessons from a programme targeting the Roma population. Both will highlight the difficulties health systems face in answering the need of vulnerable population. Catherine Jenkins (United Kingdom), will describe a city-region intervention for galvanising community-level innovation to reduce gambling-related harms. Luis Saboga-Nunes, President of the EUPHA Health Promotion Section and Goof Buijs, Manager of the UNESCO Chair Global Health & Education will conclude the session. We trust that this very interactive workshop will help attendees of the EUPHA conference in Dublin working in community health to find each other and facilitate the development of partnerships. Key messages • Community Health strategies are essential in improving populations’ health and well-being. Yet, this contribution is hardly reflected in national health policies and in the resources invested locally. • The COVID-19 pandemic cast a harsh light on the limits of health systems under-investing in community engagement, community health workers and in the mobilisation of local stakeholders.

Romanian students’ knowledge on radiation protection

Abstract Since March 2022, Romania has become a country in the vicinity of a military conflict (there are 649 km border between Romania and Ukraine). As the Russian Federation threatens with using its nuclear arsenal against Ukraine or NATO member states, the risk the Romanian population to be exposed to high radioactivity levels (including radioactive iodine) has to be taken into consideration. In this context, in April 2022 the Romanian Ministry of Health decided to provide iodine tablets to all people under the age of 40; it also launched a public information campaign aimed to advise people on how to avoid radiation exposure, including how to take iodine tablets. One year after this campaign, we evaluated the students’ knowledge on potassium iodide (KI) administration. A number of 828 students (in Medicine, Dentistry, Nursing, Pharmacy, Sciences, Electronics, and Philology), 68% females, aged 20-24 years, answered a 12-item questionnaire on KI administration. The results show 78.3% of the subjects associated KI administration with a nuclear accident/use of nuclear weapons; about 70% knew they can have KI from the pharmacist's using a prescription from the general practitioner. Only 38.6 % of the students correctly mentioned the age of KI administration; 41.1% knew a single dose administration is necessary. About 63% of the respondents knew KI is necessary to protect the thyroid; 53.1% mentioned thyroid cancer as the risk of KI non-administration. As expected, most correct answers were given by students in health-care specialties, while the less correct - by students in Philology (p < 0.001). Surprisingly, best informed medical students were respondents from Nursing, followed by those in Medicine, Pharmacy, and Dentistry (p < 0.01). Even students are considered a well-informed population group, the results indicate more than half of the subjects miss important information concerning radiation exposure attitude. Key messages • Nowadays nuclear weapons use is a threat everybody should be aware of. • Information is an essential tool to make people able to protect themselves against radiation exposure.

Assessing the Level of Knowledge and Experience Regarding Cervical Cancer Prevention and Screening among Roma Women in Romania.

Background and Objectives: Romania ranks among the countries with a particularly high rate of mortality that can be prevented through prevention programs, screening, early detection, and prompt care. Cervical cancer (CC) is a major cause of these preventable deaths, affecting individuals from marginalized and rural regions, as well as the Roma population. The purpose of this article was to identify accurate and consistent information about the Roma population on the risk of CC, as well as the importance of understanding the causes of the disease and awareness of the available prevention methods. Materials and Methods: A cross-sectional study was conducted using a self-administered questionnaire applied only to Roma women in Romania. Results: We enrolled 759 patients in this study. These were divided into two groups: Group 1 comprised 289 (38.1%) women who had been tested for HPV infection, while Group 2 included 470 (61.9%) women who had never been tested for HPV infection. Characterization of women in Group 1: mostly aged between 25 and 54 years, with high school education, married, who started sexual activity under the age of 18 years, with only one sexual partner, and had over five pregnancies. Regarding contraceptive methods, 35.7% of women do not know or use any contraceptive method, and 32.2% use hormonal contraceptives. Two thirds of the women tested had heard of HPV, and 19.7% were vaccinated against HPV with at least 2-3 doses. A percentage of 8.7 had a diagnosis of CC, compared to those who were not tested (p-0.0001), whereas 63% of the tested women did not know much about CC, as opposed to 85.7% of the group of untested women. Conclusions: Cervical cancer (CC) continues to be a public health concern in Romania, particularly among vulnerable groups. Promoting campaigns to raise awareness for HPV vaccination and CC screening are necessary to reduce the associated mortality and morbidity.

Engaging with the claim of Roma people through twitter: who is behind the hashtags?

Grassroots Roma communities play a pivotal role in organizing at the grassroots level, advocating for their rights, and challenging anti-Roma sentiment across Europe. Nevertheless, there remains a need for a deeper understanding of how these efforts manifest within the digital landscape. Within the overarching framework of the Narratives4Change project (EU Marie Curie Action, Nr. 841,355), this study seeks to examine the use of Twitter as a platform for advocating Roma-related issues. Specifically, it investigates the types of actors engaged in tweeting about Roma-related content and explores potential variations in profiles (organizations vs. individuals) based on the content being tweeted. The analysis encompasses six Roma-related hashtags spanning the years 2017 to 2020: #RomaLivesMatter, #InternationalRomaDay, #OpreRoma, #OpreRomnia, #MujerGitana, and #RomaWomen. The findings reveal that organizations are most active when employing the hashtags #InternationalRomaDay and #MujerGitana, whereas for the other hashtags studied, individual users dominate. Our data underscore the untapped potential of social media spaces and their ecosystems as strategic tools for advocacy and mobilization in support of Roma rights throughout Europe.

Support for the Inclusion of Roma Children through the Project Teaching Model

Roma are the largest minority ethnic group in Europe, but very few Roma achieve a level of education that enables them to secure employment or positive life chances. The general perception of Roma is based on a series of stereotypes such as poverty, asociality, unemployment, poor education, a tendency towards social tension, and susceptibility to educational deficiencies. Their values, lifestyle, principles, language, generally lower social status, and their socio-cultural traditions are noticeably different from those of the majority population of any given European country. The inclusion of Roma in the education system would soften the existing discourse and encourage their integration into a society. The paper aims to point out the possibility of integrating the Roma population into schools, with the given model of project teaching, in such a way that the other students also get to know their culture and traditions. The paper proposed the model of project teaching, which aims to introduce students to the Roma people and their famous representatives through the contents of legends, music, and true war stories, in order to develop knowledge about the other and different, and foster a climate of togetherness in the class and school.

The Molecular Evidence for Invasive Climber Echinocystis lobata (Michx.) Torr. & A. Gray in Eastern and Central Europe

The climbing cucurbit Echinocystis lobata, native to North America and alien to many European countries, was assessed for its genetic diversity and differentiation across its introduced range of populations by applying markers of amplified fragment length polymorphism (AFLP). Various tests, including an evaluation of the intrapopulation diversity, principal coordinate, and molecular variance analyses, showed that the Central and Eastern European populations differing in geography and arrival history are also distinct in the genetic parameters. Genetic diversity, defined as the percentage of polymorphic AFLP loci, ranged within 28–62% (on average 51%) at the regional scale (in Romanian, Baltic State, and Central Russian populations), and was very similar to this parameter at the local scale (on average 52% for Lithuanian populations). The differentiation was significant among the populations of the regions (Ф = 0.125, p = 0.001) and at the local scale (among the Lithuanian populations of the different river basins, Ф = 0.058, p = 0.010). The Bayesian results suggested the presence of three genetic clusters among the 29 sites, with populations from Romania, Latvia, Estonia, and the northern part of Lithuania comprising one prevailing cluster, populations from the Nemunas river basin of Lithuania comprising either the former mentioned cluster or the second cluster, and populations of Central Russia comprising the third genetic cluster. Overall, E. lobata in Europe has probably originated from multiple introductions. The intentional anthropogenic seed dispersal by marketing accompanied by hydrochory might have an impact on such a profile of genetic clusters.

Relationships of the Romanian population of Bukovina with representatives of the authorities during World War I

The purpose of the study is to analyze the relationships of the Romanian popula- tion of Bukovyna with the Austrian and Russian authorities during World War I. Th e method- ology of the study is based on the principles of historicism, objectivity, systematic approach and the use of methods of analysis and synthesis, as well as problematic and chronological, historical and typological, historical and systematic ones. Th e scientifi c novelty is defi ned by the fact that the situation of the Romanian population of Bukovyna during World War I and the measures taken by the Austrian and Russian authorities to control the population have been comprehen- sively analyzed for the fi rst time in Ukrainian historiography. Bukovyna became a part of the combat zone from the beginning of the Great war, and its population was forced to face a new attitude of the Austrian authorities, who considered it necessary to eliminate any manifestations of Russophilia, both among Ukrainians and Romanians. Since the Russian authorities intended to achieve the appropriate attitude towards the Romanian population of Bukovyna in order of Romania entering the war, the Austrian authorities made some steps to restrict the freedom of teachers and priests as mentors of the peasants. Despite the belief in the existence of irredenta among the Romanians, the Austrian authorities tried to attract Romanians to participate in volunteer armed forces during defensive battles in Bukovyna. Accusations of treason oft en resulted in the dismissal of the accused, but such cases occurred mainly at the end of the war and oft en concerned representatives of the upper world, as was the case with Yanku Flondor. The imbalance of the Austrian authorities’ attitude towards the Romanians caused some animosity towards them among the latter. Conclusion. The Romanian population of Bukovyna became the element by infl uencing which the Russian occupation authorities intended to trigger the break-up of Austria-Hungary during World War I. The loyalty of the Russian authorities to the Romanian population should have helped to convince the country’s authorities of the need to join the Entente countries. However, the authorities had not always been able to fi nd the right solutions to social issues, which had kept the latter ones in the background. Aft er all, the Russian authorities failed to avoid the pogroms of Romanian farms, which did not prevent the Russian side from Romania entering the war on the Entente side.

Minulosť v (ne)pamäti Rómov

This study uses authentic interviews from field research into the Roma people of Slovakia to search for partial answers to questions concerning the functioning of collective and individual memory of the marginalised ethnic group that to this day almost exclusively leans on oral presentation instead of written recordings when sharing stories and experiences between generations. Witnesses to wartime events are dying out. Their stories need to be re-interpreted. They are too often lost, however, in the chasm of oblivion caused by ostracisation, neglected education, politics and, above all, poverty. The state has failed in the past and continues to fail today, albeit differently, by enabling the process of forgetting.

Gypsy “flavor” within a social structure

In Turkey Romani people have preserved their basic cultural values throughout ages, in fact ever since the Byzantium times. Their origins can be traced back to India, from where they somehow dispersed practically everywhere around the globe. Certain tribes kept living as nomadic people until fairly recent times; while others got settled collectively in districts of certain provinces and counties. In Istanbul sedentarized Romanies essentially pertain to some old neighborhoods near the ancient citywall. The bigger society used to attribute some undeserved negative traits to those jovial, carefree communities; while some of their true virtues (like music-talent or skilled handicrafts) could never be contested, enjoying universal appreciation. In this particular study; Romany people are handled from a sociologicay viewpoint in as much detail as possible or appropriate for the scope of an academic article. The major sources hereby consulted comprise an expert work in French by the prominant social scientist François de Vaux de Foletier, as well as a few volumes of the masterpiece of a social-historian, late Reşat Ekrem Koçu, namely İstanbul Ansiklopedisi (The Encyclopedia of İstanbul). (The publishment of the precious serial came to an end with the untimely-death of the chief-editor). Auxuliary complementary literature is also included. The author of this article did insert a sequence of his own life experiences/Erlebnis, as well. The outdated-and-despised word “Gypsy” is mostly omitted in the text, except solely in obligatory quotations. Instead, it is replaced by euphumistic words, above all “Romany”.

The Romanian Consumers’ Perception Regarding the Immunization against the Coronavirus

Considering the different perceptions of the population on the efficiency and side-effects of the Corona vaccine the present study has in attention the perception of the Romanian population on the COVID-19 vaccines and the most important determinants of the consumer’s choice on vaccination. The study consists of analyzing data collected through a survey applied in the West Region of Romania. The collected responses are resumed to a set of constructs, obtained by running an exploratory and confirmatory factor analysis, part of them being used as dummy variables. Estimating a generalized linear ordinal regression model, the purpose of our study is to identify the drivers which influence the respondents’ perception regarding the efficiency and the side effects related to the COVID-19 vaccine. Our results confirm a significant influence of the respondents’ profile on their perception. Inter-personal relations and media channels seem to influence only the respondents’ perception of the efficiency of the COVID-19 vaccine. Our study emphasizes as well how important it is for people to get a better understanding of the COVID-19 virus, which helps to form their own opinion regarding the vaccine. On the other side, the results show how essential it is for the authorities to change their vision on pandemic information transparency. Otherwise, scenarios like mandatory vaccination against COVID-19 seem to make people even more reluctant. This research paper shows that Romanians are not sufficiently interested in vaccination, first of all because there is a lack of trust even among specialists, which determines a lack of trust among the population in the efficacy of the recommended immunization. Romanian people seem to be more interested in the side-effects of vaccination against COVID-19, rather than how efficient the vaccine is.

Predictors of height in Romanian infants 6-23 months old: findings from a national representative sample.

The research explored the association between infants' height and various demographic factors in Romania, a country where such critical information has been lacking. This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6-23 months of age (M=14.26; SD=5.15). Infants' height-for-age z-scores (HAZ) were calculated using the World Health Organization's computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother's age, location, marital status, socioeconomic status (SES), as well as infant's term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ. The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18-23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age. The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.

Diabetes Care in Romania: A Lesson on the Central Role of Lifestyle Medicine

In this narrative review, diabetes care in Romania is discussed in terms of epidemiological data, lifestyle medicine, and research/knowledge/practice gaps. The principal drivers of cardiometabolic-based chronic disease—adiposity and dysglycemia—are manifest in Romania at concerning levels. Diabetes prevalence in Romania is 8.4%–11.6% of which 21.3% are unaware. Obesity prevalence in Romania is 31.9% and correlated with adverse lifestyle trends and cardiovascular risk. The large epidemiological studies conducted in Romania are highlighted to fully portray the magnitude of how lifestyle, diabetes, and cardiometabolic risk are related. Knowledge gaps among patients regarding this health risk are in large part due to low health literacy in the Romanian population. Educational programs and delivery of lifestyle medicine in structured centers are outlined as potential solutions to close knowledge and practice gaps. Understanding how lifestyle medicine issues affect diabetes and cardiometabolic care in Romania can prompt transformative management strategies in other ethnocultural settings across the globe.

The Psoriasis Disability Index in Romanian Psoriasis Patients during COVID-19 Pandemic: Contribution of Clinical and Psychological Variables.

Psoriasis is one of the most frequent chronic inflammatory skin diseases and has a negative impact on the interpersonal relationship and psychosocial well-being. The aims of this study were to examine the effects of intensity of pruritus on quality of life and depression, to investigate the relationship between anger, self-esteem, and depression, and to compare patients with early and late onset of psoriasis. As our study was carried out during the COVID-19 pandemic, we aimed also to investigate the safety concerns and anxiety related to COVID-19 in psoriasis patients. This cross-sectional study included 137 patients diagnosed with plaque psoriasis. The patients were classified as early-onset (age < 30 years) and late-onset psoriasis (age ≥ 30 years). Duration of disease, pruritus scores, and socio-demographic characteristics were recorded. Measures included the State-Trait Anger Expression Inventory (STAXI), Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI-II), Psoriasis Disability Index (PDI), and Fear and anxiety in relationship with COVID-19 Scale were used for determining anger, anger expression style, self-esteem, depression, anxiety, and quality of life. The psoriasis patients had a lower score for self-esteem than the normative data from the Romanian general population. The average scores for state anger and trait anger are similar to the normative data from the Romanian general population, but the scores for anger-in and anger-out are higher. Patients with early onset had higher depression scores and lower quality of life. Self-esteem correlates negatively with depression, anger, severity of disability due to psoriasis, number of affected areas, and duration of disease. Lower level of self-esteem led to increased anger. Reduced self-esteem, increased anger levels, and depression are present in psoriasis patients. The effective treatment of psoriasis must, therefore, consist of a multidisciplinary approach, in which the personalized treatment of the skin condition is as important as the adjuvant therapies that reduce the patients' stress level.

Comparative study of factors influencing cytological screening for cervical cancer attendance in Hungary among Roma and non-Roma population, in relation to Slovak and Romanian results

To the present day, the prevalence and incidence of cervical cancer remains very significant. For disadvantaged groups such as the Roma, screening for the disease should be given increased attention, as members of this minority have lower access to health care and lower average health literacy. The aim of our study was to assess the prevalence of cytological screening for cervical cancer among Hungarian-speaking Roma and non-Roma populations in Hungary, Romania and Slovakia, in relation to the possible influencing factors. We also investigated respondents' perceptions of the importance of cervical cancer screening and HPV vaccination. In this paper, we focus on presenting the data from Hungary in relation to the results from the other two countries. The study sample size was 1366. Data were presented as mean ± SD and proportion. To compare Roma and non-Roma samples, the independent samples t-test was used. Cross tabulation with Pearson's chi-square test with calculating phi/Cramér's V effect size (p<0.05) was used to reveal association between ethnicity and studied variables. In Hungary, a higher proportion of Roma women (p = 0.004) did not attend cytological screening for cervical cancer compared to non-Roma women, a difference confirmed in the other two countries. Non-Roma women attached greater importance to attendance at cervical cancer screening (p = 0.022). The Roma population aged 18-65 years had lower rates of annual cytological screening for cervical cancer compared to non-Roma in all age groups, while the annual screening rate decreased with age, regardless of ethnicity. Further health promotion to prevent cervical cancer in the Roma and non-Roma population would be necessary, regardless of national borders, specifically to address risk factors in all age groups, with a focus on young people, who are less aware of the risk, and older age groups, who mostly believe that the disease does not affect them due to their age. Orv Hetil. 2023; 164(36): 1416-1425.

The Human Rights and Freedoms in Constitution of Romania of 1866

The purpose of the article is the analysis of the provisions of the first Constitution of Romania of 1866 in terms of guaranteeing of Human Rights and freedoms by the state. The article points out that the adoption of the Constitution of 1866 became a fateful state legal act for the entire Romanian people, since it meant a radical change in the ratio of external and internal factors in the state-building process of the Romanian state. To achieve this goal, general scientific and special-scientific methods of cognition were used, in particular, dialectical-legal-comparative, legal-formal. It has been determined that the accepted Constitution in 1866 in terms of guaranteeing Human Rights and freedoms has had a truly liberal character and has become the progressive state-legal act for the state-building process of Romania; the need to follow the norms of the Basic Law gradually have made constitutionalism as the form of thinking, which has contributed to the further expansion of democratic rights and freedoms and the development of the democratic views in the country.

THE INCIDENCE OF THE PANDEMIC CONTEXT ON THE SOCIAL EXCLUSION AND MATERIAL DEPRIVATION IN ROMANIA

In Romania, social exclusion highlights a reality that removes the perspectives of sustainable development of social equity and economic stability. The pandemic context caused a major discrepancy between national socio-economic environments, placing Romania first in the European ranking regarding the level of social exclusion and material deprivation. The insufficient space of the labor market, the intensity of unemployment, the government restrictions imposed to limit the pandemic context argue the alarming statistics of social exclusion, while the policies and strategies implemented to ensure an honorable standard of living for the Romanian population do not show notable results, limiting the possibilities reducing the level of poverty. The purpose of the article is to measure the level of social exclusion and material deprivation in Romania, formulating sustainable proposals for improving the quality of life of people whose socio-economic status is at the limit of existence.

Evaluation of Non-Alcoholic Beverages and the Risk Related to Consumer Health among the Romanian Population.

The range of non-alcoholic drinks is very varied both from a compositional point of view and from a caloric and nutritional point of view. The excessive consumption of sweetened non-alcoholic beverages represents an important risk factor for health, especially when it is accompanied by an unbalanced diet and a disordered lifestyle. In order to evaluate the consumption of non-alcoholic beverages correlated with the evaluation of the main lifestyle factors that can affect the state of health among Romanians, a cross-sectional observational study was carried out based on a questionnaire. The results of the study indicate that among the most consumed non-alcoholic drinks are coffee and sweetened carbonated and non-carbonated drinks, which are indicated as being responsible for the development of consumption addictions: 44% for coffee, 16.5% for sweetened or tonic carbonated drinks and 12% for sweetened non-carbonated drinks. Considering that the consumption of coffee is usually associated with sweeteners, there is a risk of excessive caffeine and caloric intake in a context where a lack of exercise predominates (59.98%) among respondents declaring that they do sports rarely or not at all, which can lead, in the long term, to the appearance of imbalances either of a psycho-emotional nature or of a metabolic nature. A significant link was found between sports activity and the environment in which they work (χ2 = 51.33, p = 0.05). Respondents with a daily activity that involves movement (working outdoors, working on a construction site) are also those who usually do sports, while 60.67% of the respondents who work a lot in front of the computer declared that they do sports very rarely or not at all. Reducing the excessive consumption of sweetened drinks can be achieved through an appropriate consumption of water and fruits and by intensifying physical activity as a way of counterbalancing the excess caloric intake.

Differences in literacy, education level, and healthcare attendance in two different Roma subgroups from Transylvania, Romania

Abstract Background: Literacy and education levels were demonstrated to be low in the Roma population. The outcomes after the implementation of different educational policies, in different countries, were not properly assessed for Roma subgroups until now. Aims: We aimed to study literacy, education level, and healthcare attendance in two well-defined Roma subgroups, compared to the majority population, in a specific Transylvanian rural region. Material and methods: A non-interventional, cross-sectional comparative survey was conducted in 2016-2017 between two Roma subgroups and the general population, from a rural region in Transylvania regarding their literacy, education level and healthcare attendance. Results: Illiteracy was 33.3%, 66.6%, and 4.2% in the Gabor, Lovari Roma, and general population (p &lt; 0.001). 29.5% of the Gabors and 45.6% of the Lovari Roma did not attend any school, compared to 2.7% of the general population. Almost none of the Roma population attended school after finishing 8 classes. Healthcare service attendance was significantly lower for the Roma subgroups, and directly related to their education level. 32.7% of the Gabors, 28.3% of the Lovari Roma, comparing to 7.3% of the general population never attended the general practitioner (p &lt; 0.001). Conclusions: Gabor Roma population had a significantly lower proportion of illiteracy and a higher school attendance than Lovari Roma group, but still illiterate by a high percentage. The Roma’s healthcare attendance was far lower than the general population’s, having been even worse in the Gabor group. Healthcare counseling was directly correlated with education level.

Association of HDL Subfraction Profile with the Progression of Insulin Resistance.

Type 2 diabetes mellitus (T2DM) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is a condition characterized by disturbances in carbohydrate and lipid metabolism that precedes T2DM. The aim of the present study was to investigate the association between HDL and its subfraction profile and the progression of IR, as assessed by the Homeostatic Model Assessment for IR (HOMA-IR) index, and to define cut-off values to identify an increased risk of IR. Individuals with a HOMA-IR greater than 3.63 were considered to have IR. The HDL subfractions were separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) in three subclasses as large (HDL-L), intermediate (HDL-I) and small (HDL-S). Analyses were performed on samples from 240 individuals without IR and 137 with IR from the Hungarian general and Roma populations. The HDL-1 to -6 subfractions and the HDL-L and -I classes showed a significant negative association with the progression and existence of IR. Among them, HDL-2 (B = -40.37, p = 2.08 × 10-11) and HDL-L (B = -14.85, p = 9.52 × 10-10) showed the strongest correlation. The optimal threshold was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. Individuals with HDL-L levels below the reference value had a 5.1-fold higher risk of IR (p = 2.2 × 10-7), while those with HDL-2 levels had a 4.2-fold higher risk (p = 3.0 × 10-6). This study demonstrates that the HDL subfraction profile (especially the decrease in HDL-2 and -L) may be a useful marker for the early detection and intervention of atherogenic dyslipidemia in subjects with impaired glucose and insulin metabolism.