Zsigmond Kósa

A comparative health survey of the inhabitants of Roma settlements in Hungary.

OBJECTIVES We compared the health of people living in Roma settlements with that of the general population in Hungary. METHODS We performed comparative health interview surveys in 2003 to 2004 in representative samples of the Hungarian population and inhabitants of Roma settlements. RESULTS In persons older than 44 years, 10% more of those living in Roma settlements reported their health as bad or very bad than did those in the lowest income quartile of the general population. Of those who used any health services, 35% of the Roma inhabitants and 4.4% of the general population experienced some discrimination. In Roma settlements, the proportion of persons who thought that they could do much for their own health was 13% to 15% lower, and heavy smoking and unhealthy diet were 1.5 to 3 times more prevalent, than in the lowest income quartile of the general population. CONCLUSIONS People living in Roma settlements experience severe social exclusion, which profoundly affects their health. Besides tackling the socioeconomic roots of the poor health of Roma people, specific public health interventions, including health education and health promotion programs, are needed.

Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary

Background: Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status in Hungary. Methods: Comparative health interview surveys were performed in 2003–04 on representative samples of the Hungarian population and inhabitants of Roma settlements. Logistic regression models were applied to study whether the relationship between Roma ethnicity and health is fully mediated by socioeconomic status, and whether Roma ethnicity modifies the association between socioeconomic status and health. Results: The health status of people living in Roma settlements was poorer than that of the general population (odds ratio of severe functional limitation after adjustment for age and gender 1.8 (95% confidence interval 1.4 to 2.3)). The difference in self-reported health and in functionality was fully explained by the socioeconomic status. The less healthy behaviours of people living in Roma settlements was also related very strongly to their socioeconomic status, but remained significantly different from the general population when differences in the socioeconomic status were taken into account, (eg odds ratio of daily smoking 1.6 (95% confidence interval 1.3 to 2.0) after adjustment for age, gender, education, income and employment). Conclusion: Socioeconomic status is a strong determinant of health of people living in Roma settlements in Hungary. It fully explains their worse health status but only partially determines their less healthy behaviours. Efforts to improve the health of Roma people should include a focus on socioeconomic status, but it is important to note that cultural differences must be taken into account in developing public health interventions.

Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries

PurposeWhile there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals’ experiences of delivering care to immigrants in districts densely populated with immigrants across Europe.MethodsForty-eight semi-structured interviews were conducted with mental health care professionals working in 16 European countries. Professionals in each country were recruited from three areas with the highest proportion of immigrants. For the purpose of this study, immigrants were defined as first-generation immigrants born outside the country of current residence, including regular immigrants, irregular immigrants, asylum seekers, refugees and victims of human trafficking. Interviews were transcribed and analysed using thematic analysis.ResultsThe interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk of marginalisation.ConclusionsAlthough mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation.

Prevalence of metabolic syndrome among Roma: A comparative health examination survey in Hungary

OBJECTIVES The objective of our study was to compare the health status of the Roma people with that of the general population in Hungary. METHODS A health examination survey to define the prevalence of metabolic syndrome and its components was performed in a representative random sample (n = 646) of the Roma population aged 20-64 years living in segregated colonies, and data were compared with that obtained in a representative random sample (n = 1819) of the Hungarian population. RESULTS The risks for central obesity, hypertension and raised triglyceride level among Roma adults were not different from the Hungarian references, while raised fasting plasma glucose or known type 2 diabetes mellitus (OR = 2.65, 95%CI 1.90-3.69), reduced HDL cholesterol level or treated lipid disorder (OR = 2.15, 95%CI 1.65-2.79) were significantly more frequent in all age groups in the Roma sample. The prevalence of metabolic syndrome (OR = 1.37, 95%CI 1.03-1.83) was also significantly higher among Roma than in the general Hungarian population. CONCLUSIONS Besides tackling the socio-economic determinants of the poor health of Roma people, specific public health interventions considering increased genetic susceptibility to metabolic disturbances are needed to improve their health status.

The decade of Roma Inclusion: did it make a difference to health and use of health care services?

ObjectivesWe investigated whether the severely disadvantaged health of Hungarian Roma adults living in segregated settlements changed by the Decade of Roma Inclusion program.MethodsWe compared the results of two paired health interview surveys that we carried out using the same methodology before and after the Decade, on the general Hungarian and Roma populations.ResultsSelf-perceived health status of younger Roma worsened, while it improved among older Roma. Reported experience of discrimination reduced considerably and health care utilization improved in general. Positive changes in smoking and nutrition, and negative changes in alcohol consumption and overweight were observed. Many of observed changes can plausibly be linked to various government policies, including a quadrupling of public works expenditure, banning smoking in public places, restricting marketing of tobacco products, increasing cigarette prices, and a new tax on unhealthy foods. Liberalization of rules on alcohol distillation coincided with worsening alcohol consumption.ConclusionsWe have shown that Roma remain severely disadvantaged and present an innovative sampling method which can be used to monitor changes in groups where identification is a challenge.

High Prevalence of Smoking in the Roma Population Seems to Have No Genetic Background

INTRODUCTION The prevalence of smoking in Romani of both genders is significantly higher than in the general population. Our aim was to determine whether a genetic susceptibility contributes to the high prevalence of smoking among Roma in a study based on data collected from cross-sectional surveys. METHODS Twenty single nucleotide polymorphisms known to be closely related to smoking behavior were investigated in DNA samples of Hungarian Roma (N = 1273) and general (N = 2388) populations. Differences in genotype and allele distribution were investigated. Genetic risk scores (GRSs) were generated to estimate the joint effect of single nucleotide polymorphisms in genes COMT, CHRNA3/4/5, CYP2A6, CTNNA3, DRD2, MAOA, KCNJ6, AGPHD1, ANKK1, TRPC7, GABRA4, and NRXN1. The distribution of scores in study populations was compared. Age, gender, and body mass index were considered as confounding factors. RESULTS Difference in allele frequencies between the study populations remained significant for 16 polymorphisms after multiple test correction (p < .003). Unexpectedly, the susceptible alleles were more common in the general population, although the protective alleles were more prevalent among Roma. The distribution of unweighted GRS in Roma population was left shifted compared to general population (p < .001). Furthermore, the median weighted GRS was lower among the subjects of Roma population compared to the subjects of general population (p < .001) even after adjustment for confounding factors. CONCLUSIONS The harmful smoking behavior of the Roma population could not be accounted for by genetic susceptibility; therefore, interventions aimed at smoking prevention and cessation should focus on cultural and environmental factors. IMPLICATIONS This is the first study designed to determine whether genetic background exists behind the harmful behavior of the smoking of the Roma population. Although the frequencies of susceptible and protective alleles strongly differ between the Hungarian Roma and general populations, it is shown that calculated GRSs being significantly higher in the general population, which do not support the hypothesis on the genetic susceptibility of the Roma population. Interventions aimed at smoking cessation in the Roma population should preferentially target cultural and environmental factors.

Data to genetic risk assessment on high-density cholesterol level associated polymorphisms in Hungarian general and Roma populations

Data obtained by genotyping single nucleotide polymorphisms (SNPs) related to high-density lipoprotein cholesterol (HDL-C) levels were utilized in Genetic Risk Score [unweighted (GRS) and weighted (wGRS)] computation on Hungarian general and Roma populations. The selection process of the SNPs as well as the results obtained are published in our research article (Piko et al., 2017) [1]. Linkage analyses were performed by study groups. Study populations were stratified by quintiles of weighted Genetic Risk Score. Multivariate linear regression analyses were performed using Genetic Risk Scores and HDL-C levels as dependent variables; and ethnicity, sex and age as independent variables. The study subjects were categorized into quintiles according their wGRS values. Associations of Genetic Risk Scores with plasma HDL-C levels (as a continuous variable) were observed in both populations. Finally, the two populations were merged and analyzed together by multivariate logistic regression where reduced plasma HDL-C level was the dependent variable; while ethnicity, age and sex were the independent ones.

Distribution Characteristics and Combined Effect of Polymorphisms Affecting Alcohol Consumption Behaviour in the Hungarian General and Roma Populations

Aims Harmful alcohol drinking habits, even among Roma children and adolescents, are more common than in the majority population. The aim of the study was to evaluate the genetic susceptibility of Roma to hazardous alcohol consumption compared to the Hungarian general population. Methods A total of 1273 samples from the population of segregated Hungarian Roma colonies and 2967 samples from the Hungarian general population were genotyped for 25 polymorphisms. Differences in genotype and allele distributions were investigated. Genetic risk scores (GRS) were generated to estimate the joint effect of individual single-nucleotide polymorphisms (SNPs). After unweighted and weighted GRS were calculated the distribution of scores in study populations was compared. Results The allele frequencies differed significantly between the study populations for 17 SNPs (P < 0.002), but the genetic alterations that predispose to or protect against harmful alcohol consumption were not overrepresented in the Roma population. The distribution of unweighted GRS in Roma population was left shifted compared to general population (P = 0.0013). The median weighted genetic risk score was lower among the subjects of Roma population compared to the subjects of general population (0.53 vs 0.65, P = 3.33 × 10−27) even after adjustment for confounding factors. Conclusions Differences in alcohol consumption habits between the Hungarian Roma and Hungarian general populations do not appear to be linked to genetic constitution, this behaviour may occur as a result of different cultural values and environmental exposures. Population-based measures to tackle the fundamental drivers of consumption, which take account of cultural acceptability, are needed to reduce harmful alcohol consumption in the Roma population.

Területi egyenlőtlenségek hosszú idősoros elemzése a várandós nők egészségi állapotát vizsgálva

Absztrakt: Bevezetes: A lakossag egeszsegi allapotanak ismerete nelkulozhetetlen az egeszsegpolitikai dontesek meghozatalahoz, kulonosen igaz ez a varandosok es gyermekek eseteben. Celkitűzes: Az elemzes celja, hogy jellemezze a varandos nők egeszsegi allapotaban bekovetkezett valtozasokat az 1997 es 2012 kozotti időszakban. Modszer: Az adatok forrasat a teruleti vedőnői jelentesek szolgaltattak. Az elemzett adatok kore: dohanyzo, fokozott gondozast igenylő, kesőn (28. het utan) gondozasba kerult varandos es gondozas nelkul szult nők. Az idősoros elemzes Microsoft Excel es STATA 13.0 programok segitsegevel tortent. Eredmenyek: A dohanyzo varandosok aranya orszagosan 13,8% volt a vizsgalt időszakban, ettől magasabb (p<0,01) a dohanyos varandosok aranya Borsod-Abauj-Zemplen, Nograd, Heves, Szabolcs-Szatmar-Bereg, es Somogy megyekben. A fokozottan gondozott varandosok aranya az orszagoshoz kepest magasabb (p<0,01) Szabolcs-Szatmar-Bereg, Somogy, Borsod-Abauj-Zemplen es Nograd megyekben. A varandosok tobb min...INTRODUCTION Monitoring the health status of populations is essential for good health policy decisions. This is particularly true in maternal and child health where targeted and timely interventions may have long-term consequences. AIM Our objective was to describe changes in the health status of pregnant women at the national and county level during the period of 1997-2012. METHOD Data were extracted from the mandatory annual reports of district nurses responsible for primary maternal care. Information on the smoking status of expecting mothers, special care during pregnancy, pregnant women entering into maternity care after 28 weeks of pregnancy, borne woman without district nurse care were analysed using Microsoft Excel and STATA 13.0. RESULTS The mean prevalence of smoking was 13.8% among pregnant women during the investigation period. The ratio of smoking pregnant women was higher (p<0.01) in Borsod-Abaúj-Zemplén, Nógrád, Heves, Szabolcs-Szatmár-Bereg, and Somogy counties. The ratio of pregnants requiring special care was higher (p<0.01) than the national average in Somogy, Szabolcs-Szatmár-Bereg, Borsod-Abaúj-Zemplén and Nógrád counties. More, than 1% of the pregnant women entered into care only after the 28th week of the pregnancy. Women who were registered by district nurses and gave birth less than 1% did not participate in pregnant nursing. CONCLUSION National data hide significant regional disparities within the country which should be amended by targeted interventions, taking into account the large regional inequalities in the country. Orv Hetil. 2017; 158(29): 1131-1142.