Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development.

• Keywords
• development, early childhood, equity, feasibility, health, interventions, marginalized Roma communities, measures,
• MeSH
• Child MeSH
• Health Services Accessibility MeSH
• Ethnicity MeSH
• Humans MeSH
• Minority Groups MeSH
• Child, Preschool MeSH
• Roma * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Slovakia MeSH

BACKGROUND: This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures. METHODS: Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study. RESULTS: Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster 'Targeting living conditions', was rated as the most urgent but least feasible, whereas the cluster 'Targeting health care', was considered least urgent but most feasible. Among the 27 priority measures, 'Planning parenthood' and 'Scaling up existing projects' had the highest priority. CONCLUSION: Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts.

• Keywords
• Early childhood development, Inequalities, Marginalized Roma communities,
• MeSH
• Child MeSH
• Humans MeSH
• Delivery of Health Care MeSH
• Child, Preschool MeSH
• Roma * MeSH
• Social Workers MeSH
• Health Status MeSH
• Health Personnel MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. METHODS: We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). RESULTS: Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. CONCLUSIONS: Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

• Keywords
• Concept mapping, Czech Republic, Ethnicity, Health care access, Interventions, Policies, Roma, Vulnerable population,
• MeSH
• Healthcare Disparities MeSH
• Adult MeSH
• Health Services Accessibility * MeSH
• Culturally Competent Care * MeSH
• Cultural Competency MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Delivery of Health Care * MeSH
• Spatial Analysis MeSH
• Roma * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Social Inclusion MeSH
• Social Isolation MeSH
• Concept Formation MeSH
• Health Policy MeSH
• Health Facilities MeSH
• Vulnerable Populations MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• China MeSH

In the Czech Republic, a number of strategy papers and policy documents are guiding the direction of Roma inclusion, including in the area of health. The conceptualization of Roma and how mainstream political and public discourse operate with the term "Roma" contribute to a mistakenly homogenous and harmful image of Roma that conforms to negative stereotypes. The aim of our study was to examine the conceptualization of Roma in policy documents related to social inclusion and health in the Czech Republic. Relevant political, strategic and project documents were selected for analysis. Emphasis is placed in them on individual responsibility in relation to health, while structural conditions and discrimination are mentioned less often. Roma are described in relation to health primarily as people who should be educated. More emphasis is placed on the economic benefits of eliminating health inequalities than on citizens' rights and the importance of inclusion. When "participation" or "empowerment" is mentioned, it is done vaguely, usually in addition to references to completely non-participatory practices. The majority is the primary actor in the field of eliminating health inequalities, as it defines the "path" that Roma need to be shown or determines what is needed to "stimulate" citizens. Although the political discourse concerning Roma has shifted more towards human rights, equity and combating discrimination in the Czech Republic, subtle forms of anti-Gypsyism still seem to be present.

• Keywords
• Czech Republic, conceptualization of Roma, health, policy documents, social inclusion,
• MeSH
• Humans MeSH
• Roma * MeSH
• Social Inclusion * MeSH
• Concept Formation MeSH
• Health Policy * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: The socioeconomic and ethnic composition of urban neighbourhoods may affect mortality, but evidence on Central European cities is lacking. The aim of this study was to assess the associations between socioeconomic and ethnic neighbourhood indicators and the mortality of individuals aged 20-64 years old in the two biggest cities of the Slovak Republic. METHODS: We obtained data on the characteristics of neighbourhoods and districts (educational level, unemployment, income and share of Roma) and on individual mortality of residents aged 20-64 years old, for the two largest cities in the Slovak Republic (Bratislava and Kosice) in the period 2003-2005. We performed multilevel Poisson regression analyses adjusted for age and gender on the individual (mortality), neighbourhood (education level and share of Roma in population) and district levels (unemployment and income). RESULTS: The proportions of Roma and of low-educated residents were associated with mortality at the neighbourhood level in both cities. Mutually adjusted, only the association with the proportion of Roma remained in the model (risk ratio 1.02; 95 % confidence interval 1.01-1.04). The area indicators - high education, income and unemployment - were not associated with mortality. CONCLUSION: The proportion of Roma is associated with early mortality in the two biggest cities in the Slovak Republic.

• MeSH
• Residence Characteristics statistics & numerical data   MeSH
• Healthcare Disparities ethnology   statistics & numerical data   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Mortality ethnology   MeSH
• Risk Factors MeSH
• Roma statistics & numerical data   MeSH
• Socioeconomic Factors * MeSH
• Cities epidemiology   ethnology   MeSH
• Multilevel Analysis MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Slovakia epidemiology   ethnology   MeSH
• Cities epidemiology   ethnology   MeSH

BACKGROUND: In the present study we aimed: 1) To establish the prevalence and clinical impact of DFNB49 mutations in deaf Roma from 2 Central European countries (Slovakia and Hungary), and 2) to analyze a possible common origin of the c.1331+2T>C mutation among Roma and Pakistani mutation carriers identified in the present and previous studies. METHODS: We sequenced 6 exons of the MARVELD2 gene in a group of 143 unrelated hearing impaired Slovak Roma patients. Simultaneously, we used RFLP to detect the c.1331+2T>C mutation in 85 Hungarian deaf Roma patients, control groups of 702 normal hearing Romanies from both countries and 375 hearing impaired Slovak Caucasians. We analyzed the haplotype using 21 SNPs spanning a 5.34Mb around the mutation c.1331+2T>C. RESULTS: One pathogenic mutation (c.1331+2T>C) was identified in 12 homozygous hearing impaired Roma patients. Allele frequency of this mutation was higher in Hungarian (10%) than in Slovak (3.85%) Roma patients. The identified common haplotype in Roma patients was defined by 18 SNP markers (3.89 Mb). Fourteen common SNPs were also shared among Pakistani and Roma homozygotes. Biallelic mutation carriers suffered from prelingual bilateral moderate to profound sensorineural hearing loss. CONCLUSIONS: We demonstrate different frequencies of the c.1331+2T>C mutation in hearing impaired Romanies from 3 Central European countries. In addition, our results provide support for the hypothesis of a possible common ancestor of the Slovak, Hungarian and Czech Roma as well as Pakistani deaf patients. Testing for the c.1331+2T>C mutation may be recommended in GJB2 negative Roma cases with early-onset sensorineural hearing loss.

• MeSH
• Alleles MeSH
• Founder Effect MeSH
• Exons genetics   MeSH
• Gene Frequency MeSH
• Genotype MeSH
• Haplotypes genetics   MeSH
• Polymorphism, Single Nucleotide * MeSH
• Infant MeSH
• Connexin 26 MeSH
• Connexins MeSH
• Humans MeSH
• MARVEL Domain Containing 2 Protein genetics   MeSH
• Mutation * MeSH
• Hearing Loss congenital   ethnology   genetics   MeSH
• Prevalence MeSH
• Roma genetics   MeSH
• Sequence Homology, Nucleic Acid MeSH
• Age of Onset MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic ethnology   MeSH
• Hungary ethnology   MeSH
• Pakistan ethnology   MeSH
• Slovakia ethnology   MeSH
• Names of Substances
• GJB2 protein, human MeSH Browser
• Connexin 26 MeSH
• Connexins MeSH
• MARVELD2 protein, human MeSH Browser
• MARVEL Domain Containing 2 Protein MeSH

OBJECTIVES: The objective of this paper is to provide information on indoor air quality and on the quality of the broader indoor environment of the houses in Roma villages in Slovakia and Romania and to discuss possible implications for health. METHODS: Indoor air was sampled in 11 houses in a Romanian Roma village and in 19 houses in a Slovakian Roma village. Levels of carbon monoxide (CO), carbon dioxide (CO2), total particulate matter (PM), temperature and humidity were measured. A questionnaire and a checklist were used to obtain additional information on the indoor environment and behavioural factors. We have sampled the same houses in winter and in summer. RESULTS: Levels of CO and CO2 were higher in winter in both countries as compared to summer. The limit value of 10 mg/m3 CO was exceeded in a few cases in both countries. In general, levels of CO, CO2 and PM were higher in Romania. Further environmental and behavioural hazards such as indoor smoking, pets inside or lack of ventilation were found. The reported self-perceived quality of the indoor environment was poor in many aspects. CONCLUSIONS: Our findings of CO, CO2 and PM levels suggest that indoor air pollution in Roma settlements has the potential to be a health threat. The fact that the inhabitants spend a relatively long time inside the houses and that a number of additional environmental and behavioural hazards were identified by our study emphasizes the importance of the indoor air quality for health and thus priority attention should be paid to these issues by health authorities and researchers. Further research is essential and study designs must consider cultural background and specific characteristics of the community, especially in order to obtain valid data on health outcomes.

• MeSH
• Housing statistics & numerical data   MeSH
• Ethnicity * MeSH
• Risk Assessment MeSH
• Air Pollutants analysis   MeSH
• Humans MeSH
• Environmental Monitoring MeSH
• Carbon Monoxide analysis   MeSH
• Carbon Dioxide analysis   MeSH
• Particulate Matter analysis   MeSH
• Seasons MeSH
• Temperature MeSH
• Humidity MeSH
• Environmental Exposure statistics & numerical data   MeSH
• Health Status MeSH
• Air Pollution, Indoor analysis   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• Romania MeSH
• Slovakia MeSH
• Names of Substances
• Air Pollutants MeSH
• Carbon Monoxide MeSH
• Carbon Dioxide MeSH
• Particulate Matter MeSH

BACKGROUND: Data on the health status of the Roma people in Central and Eastern Europe are sparse and the reasons for their poor health are not clear. The objective of this study was to quantify the differences in birth outcomes between Roma and non-Roma mothers in the Czech Republic and to investigate the potential causes of such differences. METHOD: A population-based study recruited 8938 non-Roma and 1388 Roma hospitalised singleton births that occurred in two Czech districts (Teplice and Prachatice) between 1995 and 2004. During their stay in hospital, mothers completed a questionnaire on their demographic and socioeconomic characteristics and maternal smoking and alcohol consumption. Data on maternal height and weight and on infants' birth weight and gestational age were taken from hospital records. RESULTS: Birth weight and gestational age of Roma infants was 373 (SE 15) g and 0.92 (0.05) weeks, respectively, lower than in non-Roma infants. Controlling for demographic, socioeconomic and behavioural factors reduced these differences to 133 (18) g and 0.57 (0.06) weeks, respectively (all p-values < 0.001). In terms of binary outcomes, the Roma vs. non-Roma odds ratios were 4.5 (95% CI 3.7-5.4) for low birth weight (< 2500 g), 2.8 (2.2-3.4) for preterm birth (< 37 weeks of gestation), and 2.9 (2.5-3.4) for intrauterine grown retardation (<10th percentile of birth weight for gestational age); controlling for all covariates reduced these odds ratios to 1.7 (1.3-2.2), 1.5 (1.1-2.0) and 1.3 (1.0-1.6), respectively. Maternal education made the largest contribution to the ethnic differences; the role of health behaviours was relatively modest. CONCLUSION: There are striking differences in birth outcomes between Roma and non-Roma mothers. The causes of these differences are complex but largely socioeconomic.

• MeSH
• White People statistics & numerical data   MeSH
• Adult MeSH
• Gestational Age MeSH
• Hospitalization MeSH
• Humans MeSH
• Adolescent MeSH
• Multivariate Analysis MeSH
• Infant, Newborn MeSH
• Odds Ratio MeSH
• Birth Weight MeSH
• Regression Analysis MeSH
• Risk Factors MeSH
• Roma statistics & numerical data   MeSH
• Socioeconomic Factors MeSH
• Educational Status MeSH
• Pregnancy MeSH
• Maternal Age MeSH
• Pregnancy Outcome ethnology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH