Publications by authors named "Jitse P van Dijk"

201 Publications

Using photos of basic facial expressions as a new approach to measuring implicit attitudes.

PLoS One 2021 13;16(5):e0250922. Epub 2021 May 13.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: Measuring implicit attitudes is difficult due to social desirability (SD). A new method, the Emotion Based Approach (EBA), can solve this by using emotions from a display of faces as response categories. We applied this on an EBA Spirituality tool (EBA-SPT) and an Actual Situation tool (EBA-AST). Our aim was to assess the structure, reliability and validity of the tools and to compare two EBA assessment approaches, i.e., an explicit one (only assessing final replies to items) and an implicit one (assessing also the selection process).

Methods: We obtained data on a sample of Czech adults (n = 522, age 30.3±12.58; 27.0% men) via an online survey; cortisol was assessed in 46 participants. We assessed the structure and psychometric properties (internal consistency and test-retest reliability; convergent, discriminant, and criterion validity) of the EBA, and examined the differences between explicit vs. implicit EBA approaches.

Results: We found an acceptable-good internal consistency reliability of the EBA tools, acceptable discriminant validity between them and low (neutral expression) to good (joy) test-retest reliability for concrete emotions assessed by the tools. An implicit EBA approach showed stronger correlations between emotions and weaker convergent validity, but higher criterion validity, than an explicit approach and standard questionnaires.

Conclusion: Compared to standard questionnaires, EBA is a more reliable approach for measuring attitudes, with an implicit approach that reflects the selection process yielding the best results.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250922PLOS
May 2021

The Coronavirus Pandemic and the Occurrence of Psychosomatic Symptoms: Are They Related?

Int J Environ Res Public Health 2021 03 30;18(7). Epub 2021 Mar 30.

Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic.

Most studies on the coronavirus pandemic focus on clinical aspects of the COVID-19 disease. However, less attention is paid to other health aspects of the pandemic. The aim of this study was to assess the relationship between the coronavirus pandemic (risk of infection by virus together with associated measures taken to combat it), and the occurrence of a wide range of psychosomatic symptoms and to explore if there is any factor that plays a role in this association. We collected data from a sample of Czech adults ( = 1431) and measured the occurrence of nine health complaints, respondents' experience during the pandemic and sociodemographic characteristics. The results showed associations between the coronavirus pandemic and increased psychosomatic symptoms and negative emotions. We further found higher risks of increased health complaints in younger people and women. It is also possible that there is higher risk of increased health complaints for respondents with secondary school education, students, and highly spiritual people, but this relationship has to be further investigated. In contrast, respondents with their highest achieved education level being secondary school graduation had a lower risk of increased frequency of stomach-ache. We also found that more negative emotions could increase the frequency of health complaints. Our findings suggest that the coronavirus pandemic and associated government measures could have a significant influence on the prevalence of health complaints and emotional state.
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http://dx.doi.org/10.3390/ijerph18073570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036614PMC
March 2021

Religious Attendance in a Secular Country Protects Adolescents from Health-Risk Behavior Only in Combination with Participation in Church Activities.

Int J Environ Res Public Health 2020 12 15;17(24). Epub 2020 Dec 15.

Olomouc University Social Health Institute, Palacký University Olomouc, 771 11 Olomouc, Czech Republic.

Religiosity and spirituality have been considered to be protective factors of adolescent health-risk behavior (HRB). The aim of this study was to assess the relationship between adolescents' HRB and their religiosity, taking into account their parents' faith and their own participation in church activities. A nationally representative sample ( = 13377, 13.5 ± 1.7 years, 49.1% boys) of Czech adolescents participated in the 2018 Health Behavior in School-aged Children cross-sectional study. We measured religious attendance (RA), faith importance (FI) (both of respondents and their parents), participation in church activities and adolescent HRB (tobacco, alcohol, and cannabis use and early sexual intercourse). We found that neither RA nor FI of participants or their parents had a significant effect on adolescents' HRB. Compared to attending respondents who participate in church activities (AP), non-attending respondents who participate in church activities were more likely to report smoking and early sexual intercourse, with odds ratios (ORs) ranging from 3.14 (1.54-6.39) to 3.82 (1.99-7.35). Compared to AP, non-attending respondents who did not participate in church activities were more likely to report early sexual intercourse, with OR = 1.90 (1.14-3.17). Thus, our findings show that RA does not protect adolescents from HRB; they suggest that RA protects adolescents from HRB only in combination with participation in church activities.
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http://dx.doi.org/10.3390/ijerph17249372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765168PMC
December 2020

Childhood Trauma and Experience in Close Relationships Are Associated with the God Image: Does Religiosity Make a Difference?

Int J Environ Res Public Health 2020 11 28;17(23). Epub 2020 Nov 28.

Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech.

Religiosity and spirituality (R/S) and some of their specific aspects are associated with health. A negatively perceived relationship with God, which has adverse health outcomes, can be formed by human attachment both in childhood and adulthood. The aim of this study was to assess the associations of childhood trauma (CT) and experience in close relationships (ECR) with the God image in a secular environment by religiosity. A national representative sample of Czech adults (n = 1800, 51.1 ± 17.2 years; 43.5% men) participated in a survey. We measured CT (Childhood Trauma Questionnaire), ECR (Experiences in Close Relationships-Revised Questionnaire), image of God (questions from the 2005 Baylor Survey) and religiosity. Our results showed associations of CT and ECR with God images. Respondents who experienced CT were less likely to describe God as loving, always present and forgiving. Religious respondents were less likely to report positive God images with odds ratios (ORs) from 0.78 (0.66-0.94) to 0.95 (0.91-0.99), nonreligious respondents reported negative God images with ORs from 1.03 (1.00-1.06) to 1.22 (1.08-1.37). We found CT and problems in close relationships in adulthood are associated with a less positive God image, especially in nonreligious people. Understanding these associations may help prevent detrimental health outcomes.
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http://dx.doi.org/10.3390/ijerph17238841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730505PMC
November 2020

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

Int J Environ Res Public Health 2020 10 28;17(21). Epub 2020 Oct 28.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia ( = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21-3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26-2.98) or anxiety (OR/95% CI: 1.81/1.22-2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients' psychological distress to ensure adequate adherence with recommended diet.
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http://dx.doi.org/10.3390/ijerph17217913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663113PMC
October 2020

Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe.

Int J Environ Res Public Health 2020 10 20;17(20). Epub 2020 Oct 20.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands.

The Roma are Europe's largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims to review the literature on communicable diseases among Roma across Eastern and Central Europe. A PubMed search was carried out for communicable diseases among Roma in these parts of Europe, specifically in Romania, Bulgaria, Hungary, Serbia, Slovakia, the Czech Republic and North Macedonia. The papers were then screened for relevance and utility. Nineteen papers were selected for review; most of them from Slovakia. Roma continue to have a higher prevalence of communicable diseases and are at higher risk of infection than the majority populations of the countries they live in. Roma children in particular have a particularly high prevalence of parasitic disease. However, these differences in disease prevalence are not present across all diseases and all populations. For example, when Roma are compared to non-Roma living in close proximity to them, these differences are often no longer significant.
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http://dx.doi.org/10.3390/ijerph17207632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588998PMC
October 2020

Test-Retest Reliability of a Questionnaire on Motives for Physical Activity among Adolescents.

Int J Environ Res Public Health 2020 10 17;17(20). Epub 2020 Oct 17.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.

The aim of this study was to investigate the test-retest reliability of the motives for undertaking physical activity (PA) items from the Health Behavior in School-Aged Children (HBSC) study questionnaire among Slovak and Czech adolescents and to determine whether this reliability differs by gender, age group and country. We obtained data from 580 students aged 11 and 15 years old (51.2% boys) who participated in a test and retest study with a four-week interval in 2013 via the Health Behavior in School-Aged Children cross-sectional study in the Czech Republic and Slovakia. We estimated the test-retest reliability of all 13 dichotomized motives by using Intraclass Correlation Coefficients (ICC) and Cohen's Kappa statistics, for continuous and dichotomized motives, respectively. Test-retest reliability showed moderate agreement for nine motives (ICC from 0.41 to 0.60) and fair agreement for four motives (ICC from 0.33 to 0.40). Kappa statistics were similarly moderate to large (0.33 to 0.61), except for three motives with small or trivial correlations. The motives "To improve my health" and "To enjoy the feeling of using my body" had consistently low Kappas and correlations. Overall, the results of this study suggest that most questions on motives for PA on the HBSC questionnaire have acceptable test-retest characteristics for use among adolescents.
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http://dx.doi.org/10.3390/ijerph17207551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589029PMC
October 2020

Social Structure in a Roma Settlement: Comparison over Time.

Int J Environ Res Public Health 2020 10 7;17(19). Epub 2020 Oct 7.

Department Community & Occupational Medicine, University Medical Centre Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.

The objective of the present study was to compare the social structure and internal establishment of a Roma community in two historical periods: in the 18th century and the present. We analysed Samuel Augustini ab Hortis's work, "" (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary), written in 1775-1776. Using content analysis, we subsequently compared his findings with our recent data from analogous qualitative research in a geographically-defined area of north-eastern Slovakia, the same region in which Augustini lived. Data collection was intensely conducted in 2012-2013 and once more in 2017-2019. The qualitative methods included direct observation, semi-structured interviews and focus groups. Four key informants and more than 70 participants collaborated in the study. The greatest difference we observed compared to the 18th century was the absence of a leader of the community, a "vajda", whose status was taken over by a new social class of "entrepreneurs". The most vulnerable group of the segregated and separated Roma communities are the "degesa", the lowest social class. They face a phenomenon consisting of so-called triple marginalization: they live in one of the most underdeveloped regions of the country, they inhabit segregated settlements and they are excluded by their own ethnic group. The socioeconomic status of the richest classes has changed faces, while the socioeconomic status of the lowest has not. We found a misconception among helping professionals (e.g., social workers) regarding the homogeneity of the Roma community. This calls for more attention to the erroneous use of the ethnic-based approach in the helping professions.
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http://dx.doi.org/10.3390/ijerph17197311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579373PMC
October 2020

The Framework Convention on Tobacco Control in Slovakia and in Finland: one law, two different practices?

BMC Int Health Hum Rights 2020 09 29;20(1):26. Epub 2020 Sep 29.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: The Framework Convention on Tobacco Control (FCTC) was ratified in 2004 in Slovakia and in 2005 in Finland. The aim of this study was to compare the implementation of the FCTC in the national laws and policies regarding smoking in Finland and Slovakia.

Methods: In this case study the following areas are compared: the legal framework; the monitoring system and health promotion; treatment; and policies aimed at reducing tobacco consumption. We report on these in this order after a short historical introduction.

Results: The legal frameworks are similar in Slovakia and in Finland. Finland far exceeds the minimum legal requirements. Slovakian regulations reflect the FCTC requirements; however, social tolerance is very high. In Finland the monitoring system and health promotion are aimed more at tobacco consumption. Slovakia does not follow the surveillance plans recommended by WHO so strictly; often there are no current data available. No additional documents regarding the FCTC have been adopted in Slovakia. The financial contribution to treatment is very low. Slovakian tobacco control policy is more focused on repression than on prevention, in contrast to Finland. Smoking bans meet European standards. Excise duties rise regularly in both countries.

Conclusion: Implementation of the FCTC is at different levels in the compared countries. Finland has a clear plan for achieving the goal of a smoking-free country. Slovakia meets only the minimum standard required for fulfillment of its international obligations. Its policy should become more transparent by making more up-to-date data available.
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http://dx.doi.org/10.1186/s12914-020-00243-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523304PMC
September 2020

Adolescent Enrollment in Psychosocial Care: Do Parents Make a Difference?

Int J Environ Res Public Health 2020 09 27;17(19). Epub 2020 Sep 27.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.

Care for adolescents with emotional and behavioral problems (EBP) is frequently unequally distributed. Parents may play a role in the access to this care. Therefore, the aim was to explore the association between parental characteristics and their adolescent's enrollment in psychosocial care. We used data from the Care4Youth cohort study. Our sample consisted of 446 adolescents (mean age 13.22 years, 48% boys) and 382 parents (mean age 42.95 years, 14% males). EBP combined with enrollment created four groups: 1, no EBP/no care; 2, no EBP/care; 3, EBP/no care; 4, EBP/care. We assessed differences in parental characteristics among the groups. Group 2 had a significantly lower socioeconomic position ( < 0.01), more psychological distress ( < 0.001), poorer supervision ( < 0.001) and lower family social support ( < 0.05) than Group 1. Group 4 had a significantly lower socioeconomic position ( < 0.01) and poorer supervision ( < 0.001) than Group 1. Group 3 had significantly poorer supervision ( < 0.001) than Group 4. The poor supervision in Group 3 requires attention, as these adolescents receive no care. The quality of parental supervision should be addressed generally, e.g., by providing better parenting support and more parental training.
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http://dx.doi.org/10.3390/ijerph17197066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579495PMC
September 2020

Health Risks Related to Domestic Violence against Roma Women.

Int J Environ Res Public Health 2020 09 24;17(19). Epub 2020 Sep 24.

Institute of Romani Studies, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia.

: Data on Roma women's experience of violence from their male partners are very scarce. We explored the process of actual domestic violence against Roma women, the threat of violence and its health consequences. We further focused on barriers in the availability of specialized support services aimed at eliminating domestic violence. : The sample included 20 Roma women living throughout Slovakia: scattered among the majority (45.0%), in crisis centers and sheltered houses (40.0%), and in segregated Roma settlements (15.0%). Data were obtained through qualitative research by means of semi-structured interviews in 20 individual case studies. All 20 women had experienced a combination of violence: physical, psychological and economic, all of them connected with social isolation. : Prevailing gender stereotypes are a precondition of domestic violence against women, regardless of their status. Violence against Roma women resulted in several health consequences, and all of the 20 women suffered from these. Most of them reported general psychological problems (75%), among which anxiety and depression (25%), headache (25%), weight loss (10%) and health problems connected with motor activity (5%). The barriers include lack of awareness among Roma women of any specialised support services and the absence of such services for abused women in the region. : Domestic violence results in serious psychological and physical health consequences. Violence elimination is generally set up without a specific ethnic or gender approach. Disregard of these specifics can lead to deepening of the uneven position of Roma women within the family, community and society, and the acceptance of violence against Roma women.
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http://dx.doi.org/10.3390/ijerph17196992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579367PMC
September 2020

MicroRNA molecules as predictive biomarkers of adaptive responses to strength training and physical inactivity in haemodialysis patients.

Sci Rep 2020 09 24;10(1):15597. Epub 2020 Sep 24.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.

The miRNA-206 and miRNA-23a play an important role in muscle tissue hypertrophy, regeneration and atrophy. Both of these miRNAs have been highlighted as promising adaptation predictors; however, the available evidence on associations is inconclusive. Therefore, our aim was to assess the expression levels of these two miRNAs as predictors of change in muscle function during strength training and physical inactivity among dialysed patients. For this purpose, 46 haemodialysis patients were monitored for 12-weeks of either intradialytic strength training (EXG, n = 20) or physical inactivity during dialysis (CON, n = 26). In both groups of patients, we assessed the baseline expression levels of miRNA-23a and miRNA-206 and the isometric force generated during hip flexion (HF) contraction before and after the 12-week period. Among the EXG group, the expression of miRNA-206 predicted the change in HF (R = 0.63, p = 0.0005) much more strongly than the expression of miRNA-23a (R = 0.21, p = 0.027). Interestingly, baseline miRNA-23a (R = 0.30, p = 0.006) predicted the change in HF much more than miRNA-206 (p = ns) among the CON group. Our study indicates that the baseline expression of miRNA-206 could predict the response to strength training, while miRNA-23a could serve as a potential predictive marker of functional changes during physical inactivity in dialysis patients.
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http://dx.doi.org/10.1038/s41598-020-72542-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519115PMC
September 2020

Teacher and classmate support may keep adolescents satisfied with school and education. Does gender matter?

Int J Public Health 2020 Nov 16;65(8):1423-1429. Epub 2020 Sep 16.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.

Objectives: To examine the associations of teacher and classmate support with school satisfaction in adolescents, and whether gender modifies these associations.

Methods: Data were used from the cross-sectional Health Behaviour in School-aged Children study collected in 2018 among Slovak 15-year-old adolescents (N = 931; 50.6% boys). School satisfaction was measured by school engagement and attitudes towards education leading to three groups of adolescents: satisfied, inconsistent and indifferent. We used multinomial logistic regression to examine the associations of teacher and classmate support with school satisfaction and its modification by gender.

Results: Adolescents who experienced support from teachers and classmates were less likely to feel indifferent (OR/95% CI: 0.77/0.70-0.85; and 0.76/0.67-0.85, respectively) or inconsistent (OR/95% CI: 0.84/0.77-0.92; and 0.73/0.65-0.81, respectively) than to feel satisfied than adolescents who did not experience such support. Adolescents who experienced support from teachers were less prone to feel indifferent than to feel inconsistent (OR/95% CI: 0.92/0.87-0.97). Gender did not modify the associations of social support with school satisfaction.

Conclusion: Teacher and classmate support keep adolescents satisfied with school and education and might increase their chances for a healthy development.
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http://dx.doi.org/10.1007/s00038-020-01477-1DOI Listing
November 2020

Compliance with the Framework Convention on Tobacco Control in Slovakia and in Finland: Two Different Worlds.

Int J Environ Res Public Health 2020 09 13;17(18). Epub 2020 Sep 13.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.

The Framework Convention on Tobacco Control (FCTC) developed by the State Parties to the World Health Organization was ratified in Slovakia in 2004 and in Finland in 2005. The aim of this study was to explore and compare compliance with the FCTC in Finland and Slovakia. This is a two-country comparative study of tobacco control policy based on implementation of the FCTC in Slovakia and Finland. Compliance with the FCTC was measured similarly in Slovakia and Finland in terms of their institutional structure supporting a smoking free environment and implementation of selected articles of the FCTC. In Finland the responsibilities for anti-tobacco policy are clearly assigned. Slovakia does not have specifically responsible institutions. Finland has a clear plan for achieving the goal of a smoking-free country based on empirical evidence. Slovakia meets only the minimum standard resulting from its commitment as ratified in the FCTC and data are out of date or missing completely.
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http://dx.doi.org/10.3390/ijerph17186661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558294PMC
September 2020

School is (not) calling: the associations of gender, family affluence, disruptions in the social context and learning difficulties with school satisfaction among adolescents in Slovakia.

Int J Public Health 2020 Nov 7;65(8):1413-1421. Epub 2020 Sep 7.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objectives: Education is an important tool to reduce health inequalities. Several factors influence the educational trajectory of children, with school satisfaction being one of them. The aim was to explore how learning difficulties, a disrupted social context and family affluence relate to school satisfaction.

Methods: We used data from the 2018 Slovak cross-sectional Health Behaviour in School-aged Children-study (age 15 years; N = 913; 50.3% boys). School satisfaction was categorized as liking school and caring about education (satisfied), disliking school but caring about education or vice versa (inconsistent), and disliking school and not caring about education (indifferent). We explored the association of learning difficulties, disrupted social context and family affluence with school satisfaction using multinomial logistic regression.

Results: Boys, and children having learning difficulties, or disruption in the social context and living in low affluence family were significantly less likely to be satisfied at school.

Conclusions: The key is to create a stimulating and encouraging environment at school, where children successfully learn functional literacy and feel well. The more satisfaction pupils get from school, the more likely is a favourable educational trajectory for them.
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http://dx.doi.org/10.1007/s00038-020-01474-4DOI Listing
November 2020

A renewed call for transdisciplinary action on NCDs.

BMC Int Health Hum Rights 2020 08 28;20(1):22. Epub 2020 Aug 28.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.

Notwithstanding COVID-19, non-communicable diseases (NCDs) will be the leading cause of death in every region in the world by 2030. This contribution, which forms an introduction to our collection of articles in this journal, identifies elements for a transdisciplinary research agenda between law, public health, health economics and international relations aimed at designing concrete interventions to curb the NCD pandemic, both globally and domestically.
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http://dx.doi.org/10.1186/s12914-020-00241-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453365PMC
August 2020

Adolescents exposed to discrimination: are they more prone to excessive internet use?

BMC Pediatr 2020 08 25;20(1):402. Epub 2020 Aug 25.

Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.

Background: The Internet may serve as a suitable environment for discriminated adolescents as they may consider the online space as the place where they have possibility to build social ties they are missing in their offline life or manage their self-presentation. Therefore, our aim was to explore the association between different types of discrimination by peers (because of gender, physical appearance, culture/skin color/language, unfavorable family situation) and excessive Internet use (EIU), and whether gender moderates this association.

Methods: We used data from a representative sample of 6,462 Slovak adolescents (mean age: 13.00, 49.6% boys) from the HBSC study conducted in 2018. Data were collected through online self-reported questionnaires. We assessed the association between various types of discrimination by peers and EIU using linear regression, and the role of gender as potential moderator.

Results: Discrimination because of physical appearance was most prevalent (18.0%). Adolescents exposed to discrimination by peers reported higher levels of EIU. We found an interaction of gender on the association of discrimination because unfavorable family situation with EIU. Boys who experienced this type of discrimination were at higher risk of EIU compared to girls.

Conclusion: Discriminated adolescents are more likely to use the Internet excessively, with some associations being stronger for boys than for girls. Prevention strategies focused on raising adolescent awareness of the risks and benefits of the Internet should target discriminated adolescents, especially boys, as they seem to be the vulnerable group.
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http://dx.doi.org/10.1186/s12887-020-02241-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448512PMC
August 2020

Does family communication moderate the association between adverse childhood experiences and emotional and behavioural problems?

BMC Public Health 2020 Aug 20;20(1):1264. Epub 2020 Aug 20.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands.

Background: Adverse childhood experiences (ACEs) and poor family support and communication can increase emotional and behavioural problems (EBP). Therefore, we assessed the association of difficult communication with mother and with father separately with both emotional and behavioural problems (EBP), and whether adolescents' communication with mother and with father moderates the association of adverse childhood experiences (ACE) with the EBP of adolescents.

Methods: We used data from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia, comprising 5202 adolescents aged from 11 to 15 (mean age 13.53; 49.3% boys). EBP were measured using the Strengths and Difficulties Questionnaire. We used generalized linear regression adjusted for age, gender and family affluence to explore the modification of the associations between ACE and EBP by communication (easy vs. difficult communication) with mother and father.

Results: Difficult communication or a complete lack of communication due to the absence of mother and father increased the probability of emotional (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.95, 95% CI: 0.91|0.99, respectively) and also of behavioural problems (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.94, 95% CI: 0.90|0.97, respectively). We found a statistically significant interaction of communication with father on the association of ACE with EBP, showing that the joint effects were less than multiplicative.

Conclusion: Difficult communication with mother and father is related to EBP among adolescents, and adolescents' communication with father moderates the association of ACE with both emotional and behavioural problems among adolescents.
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http://dx.doi.org/10.1186/s12889-020-09350-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439671PMC
August 2020

Anxiety and Avoidance in Adults and Childhood Trauma Are Associated with Negative Religious Coping.

Int J Environ Res Public Health 2020 07 16;17(14). Epub 2020 Jul 16.

Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic.

Religion as a coping strategy is mostly connected with positive health outcomes. Yet, negative religious coping (NRC) has been associated with rather negative outcomes that affect one's health. The aim of this study was to explore whether insecure adult attachment and childhood trauma are associated with higher NRC. A sample of Czech adults ( = 531, 51.1 ± 17.2 years; 43.5% men) participated in a survey. As measures, the NRC subscale of the Brief RCOPE, the Experiences in Close Relationships-Revised questionnaire, and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used. From the whole sample, 23.7% respondents reported higher NRC. Respondents with higher anxiety in close relationships were more likely to use negative coping strategies, with an odds ratios (OR) of 1.27 (95% confidence interval 1.01-1.59). Similarly, avoidance was associated with negative coping OR = 1.41 (1.13-1.75). Moreover, each subscale of the CTQ-SF revealed a significant association with high summary NRC. Respondents who reported physical neglect scored highest on summary NRC with OR = 1.50 (1.23-1.83) after controlling for sociodemographic variables, but also for anxiety and depression. Our findings support the idea that childhood trauma experience and adult attachment style are associated with higher use of NRC strategies.
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http://dx.doi.org/10.3390/ijerph17145147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400485PMC
July 2020

Is BMI a Valid Indicator of Overweight and Obesity for Adolescents?

Int J Environ Res Public Health 2020 07 4;17(13). Epub 2020 Jul 4.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713AV Groningen, The Netherlands.

: Overweight and obesity are mostly monitored via the Body Mass Index (BMI), based on self-reported or measured height and weight. Previous studies have shown that BMI as a measure of obesity can introduce important misclassification problems. The aim of this study was to assess the validity of overweight and obesity classification based on self-reported and on measured height and weight versus the proportion of body fat as the criterion. : We used data on 782 adolescents (mean age = 13.5, 55.8% boys) from the Health Behaviour in School-Aged Children (HBSC) study conducted in 2018 in Slovakia. We obtained self-reported (height and weight) and objective measures (height, weight) and the proportion of fat (as the criterion measure) measured via bioimpedance body composition analysis (BIA) with an InBody 230 from the adolescents. : Both measured and self-reported BMI indicated overweight and obesity with relatively low sensitivity (66-82%), but high specificity (90-92%). The superior accuracy of measured BMI in comparison to self-reported BMI was confirmed by the area under the curve (AUC) based on the receiver operating characteristics (ROC) curves (AUC measured/self-reported: 0.94/0.89; < 0.001). The misclassification of overweight and obesity was significantly higher when using self-reported BMI than when using measured BMI. : Both self-reported and measured BMI as indicators of overweight and obesity underestimate the prevalence of adolescents with overweight and obesity.
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http://dx.doi.org/10.3390/ijerph17134815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369744PMC
July 2020

Prevalence of non-motor symptoms and their association with quality of life in cervical dystonia.

Acta Neurol Scand 2020 Dec 13;142(6):613-622. Epub 2020 Jul 13.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objectives: Non-motor symptoms (NMS) are commonly present along with motor impairment in patients with cervical dystonia (CD) and have a significant impact on health-related quality of life (HRQoL). However, the prevalence of NMS and their association with dystonia are still unclear. The aim of our study was to assess the prevalence of depression, anxiety, fatigue, apathy, pain, sleep problems, and excessive daytime sleepiness (EDS) in CD using different evaluation approaches and to explore their association with HRQoL relative to that of motor symptoms.

Materials And Methods: We enrolled 102 Slovak patients with CD. The severity of both motor and non-motor symptoms was assessed using validated scales. HRQoL was determined by the 36-item Short Form Health Survey (SF-36). Association of NMS with poor HRQoL was assessed using multiple regressions.

Results: The most frequent NMS in our sample were sleep impairment (67.3%), anxiety (65.5%), general and physical fatigue (57.5% and 52.9%, respectively), depression (47.1%), mental fatigue (31.4%), apathy (30.4%), reduced activity (29.4%), EDS (20.2%), and reduced motivation (18.6%). Univariate analysis showed that NMS, but not motor symptoms, were significantly linked to poor HRQoL, with EDS being most commonly associated with poor HRQoL, followed by disrupted sleep, depression, and fatigue.

Conclusions: The prevalence of NMS among patients with CD is high, and some NMS are strongly associated with poor HRQoL, while motor impairment was not associated with the severity of NMS or poor HRQoL. Actively diagnosing and treating NMS should therefore be a routine part of the clinical management of patients with CD.
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http://dx.doi.org/10.1111/ane.13304DOI Listing
December 2020

The effects of an intradialytic resistance training on lower extremity muscle functions.

Disabil Rehabil 2020 May 24:1-7. Epub 2020 May 24.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

The loss of muscle functions is a significant health issue among dialysis patients. Poor muscle strength negatively affects a patient's mobility, independence and quality of life. The aim of the study was to assess the effects of an intradialytic resistance training (IRT) on lower extremity muscle functions among dialysed patients. Ninety patients were allocated into an experimental group ( = 57) or control group (CNG) ( = 33) according to the location of the dialysis service center. Fifty-eight patients completed the study follow-up. The intervention regarded 12-week IRT, while the controls remained physically inactive during hemodialysis. In both groups of patients, we assessed lower extremity muscle functions by a diagnostics of maximal isometric force generated during hip flexion (HF), hip extension (HE), and knee extension (KE) contractions at baseline, after the 12-weeks intervention and after a further 12-weeks follow up. We found that improvements in HE between baseline and post-intervention were significantly larger for the experimental than the CNG (difference 32.0, 95% CI = 12.3-51.8,  = 0.002). For the other primary outcomes, we found no differences between the groups, and neither for the two other indices of muscle strength (HF and KE). At 12-weeks follow-up, we found no statistically significant differences between the two groups. Our findings indicate that exercise during dialysis not just suppresses adverse effects in muscle strength and functioning, but effectively and safely increases lower extremities muscle function in a relatively short time.Implications for RehabilitationRegular, progressive, resistance training realized during dialysis is well tolerated and safe for exercise interventions in hemodialysis patients.A 12-weeks intradialytic resistance training is effective in the prevention and clinical management of muscle function loss among hemodialysis patients.The range of improvements in muscle functions, demonstrated by the assessment of maximal isometric force, varied severely during different lower extremity movements of hemodialysis patients.
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http://dx.doi.org/10.1080/09638288.2020.1766581DOI Listing
May 2020

Appropriate Employment for Segregated Roma: Mechanisms in a Public-Private Partnership Project.

Int J Environ Res Public Health 2020 05 20;17(10). Epub 2020 May 20.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Our earlier article showed that increased employability of segregated Roma may improve their well-being and health. To achieve that, appropriate employment based on a public-private partnership could be the key. For optimal design of such a partnership, we need insight into its potential mechanisms. Evidence on this is lacking, however. This paper builds on the previously published article by focusing on mechanisms for achieving better health. Therefore, our aim was to identify the potential mechanisms by which a public-private Roma employment project could increase employability. We investigated a Roma employment project called Equality of Opportunity established by a private company, U.S. Steel Kosice in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain key stakeholders' perspectives on the potential mechanisms of a public-private Roma employment project in terms of increased employability. We found three types of mechanisms. The first type regarded formal job mechanisms, such as an appropriate employment and salary offer and a bottom-up approach in capacity building. The second type involved sustainability mechanisms, such as the personal profile of project and work-shift coordinators, the continuous offer of training and cooperation with relevant stakeholders (municipalities, community centers, etc.). The third type was cultural mechanisms, such as personal contact with project participants, attention to less-voiced groups like children, the motivation of project participants, a counter-value reciprocity approach and respect for the specifics of Roma history. Our findings imply that policymakers could consider public-private partnerships for increasing the employability of segregated Roma, as they have the potential to address a wider range of social needs simultaneously.
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http://dx.doi.org/10.3390/ijerph17103588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277156PMC
May 2020

Availability, prices, and affordability of selected essential cancer medicines in a middle-income country - the case of Mexico.

BMC Health Serv Res 2020 May 14;20(1):424. Epub 2020 May 14.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Background: More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. We assessed the availability and affordability of essential cancer medicines in Mexico, and compared their prices against those in other countries of the region.

Methods: We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO's Strategic Fund.

Results: Of the various medicines, mean availability in public and private sector outlets was 61.2 and 67.5%, respectively. In the public sector, medicines covered by the public health insurance "People's Health Insurance" were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region.

Conclusions: The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization's 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.
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http://dx.doi.org/10.1186/s12913-020-05167-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222474PMC
May 2020

To Comply or Not to Comply: Roma Approach to Health Laws.

Int J Environ Res Public Health 2020 04 29;17(9). Epub 2020 Apr 29.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.

According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior in the field of health laws. We used the concept of a semi-autonomous field proposed by Moore (1973) and the theory of planned behavior by Ajzen (1985). We found that Roma (non-)compliance with health laws was influenced by many different factors, such as beliefs, traditions, living conditions and culture. Group beliefs overrule national laws and also individual preferences, which tend to be subordinate to the group view. The less contact Roma from settlements have with non-Roma, the stronger their own rules are in the field of health. Roma health status is influenced by many factors: group beliefs and community traditions are stronger and overrule individual and state behavioral influence. A community-based participatory approach together with improvement of living conditions in cooperation with Roma is desirable.
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http://dx.doi.org/10.3390/ijerph17093087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246461PMC
April 2020

Juvenile Idiopathic Arthritis: Roma Children Seem to Run More Risk than Non-Roma.

Int J Environ Res Public Health 2020 03 31;17(7). Epub 2020 Mar 31.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Ethnic information regarding juvenile idiopathic arthritis (JIA) exists for various populations across the world but is fully lacking for Roma. We assessed the occurrence and clinical characteristics of JIA in Roma vs. non-Roma children. : We obtained data on all outpatients ( = 142) from a paediatric rheumatology centre (age 3 to 18 years) in the eastern part of Slovakia (Kosice region). We assessed patients' age, gender, disease type and related extra-articular conditions by ethnicity. We obtained population data from the 2011 census. : The share of Roma children was higher in the clinical JIA sample than in the overall population (24.6%, = 35, Roma in the sample vs. 10.8%, = 142, Roma in the population, < 0.05). Moreover, Roma children had been diagnosed more frequently with extra-articular conditions but did not differ in other symptoms. Treatments also did not differ by ethnicity. : Roma children had been diagnosed more with JIA than their non-Roma peers. This calls for further research on the causes of this increased disease burden in Roma children.
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http://dx.doi.org/10.3390/ijerph17072377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177970PMC
March 2020

Spirituality, Religious Attendance and Health Complaints in Czech Adolescents.

Int J Environ Res Public Health 2020 03 30;17(7). Epub 2020 Mar 30.

Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech.

Research in some religious countries shows that religiosity and spirituality positively affect adolescent health. We studied whether religiosity and spirituality also have positive associations with adolescent health in a secular country. We tested the associations between religious attendance and spirituality and self-reported health and health complaints using a representative sample of Czech adolescents ( = 4182, 14.4 ± 1.1 years, 48.6% boys) from the 2014 health behavior in school-aged children (HBSC) study. We used religious attendance, the adjusted shortened version of the spiritual well-being scale (SWBS), and its two components-religious well-being (RWB) and existential well-being (EWB)-as independent variables and the eight item "HBSC symptom checklist" and self-reported overall health as dependent variables. A higher level of spirituality was associated with lower chances of health complaints and self-reported health, ranging from a 9% to 30% decrease in odd ratios (OR). Religious attendance was not associated with any of the observed variables. The EWB showed a negative association with all of the observed variables, with associations ranging from a 19% to 47% decrease. The RWB was associated with a higher risk of nervousness (OR = 1.12), while other associations were not significant. Non-spiritual but attending respondents were more likely to report a higher occurrence of stomachache (OR = 2.20) and had significantly worse overall health (OR = 2.38). In a largely secular country, we found that spirituality and the EWB (unlike religious attendance and the RWB) could have a significant influence on adolescent health.
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http://dx.doi.org/10.3390/ijerph17072339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177996PMC
March 2020

Childhood Trauma Is Associated with the Spirituality of Non-Religious Respondents.

Int J Environ Res Public Health 2020 02 17;17(4). Epub 2020 Feb 17.

Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic.

Childhood trauma experience (CT) is negatively associated with many aspects of adult life. Religiosity/spirituality (R/S) are often studied as positive coping strategies and could help in the therapeutic process. Evidence on this is lacking for a non-religious environment. The aim of this study was to assess the associations of different types of CT with R/S in the secular conditions of the Czech Republic. A nationally representative sample ( = 1800, mean age = 46.4, SD = 17.4; 48.7% male) of adults participated in the survey. We measured childhood trauma, spirituality, religiosity and conversion experience. We found that four kinds of CT were associated with increased levels of spirituality, with odds ratios (OR) ranging from 1.17 (95% confidence interval 1.03-1.34) to 1.31 (1.18-1.46). Non-religious respondents were more likely to report associations of CT with spirituality. After measuring for different combinations of R/S, each CT was associated with increased chances of being "spiritual but non-religious", with OR from 1.55 (1.17-2.06) to 2.10 (1.63-2.70). Moreover, converts were more likely to report emotional abuse OR = 1.46 (1.17-1.82) or emotional neglect with OR = 1.42 (1.11-1.82). Our findings show CT is associated with higher levels of spirituality in non-religious respondents. Addressing spiritual needs may contribute to the effectiveness of psychotherapeutic treatment of the victims.
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http://dx.doi.org/10.3390/ijerph17041268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068247PMC
February 2020

Religiosity and Mental Health: A Contribution to Understanding the Heterogeneity of Research Findings.

Int J Environ Res Public Health 2020 01 13;17(2). Epub 2020 Jan 13.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.

Most studies report positive associations between religiosity and spirituality and aspects of mental health, while a small proportion report mixed or fully negative associations. The aim of this study was to assess the associations of religiosity measured more specifically, with mental health in a secular environment, using a nationally representative sample of Czech adults ( = 1795). We measured religious affiliation, conversion experience, non-religious attitudes and the stability of these attitudes, mental health problems, and anxiety levels. Compared to stable non-religious respondents, unstable non-religious and converted respondents who perceived God as distant were more likely to experience anxiety in close relationships, and had higher risks of worse mental health. Our findings support the idea that the heterogeneity of findings in associations between religiosity/spirituality and mental health could be due to measurement problems and variation in the degree of secularity. A shift towards religiosity could be expected to be seen in a substantial part of non-religious respondents in problematic times.
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http://dx.doi.org/10.3390/ijerph17020494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014109PMC
January 2020

Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices.

Soc Sci Med 2020 02 19;246:112739. Epub 2019 Dec 19.

Department of Community and Occupational Medicine, University Medical Center Groningen University of Groningen, Groningen, the Netherlands. Electronic address:

Rationale: Unequal provision of health care contributes to the poor health status of segregated Roma in Central and Eastern Europe. Studies on the drivers and mechanisms behind this are lacking.

Objective: We explored what kinds of substandard practices health care frontline professionals engage in regarding segregated Roma and what mechanisms support such practices during the professionals' careers in care services.

Methods: Over a three-month period at five different locations in Slovakia we interviewed and observed 43 frontline professionals serving segregated Roma. Next, through qualitative content analysis we identified in the data three themes regarding kinds of substandard practices and 22 themes regarding supporting mechanisms. We organized these themes into an explanatory framework, drawing on psychological models of discrimination and intergroup contact.

Results: The frontline staff's substandard practices mostly involved substandard communication and commitment to care, but also some overt ethnic discrimination. These practices were supported by five mechanisms: the staff's negative experiences with people labelled "problematic Roma patients"; the staff's negative attitudes regarding segregated Roma; adverse organizational aspects; adverse residential-segregation aspects; and poor state governance regarding racism. In the course of their careers, many professionals first felt obliged and diligent regarding segregated Roma patients, then failing, unequipped and abandoned, and ultimately frustrated and resigned regarding the equal standard of care towards the group.

Conclusions: Health care frontline staff's practices towards segregated Roma are frequently substandard. The psychological processes underlying this substandard care are supported by specific personal, organizational and governance features. These mechanisms cause many frontline professionals gradually to become cynical regarding segregated Roma over the course of their careers. Health care staff should be supported with skills and tools for effectively handling their own and others' racism, the culturebound and structural vulnerabilities of patients as well as related professional expectations regarding equity.
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http://dx.doi.org/10.1016/j.socscimed.2019.112739DOI Listing
February 2020