Syndemic effects in complex humanitarian emergencies: A framework for understanding political violence and improving multi-morbidity health outcomes.
Syndemic effects in complex humanitarian emergencies: A framework for understanding political violence and improving multi-morbidity health outcomes.
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复杂的人道主义紧急情况下的联合效应：理解政治暴力和改善多种健康状况的框架。
DOI：
10.1016/j.socscimed.2020.113378
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Carruth L
中科院分区：
文献类型：
--
作者：
Kohrt BA;Carruth L
复杂的人道主义紧急情况的一个特点是，集体遭受战争、恐怖主义、政治恐吓、镇压、非法拘留和强迫流离失所等形式的政治暴力，而且往往持续很长时间。处于复杂人道主义紧急情况下的人口患多种共病的风险更高：精神障碍、传染病、营养不良和慢性非传染性疾病。然而，人道主义紧急情况之间和内部的健康影响差异很大。症状群理论是一种概念化疾病和社会决定因素的方法，以了解多种发病率的差异模式，阐明潜在的机制，并更好地设计干预措施。如果将共病理论应用于复杂的人道主义紧急情况，则有可能揭示政治暴力和历史不平等造成的多种发病率局部模式的根源。在本文中，我们提出了两个基于混合方法研究的案例研究，以说明如何在复杂的人道主义紧急情况中应用流行病学模型。首先，在尼泊尔的案例研究中，我们探讨了不同模式的创伤后应激障碍（PTSD）和抑郁症的共同发病率之间的女性前儿童兵战后返回家园。尽管暴露于与战争有关的创伤，高种姓印度教社区的女童兵有63%的创伤后应激障碍和抑郁症的共同发病率，而在混合种姓和宗教的社区，女童兵有8%的创伤后应激障碍患病率，但没有创伤后应激障碍和抑郁症的共同发病率。在第二个案例研究中，我们探讨了政治暴力和人口流离失所激增期间2型糖尿病的高发病率。尽管肥胖率和其他常见风险因素较低，但埃塞俄比亚的索马里人经历了2型糖尿病的病例增加和不良结局。政治暴力塑造了医疗资源，饮食，以及潜在的流行病学异常。基于这些案例研究，我们提出了一个人道主义的综合研究议程的观察和干预研究，重点是公共卫生工作需要在家庭，社区，国家和全球层面的暴力预防。
A hallmark of complex humanitarian emergencies is the collective exposure, often over extended periods of time, to political violence in the forms of war, terrorism, political intimidation, repression, unlawful detention, and forced displacement. Populations in complex humanitarian emergencies have higher risks of multiple co-morbidities: mental disorders, infectious diseases, malnutrition, and chronic non-communicable diseases. However, there is wide variation in the health impacts both across and within humanitarian emergencies. Syndemic theory is an approach to conceptualizing disease and social determinants to understand differential patterns of multi-morbidity, elucidate underlying mechanisms, and better design interventions. Syndemic theory, if applied to complex humanitarian emergencies, has the potential to uncover origins of localized patterns of multi-morbidity resulting from political violence and historical inequities. In this paper, we present two case studies based on mixed-methods research to illustrate how syndemic models can be applied in complex humanitarian emergencies. First, in a Nepal case study, we explore different patterns of posttraumatic stress disorder (PTSD) and depression co-morbidity among female former child soldiers returning home after war. Despite comparable exposure to war-related traumas, girl soldiers in high-caste Hindu communities had 63% co-morbidity of PTSD and depression, whereas girl soldiers in communities with mixed castes and religions, had 8% PTSD prevalence, but no cases of PTSD and depression co-morbidity. In the second case study, we explore the high rates of type 2 diabetes during a spike in political violence and population displacement. Despite low rates of obesity and other common risk factors, Somalis in Ethiopia experienced rising cases of and poor outcomes from type-2 diabetes. Political violence shapes healthcare resources, diets, and potentially, this epidemiological anomaly. Based on these case studies we propose a humanitarian syndemic research agenda for observational and intervention studies, with the central focus being that public health efforts need to target violence prevention at family, community, national, and global levels.
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影响因子：
4.4
作者：
Herbert, Hadley K.;Hyder, Adnan A.;Norton, Robyn
通讯作者：
Norton, Robyn
DOI：
10.1097/wtf.0000000000000056
发表时间：
2014-11-01
影响因子：
1.4
作者：
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通讯作者：
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影响因子：
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作者：
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影响因子：
5.4
作者：
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通讯作者：
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影响因子：
3.2
作者：
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通讯作者：
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