Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations.
Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations.
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DOI：
10.1016/s0140-6736(17)30402-6
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发表时间：
2017-03-04
期刊：
影响因子：
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通讯作者：
Prabhakaran D
中科院分区：
文献类型：
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作者：
Mendenhall E;Kohrt BA;Norris SA;Ndetei D;Prabhakaran D
转型期人口，特别是在特定的社会经济和文化背景下，同时出现的健康负担，要求建立概念框架，以提高对风险因素的认识，从而更好地设计和实施预防和干预方案，以解决合并症。由医学人类学家提出的“共病”概念为预防和治疗共病提供了一个框架。流行病一词是指在持续的社会和经济不平等的背景下影响人口健康的协同健康问题。到目前为止，共病理论已被应用于翻译有限的高收入国家和低收入或中等收入国家的贫困移民社区的共病健康问题。在这篇系列论文中，我们研究了在低收入和中等收入国家共病和多病中的共病理论的应用。我们以糖尿病为例，讨论了它与肯尼亚的艾滋病、印度的结核病和南非的抑郁症的共病性。使用一个模型的综合症，解决交易的病理生理学，社会经济条件，卫生系统结构，和文化背景下，我们说明了不同的综合症在这些国家和综合症护理患者的潜在利益。最后，我们建议研究和护理系统，以解决低收入和中等收入国家的流行病。
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.