Soweto Syndemics: A Two-Phase Study of Surveillance and Co-Morbid Experiences

索韦托综合症：监测和共病经历的两阶段研究

• 批准号: 9614005
• 负责人: Emily A Mendenhall
• 金额: $ 19.36万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9614005
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Africa South of the Sahara; Age-Years; Behavior; Biological; Caring; Cessation of life; Chronic; Clinical; Communicable Diseases; Comorbidity; Country; Data; Diabetes Mellitus; Diabetes prevention; Diagnosis; Disease; Disease Clusterings; Economic Factors; Economics; Enrollment; Ensure; Environment; Epidemic; Event; Fostering; Glucose Intolerance; HIV; Health; Health system; Healthcare; Hypertension; Individual; Intervention; Investigation; Low Income Population; Low income; Malaria; Medical; Medicine; Mental Depression; Mental disorders; Methods; Mission; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Pathology; Patients; Phase; Policies; Politics; Population; Positioning Attribute; Poverty; Prevalence; Primary Health Care; Public Health; Recommendation; Research; Resources; Rifampin; Risk; Sample Size; Sampling; Social Policies; South Africa; South African; Taxes; Testing; Time; Tuberculosis; United States National Institutes of Health; Urban Population; Vulnerable Populations; Woman; antiretroviral therapy; blood glucose regulation; care systems; clinical care; design; experience; falls; global health; improved; innovation; insight; interest; international center; low and middle-income countries; mortality; multiple chronic conditions; patient population; peri-urban; psychologic; recruit; social; sugar; surveillance study; sweetened beverage; synergism; theories; tuberculosis drugs

The proposed research will be the first to test the theory of syndemics among a vulnerable population. The syndemics concept, in contrast to the epidemics concept, provides an innovative theoretical and practical approach that combines concepts of “synergy” with “epidemic” to investigate how social, political, and ecological factors promote disease clustering at the population-level and impact disease pathologies at the individual-level. The notion of syndemic incorporates three core concepts: 1) two or more diseases cluster together within a population, 2) these diseases interact, often biologically, and 3) large-scale social forces precipitate them. Syndemic clusters with Type 2 diabetes (T2DM) among black South Africans exemplify the syndemics concept, and in-depth investigation of this phenomenon will provide important policy and clinical perspectives. T2DM is escalating among low-income populations in low- and middle-income countries, with T2DM affecting people younger than 60 years of age and often going undiagnosed. Co-occurring conditions, including depression, are common and afflict women disproportionately residing in low-resource settings. The proposed research will recruit 5,000 individuals enrolled in an established surveillance study to create a platform to syndemic clusters. The first aim will test syndemic theory by evaluating the social and economic factors that produce syndemic clusters of T2DM, with hypertension (HTN), depression, HIV, and tuberculosis (TB), from that surveillance platform. We hypothesize that social and economic determinants of co-occurring conditions will differ from those determinants that foster singular diseases apart from syndemic clusters. The second aim will employ mixed methods to investigate the social and medical experiences and health care behaviors among 150 people with T2DM and co-occurring HTN, HIV, TB, or depression to examine what social and biological experiences characterize these syndemic clusters. We hypothesize that unique social, economic, psychological, and personal experiences will afflict people experiencing one syndemic cluster compared to another. These data will be imperative during the planning stages of the new primary care system currently underway in South Africa, and we anticipate that insights into integrated primary care will be timely, relevant, and informative. The public health impact of this research is to 1) demonstrate that using a syndemics framework is more effective than a singular disease framework to evaluate complicated disease events, 2) inform social policy, such as the new sugar sweetened beverage tax in South Africa, and 3) provide targeted information for integrated primary care that can inform the restructuring of the South African health system underway. The design of integrated clinical interventions as well as the preliminary research to support further research on syndemics will have broader applicability to clinical care in the U.S. and other syndemic conditions.

拟议的研究将是第一个在脆弱人群中测试联合学理论的研究。这 与流行病的概念相反，Syndemics概念提供了创新的理论和实用性 将“协同作用”与“流行病”相结合的方法来研究社会，政治和生态 因素促进疾病级别的疾病聚类，并影响个体水平的疾病病理。 辛迪克的概念纳入了三个核心概念：1）两种或多种疾病聚集在一起 人口，2）这些疾病通常在生物学上相互作用，以及3）大规模的社会力量珍贵。 黑人南非人中有2型糖尿病（T2DM）的联合群集体现了Syndemics概念， 对这种现象的深入研究将提供重要的政策和临床观点。 T2DM是 低收入和中等收入国家的低收入人群中升级，T2DM影响人们 年龄在60岁以上，经常被诊断出来。包括抑郁在内的同时发生条件是 常见和受苦的妇女不成比例地居住在低资源环境中。拟议的研究将 招募了5,000名参加既定监视研究的人，以创建一个集团集群的平台。 第一个目标将通过评估产生联合性的社会和经济因素来测试联合理论 T2DM的簇，具有高血压（HTN），抑郁，HIV和结核病（TB），从该监测中 平台。我们假设同时发生条件的社会和经济决定者将与 促进奇异疾病的决定因素除了合成簇外。第二个目标将使员工混合 调查150人患有社会和医疗经验以及医疗保健行为的方法 T2DM和同时发生的HTN，HIV，结核病或抑郁症来检查社会和生物学经验 表征这些合成集群。我们假设独特的社会，经济，心理和 与另一个人相比，个人经历将困扰一个经历一个联合集群的人。这些数据将 在目前在南非正在进行的新初级保健系统的计划阶段必须务必进行 我们预计，对综合初级保健的见解将是及时，相关和信息丰富的。公众 这项研究的健康影响是1）证明，使用Syndemics框架比一个 评估复杂疾病事件的奇异疾病框架，2）为社会政策提供信息，例如新的 南非的糖甜卧室税，3）为综合初级保健提供了目标信息 这可以为正在进行的南非卫生系统的修发性提供信息。集成临床的设计 干预措施以及初步研究以支持对联合技术的进一步研究 美国和其他合成条件的临床护理适用性。