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SYNDEMICS as MODERN THREAD for PUBLIC HEALTH

Year 2019, , 184 - 195, 14.05.2019
https://doi.org/10.35232/estudamhsd.561176

Abstract




















Syndemics is a word derived from ancient Greek words
“synergos” meaning “working together” and “demos” meaning “people”. It has been
used to express the aggregation of two or more disease clusters or epidemics in
a population within social and environmental context and explain the unexpected
increases in burden of diseases.




Our knowledge about social, cultural and economic
determinants of health and diseases is not new and has an old history. The
thing which is new regarding syndemics is the interaction of social conditions
with epidemics which exacerbate the prognosis and burden of disease more than
expected.




The Dynamics of this occurrence is different than epidemics,
pandemics and comorbidity and needs to be clarified. However, despite the
presence of several efforts to explain the role of psychosocial and structural
variables on such interactions, there is no satisfactory formulation regarding
the causality of syndemics.




First syndemics was defined among AIDS patients and high
risk groups of HIV/AIDS infections. Within a short time it was understood that
syndemic interactions could occur between several communicable or
non-communicable diseases and health problems. Tuberculosis among communicable
diseases, and depression, diabetes and obesity among noncommunicable diseases
are well known examples. There are studies and publications regarding the
syndemic characteristics of sudden infant deaths (SID/SUID), anemia and
childhood developmental problems.




Results of the studies published in recent two decades
indicate the existence of several syndemics which are significant threats to
public health. “Syndemic care”, a holistic medicine approach instead of single
disease oriented therapies is needed for overhelming these problems. Such an
approach emphasize the necessity and importance of social sciences during the
medical education.








References

  • 1-Singer M, Snipes C. Generations of suffering: experiences of a treatment program for substance abuse during pregnancy. Journal of Health Care for the Poor and Underserved 1992;3(1):222-34.
  • 2-Singer M. A Dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA Syndemic. Free Inquiry in Creative Sociology 1996;24(2):99-l 10.
  • 3-CDC, National Cancer Institute. Greater than the sum: System thinking in tobacco control. NIH Pub No 06-6085, 2007.
  • 4-Hays J. The burdens of disease: Epidemics and human response in western history. New Brunswick, NJ :Rutgers University Press, 2000.
  • 5-Singer, M. AIDS and the Health Crisis of the US Urban Poor: The Perspective of Critical Medical Anthropology. Social Science and Medicine 1994;39:931–948.
  • 6-Mendelhall E. Beyond comorbidity: A critical perspective of syndemic depression and diabetes in cross-cultural contexts. Medical Anthropology Quarterly 2015.
  • 7-Prentice A, Jebb S. TV and inactivity are separate contributors to metabolic risk factors in children . PLoS Medicine 2006;3:2197-2198.
  • 8-Tsai AC, Mendenhall E, Trostle JA, Kawachi I. Co-occurring epidemics, syndemics, and population health. Lancet 2017;389 (10072): 978-982.
  • 9-Milstein B. Introduction to the syndemics prevention network. Atlanta: Centers for Disease Control and Prevention, 2001.
  • 10-Tsai AC, Venkataramani AS. Syndemics and health disparities: A methodological note. AIDS Behav 2016;20:423–430.
  • 11-Lerman S. The syndemogenesis of depression: Concepts and examples. Medicine Anthropology Theory 2018;5 (4): 56–85.
  • 12- Tsai AC. Syndemics: A theory in search of data or data in search of a theory? Social Science & Medicine 2018;206:117–122.
  • 13-Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017;389(10072):951-963.
  • 14-Mendenhall E. Syndemic suffering: Social distress, depression, and diabetes among Mexican immigrant women. Walnut Creek, CA: Left Coast Press Inc., 2012.15-Weaver LJ, Mendenhall E. Applying syndemics and chronicity: Interpretations from studies of poverty, depression, and diabetes. Medical Anthropology: Cross-Cultural Studies in Health and Illness 2014;33 (2): 92–108.
  • 16-Schmitz N, Garepy G, Smith KJ et al.. Recurrent subtreshold depression in type 2 diabetes: an important risk factor for poor helth outcomes. Diabetes Care 2014;37:970-978.
  • 17-Anderson R, Grigsby A, Freedland K, et al.. Anxiety and poor glysemic control:a meta-analytic review of the literatüre. Int J Psychiatry Med 2002;32:235-247.
  • 18-Gonzalez IS, Peyrot M, McCarl LA, et al.. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008;31:2398-2403.
  • 19-Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor fort he onset of type 2 diabetes mellitus: A meta-analysis. Diabetologica 2006;49:837-845.
  • 20-Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 2000;23:1556-1562.
  • 21-Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the research for shared mechanisms. Lancet Diabetes Endocrinol 2015;3:461-471.
  • 22-Kivimäki M, Batty G, Jokela M, et al. Antidepressant medication use and risk of hyperglycemia and diabetes mellitus: a noncausal association? Biol Psychiatry 2011; 70:978–984.
  • 23-Deuschle M. Effects of antidepressants on glucose metabolism and diabetes mellitus type 2 in adults. Curr Opin Psychiatr 2013;26:60-65.
  • 24-Leone T, Coast E, Narayanan S, De-Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Global Health 2012; 8:1.
  • 25-Diderichsena F, Andersena I. The syndemics of diabetes and depression in Brazil – An epidemiological analysis. Population Health 2019;7.
  • 26-Chachra V, Arora V. Study on prevalence of diabetes mellitus in patients with TB under DOTS strategy. Indian J Tuber 2014;61:65-71.
  • 27-Editorial. Diabetes and tuberculosis-a wake-up call. Lancet Diabetes Endocrinol 2014;2:677.
  • 28-Pearson F, Huangfu P, McNally R, Pearce M, Unwin N, Critchley JA. Tuberculosis and diabetes: bidirectional association in a UK primary care data set J Epidemiol Community Health 2019;73:142-147.
  • 29-Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5(7):e152.
  • 30-Bardenheier, B.H., Pavkov, M.E., Winston, C.A., Klosovsky A, Yen C, Benoit S, Gravenstein S, Posey DL, Phares CR. Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease. J Immigrant Minority Health 2019.
  • 31-Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. Matern Child Nutr 2019;15:e12652.
  • 32-Tran T, Biggs B, Holton S, Nguyen H, Hanieh S, Fisher, J. Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: A syndemic. Public Health Nutrition 2019;22(1), 35-43.
  • 33-Boyd A Swinburn, Vivica I Kraak, Steven Allender, Vincent J Atkins, Phillip I Baker, Jessica R Bogard, Hannah Brinsden, Alejandro Calvillo, Olivier De Schutter, Raji Devarajan, Majid Ezzati, Sharon Friel, Shifalika Goenka, Ross A Hammond, Gerard Hastings, Corinna Hawkes, Mario Herrero, Peter S Hovmand, Mark Howden, Lindsay M Jaacks, Ariadne B Kapetanaki, Matt Kasman, Harriet V Kuhnlein, Shiriki K Kumanyika, Bagher Larijani, Tim Lobstein, Michael W Long, Victor K R Matsudo, Susanna D H Mills, Gareth Morgan, Alexandra Morshed, Patricia M Nece, An Pan, David W Patterson, Gary Sacks, Meera Shekar, Geoff L Simmons, Warren Smit, Ali Tootee, Stefanie Vandevijvere, Wilma E Waterlander, Luke Wolfenden, William H Dietz. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Published Online January 27, 2019 http://dx.doi.org/10.1016/S0140-6736(18)32822-8

SİNDEMİLER YA DA SİNERJİK EPİDEMİLER: TOPLUM SAĞLIĞININ ÇAĞDAŞ TEHDİTLERİ

Year 2019, , 184 - 195, 14.05.2019
https://doi.org/10.35232/estudamhsd.561176

Abstract

Özet

 

Eski Yunanca’da iki veya daha fazla etkenin bir araya gelerek toplamlarından daha büyük bir etkiye neden olmaları anlamına gelen “synergos” ile halk anlamına gelen “demos” sözcüklerinin bileşiminden oluşan Sindemi sözcüğü iki veya daha fazla hastalık ya da sağlıkla ilgili sorun epidemisinin, karşılıklı etki ve etkileşimlerini arttıran sosyal-çevresel koşullar kapsamında bir araya gelmesini ve hastalık yükü artışını ifade etmektedir.  

Pek çok hastalığın ve sağlık sorununun sosyal belirleyicilerinin olduğu, ekonomik ve/ya kültürel değişkenlerle yakından ilişkili olduğu konusundaki bilgilerin geçmişi oldukça eski olmakla birlikte Sindemi kavramı ile gündeme gelen yenilik sosyal koşulların, hastalık epidemileri ile etkileşime girerek toplumsal hastalık yükünü beklenenin üzerinde arttırıyor olmasıdır. 

Klasik epidemilerden, pandemiden ve komorbiditeden farklı olan bu birlikteliğin neden olduğu sorunları çözmek için aralarındaki ilişki dinamiğini açıklığa kavuşturmak gerekmektedir. Ne var ki çeşitli sindemilerin oluşumunda psikososyal etkenler ve yapısal özellikler arasındaki etkileşim konusunda pek çok algoritmalar, nedensellik modelleri geliştirme çalışmaları bulunsa da bu etkileşimler henüz tam olarak formüle edilebilmiş değildir. 

İlk olarak AIDS hastalarında tanımlanan ve uzun süre HIV/AIDS risk gruplarında çalışma konusu olan  sindemik ilişkilerin geçen kısa sure içerisinde bulaşıcı olan ve olmayan pek çok sorun için söz konusu olabileceği anlaşılmıştır. Bulaşıcı hastalıklardan AIDS’e ek olarak Tüberküloz, bulaşıcı olmayan hastalıklardan ise diyabet, depresyon ve obezite öne çıkan hastalıklardır. Ancak, ani bebek ölümü (SUID/SID), çocuklardaki anemi ve gelişme geriliği gibi sorunların da sindemik özellikler taşıdığına ilişkin çalışmalar bulunmaktadır. 

Son yirmi yılda yapılan araştırma ve yayınlar çok sayıda sindeminin varlığını ve yayılmakta olduğunu göstermektedir. Sindemilerin özelliği gereği sindemik hastalıkların tek tek tedavisi yerine bir bütün olarak, holistik bakım anlayışı ile tedavi edilmeleri önemlidir. Bu anlamda hastalıkların sosyal bileşenlerini de dikkate alan sindemik bakım anlayışının geliştirilmesi, yaygınlaştırılması, tıp eğitiminde sosyal bilimlere daha fazla yer verilmesi gerekmektedir.

References

  • 1-Singer M, Snipes C. Generations of suffering: experiences of a treatment program for substance abuse during pregnancy. Journal of Health Care for the Poor and Underserved 1992;3(1):222-34.
  • 2-Singer M. A Dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA Syndemic. Free Inquiry in Creative Sociology 1996;24(2):99-l 10.
  • 3-CDC, National Cancer Institute. Greater than the sum: System thinking in tobacco control. NIH Pub No 06-6085, 2007.
  • 4-Hays J. The burdens of disease: Epidemics and human response in western history. New Brunswick, NJ :Rutgers University Press, 2000.
  • 5-Singer, M. AIDS and the Health Crisis of the US Urban Poor: The Perspective of Critical Medical Anthropology. Social Science and Medicine 1994;39:931–948.
  • 6-Mendelhall E. Beyond comorbidity: A critical perspective of syndemic depression and diabetes in cross-cultural contexts. Medical Anthropology Quarterly 2015.
  • 7-Prentice A, Jebb S. TV and inactivity are separate contributors to metabolic risk factors in children . PLoS Medicine 2006;3:2197-2198.
  • 8-Tsai AC, Mendenhall E, Trostle JA, Kawachi I. Co-occurring epidemics, syndemics, and population health. Lancet 2017;389 (10072): 978-982.
  • 9-Milstein B. Introduction to the syndemics prevention network. Atlanta: Centers for Disease Control and Prevention, 2001.
  • 10-Tsai AC, Venkataramani AS. Syndemics and health disparities: A methodological note. AIDS Behav 2016;20:423–430.
  • 11-Lerman S. The syndemogenesis of depression: Concepts and examples. Medicine Anthropology Theory 2018;5 (4): 56–85.
  • 12- Tsai AC. Syndemics: A theory in search of data or data in search of a theory? Social Science & Medicine 2018;206:117–122.
  • 13-Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017;389(10072):951-963.
  • 14-Mendenhall E. Syndemic suffering: Social distress, depression, and diabetes among Mexican immigrant women. Walnut Creek, CA: Left Coast Press Inc., 2012.15-Weaver LJ, Mendenhall E. Applying syndemics and chronicity: Interpretations from studies of poverty, depression, and diabetes. Medical Anthropology: Cross-Cultural Studies in Health and Illness 2014;33 (2): 92–108.
  • 16-Schmitz N, Garepy G, Smith KJ et al.. Recurrent subtreshold depression in type 2 diabetes: an important risk factor for poor helth outcomes. Diabetes Care 2014;37:970-978.
  • 17-Anderson R, Grigsby A, Freedland K, et al.. Anxiety and poor glysemic control:a meta-analytic review of the literatüre. Int J Psychiatry Med 2002;32:235-247.
  • 18-Gonzalez IS, Peyrot M, McCarl LA, et al.. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008;31:2398-2403.
  • 19-Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor fort he onset of type 2 diabetes mellitus: A meta-analysis. Diabetologica 2006;49:837-845.
  • 20-Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 2000;23:1556-1562.
  • 21-Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the research for shared mechanisms. Lancet Diabetes Endocrinol 2015;3:461-471.
  • 22-Kivimäki M, Batty G, Jokela M, et al. Antidepressant medication use and risk of hyperglycemia and diabetes mellitus: a noncausal association? Biol Psychiatry 2011; 70:978–984.
  • 23-Deuschle M. Effects of antidepressants on glucose metabolism and diabetes mellitus type 2 in adults. Curr Opin Psychiatr 2013;26:60-65.
  • 24-Leone T, Coast E, Narayanan S, De-Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Global Health 2012; 8:1.
  • 25-Diderichsena F, Andersena I. The syndemics of diabetes and depression in Brazil – An epidemiological analysis. Population Health 2019;7.
  • 26-Chachra V, Arora V. Study on prevalence of diabetes mellitus in patients with TB under DOTS strategy. Indian J Tuber 2014;61:65-71.
  • 27-Editorial. Diabetes and tuberculosis-a wake-up call. Lancet Diabetes Endocrinol 2014;2:677.
  • 28-Pearson F, Huangfu P, McNally R, Pearce M, Unwin N, Critchley JA. Tuberculosis and diabetes: bidirectional association in a UK primary care data set J Epidemiol Community Health 2019;73:142-147.
  • 29-Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5(7):e152.
  • 30-Bardenheier, B.H., Pavkov, M.E., Winston, C.A., Klosovsky A, Yen C, Benoit S, Gravenstein S, Posey DL, Phares CR. Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease. J Immigrant Minority Health 2019.
  • 31-Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. Matern Child Nutr 2019;15:e12652.
  • 32-Tran T, Biggs B, Holton S, Nguyen H, Hanieh S, Fisher, J. Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: A syndemic. Public Health Nutrition 2019;22(1), 35-43.
  • 33-Boyd A Swinburn, Vivica I Kraak, Steven Allender, Vincent J Atkins, Phillip I Baker, Jessica R Bogard, Hannah Brinsden, Alejandro Calvillo, Olivier De Schutter, Raji Devarajan, Majid Ezzati, Sharon Friel, Shifalika Goenka, Ross A Hammond, Gerard Hastings, Corinna Hawkes, Mario Herrero, Peter S Hovmand, Mark Howden, Lindsay M Jaacks, Ariadne B Kapetanaki, Matt Kasman, Harriet V Kuhnlein, Shiriki K Kumanyika, Bagher Larijani, Tim Lobstein, Michael W Long, Victor K R Matsudo, Susanna D H Mills, Gareth Morgan, Alexandra Morshed, Patricia M Nece, An Pan, David W Patterson, Gary Sacks, Meera Shekar, Geoff L Simmons, Warren Smit, Ali Tootee, Stefanie Vandevijvere, Wilma E Waterlander, Luke Wolfenden, William H Dietz. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Published Online January 27, 2019 http://dx.doi.org/10.1016/S0140-6736(18)32822-8
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Review
Authors

Osman Hayran 0000-0002-9994-5033

Publication Date May 14, 2019
Submission Date May 7, 2019
Published in Issue Year 2019

Cite

Vancouver Hayran O. SİNDEMİLER YA DA SİNERJİK EPİDEMİLER: TOPLUM SAĞLIĞININ ÇAĞDAŞ TEHDİTLERİ. ESTÜDAM Halk Sağlığı Dergisi. 2019;4(2):184-95.

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