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This essay builds on the exciting trove of disaster social science research surfacing since the earliest days of the COVID-19 pandemic. It tracks the ways that both practitioners of medicine and public health, and their social science analogues, have approached the pandemic, explicitly considering the ways they reached for new concepts to explain the temporal phenomena presented by COVID-19 and its global course. The essay highlights a series of interviews conducted in the first two years of the pandemic as part of the COVIDCalls podcast. COVID is the moment for a scholarly convergence that was missed after September 11, and again after Hurricane Katrina, and should not be missed again. Accordingly, this essay explores themes where medicine/health studies and disaster studies seem to offer great help to one another in making sense of our COVID times: the origins of disaster, disasters in combination, and the end of a disaster. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among Black emerging adults. The concurrent effect of the COVID-19 pandemic and racial discrimination were projected to exacerbate suicide vulnerability for Black Americans. The purpose of the present study was to utilize a risk-resilience model to examine the effects of racial discrimination and COVID-related stress on suicide risk for Black emerging adults, as well as the moderating effect of three central components of radical healing: critical consciousness, resilience, and cultural authenticity. Study participants included 521 Black emerging adults between the ages of 18 and 29 (51.6% male; Mage = 24.6, SD = 2.6) who completed measures evaluating symptoms of racial discrimination, COVID-related stress, suicide risk, and psychological well-being. After controlling for age, gender, socioeconomic status, and general stress, structural equation modeling analyses revealed unique and interactive effects of racial discrimination, COVID-related stress, and culturally relevant protective factors on suicide risk for Black emerging adults. These findings provide preliminary insight into novel risk and protective factors that influence suicide risk for Black emerging adults. Public Significance Statement: Overall, findings suggest that the synergistic effects of COVID-related stress and racial discrimination play a role in suicide vulnerability for Black emerging adults. The present study's contributions are important in the context of providing empirical evidence for the role of social marginalization and culturally relevant buffers in suicide risk for Black Americans, highlighting the need for culturally informed models of suicide risk. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Discussion and Conclusions While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV.A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub‐sample (n = 24) was recruited for semi‐structured interviews for qualitative analyses.The network analysis revealed two statistically significant bivariate associations: between post‐traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post‐traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts.Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high‐priority population. [ABSTRACT FROM AUTHOR]

Syndemic theory proposes that co-occurring, mutually reinforcing psychosocial challenges (mental health, substance use, minority stress [discrimination/stigma], abuse, unmet basic needs) drive HIV risk behavior and create barriers to care for marginalized populations. It is thus necessary to address this holistic, complex picture in HIV prevention. Emergency department (ED) visits are a prime opportunity to engage key risk groups, given their low engagement in regular clinic-based care and high utilization of drop-in care via EDs. Yet, EDs are overburdened and under-resourced; mHealth may be a vehicle for intervention delivery in this context. This study aimed to 1) characterize demographics, syndemic profiles, and HIV risk behavior among ED patients and 2) assess the acceptability of addressing syndemic issues, particularly via an mHealth approach, in the ED. A sample of N = 198 ED patients with an indication of HIV risk completed a cross-sectional psychosocial assessment. Descriptive statistics and bivariate correlations between syndemic issues were examined. Patients presenting to the ED reported marginalized identities and complex syndemic profiles including mental health issues (77%), at risk substance use (30%), childhood abuse (35%), adult abuse (31%), minority stress (63%), and unmet basic needs (37%). Over half the sample reported at least three syndemic issues (54%). All syndemic issues were significantly correlated with each other, supporting a synergistic nature. The sample reported indicators of HIV risk including lack of PrEP awareness (33%)/uptake (94%), condomless sex (37%), and not testing for HIV (41%). Majority reported syndemic profiles have never been addressed in the ED (71%), think it would be helpful (88%), and willing to utilize mHealth during an ED visit (76%). The current study provides information to guide next steps for ED-based point-of-care HIV prevention, and more broadly, working towards equitable HIV prevention services reaching those missed by existing interventions. [ABSTRACT FROM AUTHOR]

In a tragically ironic twist, antiretroviral therapy (ART) that promised an end to AIDS ushered in a syndemic of viral cancers, transforming hope to despair. In this article we draw from the illness narratives of HIV positive women attending a cervical cancer screening clinic in Johannesburg, South Africa, and chart their pathways from HIV to cancer, and their quest for treatment. Our interlocutors described protracted struggles to access surgical procedures to prevent the onset of cervical cancer. Dealt a double blow of HIV and cervical cancer, women's narratives reveal the intersections of exposure to pathogens and the precarity of hope. [ABSTRACT FROM AUTHOR]

Objectives. To examine linear and nonlinear associations between psychosocial syndemic factors and HIV risk and engagement in HIV prevention care among sexual and gender minority (SGM) youths. Methods. Between February and October 2022, we recruited 17 578 SGM youths aged 13 to 18 years in the United States for an online survey. We examined the relationship of syndemics (i.e., binge drinking, drug use, sexual victimization, and anti–lesbian, gay, bisexual, and transgender discrimination) with sexual behaviors (i.e., sexual initiation, condomless anal or vaginal sex, and number of sexual partners) and HIV prevention care (i.e., HIV testing, preexposure prophylaxis awareness and utilization) using regression. Results. Psychosocial syndemic burden (number of syndemic factors reported) was linearly and cubically associated with engagement in sexual behaviors. Psychosocial syndemic burden was linearly associated with higher HIV testing and preexposure prophylaxis awareness and cubically associated with higher preexposure prophylaxis utilization. Conclusions. Our findings are evidence of synergism across psychosocial syndemic factors regarding HIV risk and engagement in HIV prevention care among SGM youths in the United States. Public Health Implications. Multicomponent interventions may help reduce HIV risk and promote access to HIV prevention services among SGM individuals aged 13 to 18 years. (Am J Public Health. 2024;114(9):892–902. https://doi.org/10.2105/AJPH.2024.307753) [ABSTRACT FROM AUTHOR]

Occupational exposures in the large industrial mining sector contributed significantly to South Africa's high excess death rate due to COVID-19. Historically poor work-protection oversight has perpetuated centuries of risky labor and living conditions within the industry, driving high levels of disease co-morbidities, and supporting enduring social vulnerabilities. In this paper, we offer a syndemic lens to consider the clustering of adversely interacting diseases among mineworkers in South Africa, drawing attention to the complex occupational health crisis and the need to move beyond simply reporting individual diseases or comorbidities among this population. The physically demanding and dangerous working conditions, the lack of adequate changes to crowded and unsanitary working and living situations, the failure to meet social and labor plan targets, the continued precarious nature of working contracts and mines, and the limited access to robust healthcare reflect the historically exploitative nature of industrial mining in South Africa that places miners at increased risk for various syndemics. This assessment of the adverse interactions of diseases and socioeconomic and political conditions highlights the need for focused research and more follow-through in comprehensive occupational reforms. [ABSTRACT FROM AUTHOR]

Purpose: To argue for trust-building as a key solution for responding to public health crises in the face of political ambiguity in international health governance. Patients and Methods: This perspective piece reviews fundamental concepts and discusses future directions using secondary data from open-access sources. Results: The promise of learning from Covid-19 and previous public health crises, along with the growing recognition of a 'Health For All Policies' approach, clash with siloed preparations, management, and recovery plans for future emergency crises. Trust is proposed as a possible solution to overcome these limitations. It acts as a binding force that unites individuals within the community, fostering a sense of belonging and participation. Trust-building is viewed as a "People-Centered" approach in Crisis Response, aimed at creating active and resilient communities to foster preparation and readiness, respond to emergent risks, facilitate recovery, and mitigate risks. A remaining question is how to measure and identify the dimensions and determinants of trust in specific circumstances. Some ideas are systematized to highlight the pathway to build trust in public health approaches, including transparency, education, robust and equitable health systems, strengthened social capital, stakeholders' engagement, and health workforce training. Conclusion: Trust in public health approaches can be fostered through consistent delivery of quality care, a clear, shared vision, and values underpinned by ethical standards. It requires a commitment to stakeholder well-being, including staff, and the integration of reliability, integrity, and transparency into policies, strategies, and practices. Exemplary leadership, openness in resource utilization, addressing waste or corruption, and effective communication of these principles are essential. [ABSTRACT FROM AUTHOR]

Abstract Occupational exposures in the large industrial mining sector contributed significantly to South Africa’s high excess death rate due to COVID-19. Historically poor work-protection oversight has perpetuated centuries of risky labor and living conditions within the industry, driving high levels of disease co-morbidities, and supporting enduring social vulnerabilities. In this paper, we offer a syndemic lens to consider the clustering of adversely interacting diseases among mineworkers in South Africa, drawing attention to the complex occupational health crisis and the need to move beyond simply reporting individual diseases or comorbidities among this population. The physically demanding and dangerous working conditions, the lack of adequate changes to crowded and unsanitary working and living situations, the failure to meet social and labor plan targets, the continued precarious nature of working contracts and mines, and the limited access to robust healthcare reflect the historically exploitative nature of industrial mining in South Africa that places miners at increased risk for various syndemics. This assessment of the adverse interactions of diseases and socioeconomic and political conditions highlights the need for focused research and more follow-through in comprehensive occupational reforms.

Much of the research on the effects of syndemics on HIV outcomes has utilized an additive approach. However, interaction effects may better account for syndemic synergy than an additive approach, but it remains difficult to specify interaction effects without empirical guidance. We sought to systematically compare additive and interaction effects approaches to modeling the effects of syndemic problems on antiretroviral therapy (ART) using empirically specified interaction terms. Participants were 194 people with HIV (PWH) who received HIV care in Khayelitsha, South Africa. In a series of linear regression models, we examined ten syndemic problems: depression, alcohol use, intimate partner violence (IPV), post-traumatic stress, social anxiety, substance use, food insecurity, poverty, housing instability, and structural barriers to care. Depression, substance use, and food insecurity were selected for interaction terms based on a prior network analysis, which found these problems to be most central. The additive models did not produce statistically significant findings. However, the interaction effects models yielded significant interaction terms in both the full model and a parsimonious model. There was a statistically significant effect of the interaction between depression and food insecurity on ART adherence (b = 0.04, Robust SE = 0.02, 95%CI [0.001–0.08], p =.012). This pattern of results was replicated in the parsimonious model. Findings suggest that when feasible, interaction effects approaches may be a helpful syndemic modeling technique. Results may inform future intervention targets, such as depression and food insecurity, and the importance of addressing both structural and psychosocial syndemic problems. [ABSTRACT FROM AUTHOR]

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While the repercussions of the novel Coronavirus or COVID-19 have been felt across the world over the past few years, the impact has not been consistent. Instead, it has been mediated by the systemic ways in which existing social and structural disparities have failed vulnerable populations globally. Drawing on document analysis and fifteen in-depth interviews (n=15) conducted among the key stakeholders in the city of San Antonio, South Central Texas, this paper reveals how structural violence worsened during the COVID-19 pandemic resulting in making it a syndemic pandemic of high rates of deaths and illnesses among the most vulnerable and disadvantaged groups. A grounded theory approach particularly revealed themes of social suffering such as low income and pre-existing medical conditions that contributed to higher mortality rates, the presence of racism and misinformation, the importance of trustworthy communication channels, and streamlined collaborative partnerships with clear and effective communication through all levels of the government, especially when communicating scientific information. [ABSTRACT FROM AUTHOR]

Studies conducted early in the COVID-19 pandemic - before vaccines were widely available - indicated that drug use may have declined among sexual minority men (SMM). This study evaluated drug use trends in the second year of the pandemic. Cross-sectional responses from cisgender SMM living in the US and recruited online (n = 15,897) were grouped for analyses: Time 1: 3/1/2021-5/30/2021; Time 2: 6/1/2021-8/31/2021; Time 3: 9/1/2021-11/30/2021; and Time 4: 12/1 2021-2/28/2022. Results of multivariable models indicated that illicit drug use (excluding cannabis) increased at Times 2 (OR = 1.249, p <.001), 3 (OR = 1.668, p <.001), and 4 (OR = 1.674, p <.001) compared to Time 1. In contrast, cannabis use was relatively stable over time. Rates did not differ significantly among Times 1, 2, and 4. While rates of COVID-19 vaccination increased over time, illicit drug use was negatively associated with the odds of vaccination (OR = 0.361, p <.001). These findings highlight the need for ongoing attention to the risks drug use poses among SMM. Illicit drug use - a long-standing health disparity among SMM - increased significantly across the second year of the pandemic. Because they are less likely to be vaccinated, SMM who use illicit drugs may be at greater risk of COVID-19 infection or complications. [ABSTRACT FROM AUTHOR]

The coronavirus and anti‐Black racial violence dual pandemics of the early 2020s brought multiple existential concerns that aligned with the four existential givens of human experience, namely, life and death anxiety, community and isolation, meaning‐making and absurdity, freedom of choice and responsibility compared to determinism, and existential guilt and shattering. These themes are examined through an analysis and summary of the seven articles included in this special issue. These seven articles substantiate a need for further research and widely implemented interventions that emphasize culturally affirming and sustaining humanistic and existential counseling practices paired with advocacy for systemic change that enhances community solidarity alongside meaning‐making and identity preservation. This approach aims to support people from marginalized communities in navigating compounded challenges during dual crises such as the early 2020s syndemic polycrisis. [ABSTRACT FROM AUTHOR]

Building upon a review of geographic research agendas and concepts related to the uneven geographies of COVID‐19, this first of three articles debates the benefits of geographic analyses to the syndemic approach and, vice versa, of a syndemics perspective to geographic analyses. The syndemics perspective was proposed by critical medical anthropologists. It seeks to deepen the understanding of the structural dimensions and processes that lead to the convergence and cascading of multiple epidemics in specific population groups. Geographers have also highlighted the intersections of multiple health or other crises during COVID‐19, when the pandemic and global health emergency coincided with and escalated existing structural inequalities produced by the climate crisis, environmental degradation, political conflicts and war, socio‐economic disparities and poverty, social divisions, racism, hatred and violence, mental health problems and stress. Geographers have mobilized concepts such as scale, territory, borders and intersectionality to unravel the uneven unfolding and consequences of the global health emergency for diverse population groups. We therefore argue that geography has a lot to contribute to the understanding of the spatial and contextual dimensions of COVID‐19 as a pandemic as well as a syndemic – but it has so far not actively employed the latter concept's analytical lens. Mobilizing the syndemics approach can contribute to more comprehensive accounts of the structural dimensions and processes that continue and cascade in pandemics. [ABSTRACT FROM AUTHOR]

Background: Syndemic models have been used in previous studies exploring HIV-related outcomes; however, these models do not fully consider intersecting psychosocial (e.g., substance use, depressive symptoms) and structural factors (unstable housing, concentrated housing vacancy) that influence the lived experiences of women. Therefore, there is a need to explore the syndemic effects of psychosocial and structural factors on HIV risk behaviors to better explain the multilevel factors shaping HIV disparities among black women. Methods: This analysis uses baseline data (May 2009–August 2010) from non-Hispanic black women enrolled in the HIV Prevention Trials Network 064 Women's Seroincidence Study (HPTN 064) and the American Community Survey 5-year estimates from 2007 to 2011. Three parameterizations of syndemic factors were applied in this analysis a cumulative syndemic index, three syndemic groups reflecting the level of influence (psychosocial syndemic group, participant-level structural syndemic group, and a neighborhood-level structural syndemic group), and syndemic factor groups. Clustered mixed effects log-binomial analyses measured the relationship of each syndemic parameterization on HIV risk behaviors in 1,347 black women enrolled in HPTN 064. Results: A higher syndemic score was significantly associated with increased prevalence of unknown HIV status of the last male sex partner (adjusted prevalence ratio (aPR) = 1.07, 95% confidence interval or CI 1.04–1.10), involvement in exchange sex (aPR = 1.17, 95% CI: 1.14–1.20), and multiple sex partners (aPR = 1.07, 95% CI: 1.06–1.09) in the last 6 months. A dose–response relationship was observed between the number of syndemic groups and HIV risk behaviors, therefore, being in multiple syndemic groups was significantly associated with increased prevalence of reporting HIV risk behaviors compared with being in one syndemic group. In addition, being in all three syndemic groups was associated with increased prevalence of unknown HIV status of the last male sex partner (aPR = 1.67, 95% CI: 1.43–1.95) and multiple sex partners (aPR = 1.53, 95% CI: 1.36–1.72). Conclusions: Findings highlight syndemic factors influence the lived experiences of black women. [ABSTRACT FROM AUTHOR]

Much progress has been made in advancing antiretroviral (ART) adherence, yet disparities remain. To explore relationships of syndemic conditions – co-occurring health conditions caused by combinations of biological, social, and structural factors – to ART adherence among African American men, we used data from longitudinal assessments of 302 African American men enrolled in a study designed to increase physical activity and healthy eating. Syndemic conditions included alcohol dependency, drug dependency, depression, post-traumatic stress disorder, and unstable housing. A syndemic conditions variable was operationalized to indicate the presence of 0–5 conditions. About 55% of participants had 1 or more syndemic conditions. Age and marriage were positively associated with ART adherence, whereas number of syndemic conditions was negatively associated with adherence during the 12-month period. The interaction of being married and the syndemic conditions variable significantly predicted greater adherence. Similarly, the interaction of more education and the syndemic conditions variable predicted greater adherence. In multiple regression models, the syndemic conditions variable remained significant (−0.018) in predicting adherence; however, there was no significant interaction among the 5 conditions. This study lends evidence to syndemics literature indicating deleterious consequences of negative life experiences on health outcomes. [ABSTRACT FROM AUTHOR]

This article offers an insight into the challenges faced by social movements when attempting to politicize the crisis of reproduction which took place during the COVID-19 syndemic in the city of Barcelona. The analysis provided here expands on the analysis of social reproduction theory and, more broadly, on Marxist feminist approaches. In fact, one of the factors accounting for the absence of politicization during the syndemic is the type of responses given to the emergency by the authoritarian neoliberal state, which were beyond those envisaged by the 10th thesis theorized by Marxism-Feminism and social reproduction theory. Thus, in this article, we argue that this situation is an opportunity to establish a dialogue between critical state theory and Marxism-Feminism to understand how the agency of the state may condition the social reproduction of life and block the emancipatory possibilities of care and the social struggles regarding the crisis of care, complementing thus the10th thesis of Marxism-Feminism. [ABSTRACT FROM AUTHOR]

Background: Mental health issues (depression and suicidal ideation) are increasingly common in children and emerge as escalating public health concerns. The syndemics that underline the importance of risk factor clustering provides a framework for intervention, but there is a lack of research on syndemics involving the adverse interactions of children's mental health problems. This study therefore examined the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation among children in China. Methods: A mental health screening census of students in grades 5–12 was conducted from November 2022 to January 2023 in Nanling County, Anhui Province, China. The prevalence and co-occurrence of vulnerable conditions (unfavorable parental marital status, left-behind experience, bullying victimization, and self-harm behavior), depression, and suicidal ideation and the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation were explored. Results: Nearly a quarter of students (24.8%) reported at least two syndemic conditions. Overall, the prevalence of depression and suicidal ideation were 20.2% and 24.2% respectively. The odds of depression and suicidal ideation were higher for children with one or more vulnerable conditions and were ten times higher for children with three or more vulnerable conditions compared with those without any vulnerable condition. These four vulnerable conditions can increase the odds of depression and suicidal ideation by interacting synergistically with each other. Conclusion: Our findings signal the importance of addressing mental health syndemics among children in China by simultaneously considering concurrent vulnerable conditions. [ABSTRACT FROM AUTHOR]

Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB‐DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB‐DM syndemic with the COVID‐19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB‐DM operationally difficult and of low effectiveness. Research regarding TB‐DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB‐DM comorbidity needs more efforts, including training and supervision of frontline workers. [ABSTRACT FROM AUTHOR]

Metal mining is associated with negative social, political, economic, health, and environmental impacts. These individual impacts are generally understood, but a deeper understanding of the combined syndemic effects of mining, particularly in Indigenous communities, is needed, especially as metal mining is expected to grow with the expansion of cleaner energy technologies. Perceptions of environmental risk and human health in Ch'orti' communities of Olopa, Guatemala, that have been impacted by the Cantera Los Manantiales antimony mine were examined via a community-based participatory research approach that included participatory mapping, interviews, and community mapping workshops. Results indicate increased violence and community divisions, increased incidence of health concerns, and an extensive loss of crops and domesticated animals following the introduction of mining operations. Furthermore, participants attributed both water and air contamination to the mine. We argue that our collective results present as a syndemic and represent a continuation of violence toward Indigenous people. Findings will support local leaders and allied research and legal organizations in efforts to effectively access justice and assess health in Indigenous communities impacted by the mine in Olopa. More broadly, this effort demonstrates how participatory mapping methods add nuance to the understanding of syndemics and other environmental health risks. [ABSTRACT FROM AUTHOR]

Syndemics, the adverse interaction of two or more coterminous diseases or other negative health conditions, have probably existed since human settlement, plant and animal domestication, urbanization, and the growth of social inequality beginning about 10–12,000 years ago. These dramatic changes in human social evolution significantly increased opportunities for the spread of zoonotic infectious diseases in denser human communities with increased sanitation challenges. In light of a growing body of research that indicates that anthropogenic air pollution causes numerous threats to health and is taking a far greater toll on human life and wellbeing than had been reported, this paper proposes the possibility that air pollution is now the primary driver of infectious disease syndemics. In support of this assertion, this paper reviews the growth and health impacts of air pollution, the relationship of air pollution to the development and spread of infectious diseases, and reported cases of air pollution-driven infectious disease syndemics, and presents public health recommendations for leveraging the biosocial insight of syndemic theory in responding to infectious disease. [ABSTRACT FROM AUTHOR]

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69–1.47; 2 syndemic factors: 1.59, 0.89–2.84; 3 syndemic factors: 1.62, 0.44–5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care. [ABSTRACT FROM AUTHOR]

Syndemic theory posits that co-occurring diseases interact in a manner that increases disease transmission, progression, and negative health outcomes. And that adverse socioeconomic and environmental conditions promote this disease or health condition clustering and interaction. The concept offers two important contributions to the health sciences. First, it positions socioeconomic, structural, and environmental conditions as central to disease burdens. Second, as a portmanteau – ‘syn’ for synergy and ‘demic’ for disease epidemics – syndemic theory indicates that in some cases diseases do not merely co-occur but synergistically interact to affect an outcome that is more than the accumulation of the individual disease effects. The difficulty in operationalizing these central elements has resulted in a divergence of scholarship from the centralizing principles of the theory towards a simpler accumulation perspective in which more conditions equate to worse health outcomes. In addition, all empirical syndemic assessments should include robust qualitative assessments of the dynamics, however, much syndemic scholarship focuses only on quantitative analyses. To address these issues, a five-step approach to quantitative analyses of syndemic arrangements is proposed: (1) identifying disease clusters within a defined population; (2) determining the relevant social and structural factors that support disease clustering; (3) determining if clusters are distinct by social/demographic groups within the population; (4) evaluating if the identified disease cluster contributes to worse health outcomes; and (5) assessing for synergy between clustering diseases. This stepwise strategy ensures not only a rigorous assessment of hypothesized syndemic interactions but also presents a closer alignment of scholarship with syndemics theory. As an illustration, the approach is applied to an assessment of a hypothesized HIV/cardiovascular disease syndemic in South Africa. While syndemics theory has proven valuable in guiding public health interventions and policy, progressive improvement must be made in the application of the theory to ensure that it continues to effectively inform comprehensive practice.

Summary: Background: Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes. Methods: This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis: chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis: age, sex, gender, race/ethnicity, sexual orientation. During follow-up: CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used. Findings: There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs. Interpretation: People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV. Funding: This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program.

Background: COVID-19's heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions. Objective: To review how the term 'syndemic' is defined and applied within peer-reviewed literature in relation to COVID-19. Design: A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed. Results: Content analysis revealed that COVID-19 has varied clustered configurations of communicable–non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept. Conclusion: This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses. [ABSTRACT FROM AUTHOR]

Abstract COVID-19 has revealed and intensified economic and health disparities, prompting a profound national and global examination of racist systems perpetuating such disadvantage. The historic confluence of COVID-19 with movements for social justice offers a window, which COVID fatigue may already be closing, for us to enact true change in the process and content of a graduate social work education. This moment calls for re-envisioned process and content that addresses issues of oppression, social justice, trauma, mental illness, and health. As social work educators with a specialization in trauma, we are thinking deeply about how to harness this juncture to shape a more rigorous and responsive social work educational process. We believe trauma-informed principles must be applied across the social work curriculum, beyond trauma-focused or clinical courses, and to our social work educational institutions. We offer examples of how we have revisioned social work training for ourselves and our students, from our multiple standpoints as faculty, administrator, and field advisor, for the complex challenges and opportunities of chronic syndemic times. We conclude with an invitation to shift away from the social work education status quo and truly practice what we teach. [ABSTRACT FROM AUTHOR]

Digital phenotyping is a process that allows researchers to leverage smartphone and wearable data to explore how technology use relates to behavioral health outcomes. In this Research Concepts article, we provide background on prior research that has employed digital phenotyping; the fundamentals of how digital phenotyping works, using examples from participant data; the application of digital phenotyping in the context of substance use and its syndemics; and the ethical, legal and social implications of digital phenotyping. We discuss applications for digital phenotyping in medical toxicology, as well as potential uses for digital phenotyping in future research. We also highlight the importance of obtaining ground truth annotation in order to identify and establish digital phenotypes of key behaviors of interest. Finally, there are many potential roles for medical toxicologists to leverage digital phenotyping both in research and in the future as a clinical tool to better understand the contextual features associated with drug poisoning and overdose. This article demonstrates how medical toxicologists and researchers can progress through phases of a research trajectory using digital phenotyping to better understand behavior and its association with smartphone usage. [ABSTRACT FROM AUTHOR]

Introduction: Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC). Methods: A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022. Results: A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services. Conclusions: This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening. [ABSTRACT FROM AUTHOR]

Background: The terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic – a portmanteau of "quantification" and "pandemic". Main text: The use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management. Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking. Conclusion: A quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities. [ABSTRACT FROM AUTHOR]

The occupation of commercial fishing is recognized as a comparatively stressful and hazardous job characterized by a myriad of risks to health, including high rates of job‐related injury, morbidity, and mortality. Nonetheless, systematic study of fisher health is limited. This paper examines a particularly understudied aspect of illness among fishers: the physical and social contexts, pathways, and potential for adverse disease interactions. The focus of the paper is on a biosocial disease process called syndemics, which increases the health burdens of this population. The paper is presented as an initial testing of the hypothesis that a "lens" of syndemics improves occupational health research and advocacy for commercial fishermen who face a substantial burden of biosocial challenges. [ABSTRACT FROM AUTHOR]

This article explores the magnifying lenses of the COVID‐19 syndemic to highlight how people racialized as migrants and refugees have been—and continue to be—disproportionally harmed. We use empirical evidence collected in our scholarly/activist work in Europe, Africa, South Asia, and the United States to examine migrant injustice as being produced by a combination of power structures and relations working to maintain colonial global orders and inequalities. This is what has been defined as "border imperialism." Our data, complemented by evidence from transnational solidarity groups, show that border imperialism has further intersected with the hygienic‐sanitary logics of social control at play during the COVID‐19 period. This intersection has resulted in increasingly coercive methods of restraining people on the move, as well as in increased—and new—forms of degradation of their lives, that is, an overall multiplication of border violences. At the same time, however, COVID‐19 has provided a unique opportunity for grassroot solidarity initiatives and resistance led by people on the move to be amplified and extended. We conclude by emphasizing the need for community psychologists to take a more vigorous stance against oppressive border imperialist regimes and the related forms of violence they re/enact. Highlights: People on the move have been, and continue to be, disproportionally harmed by the COVID‐19 syndemic.Migrant injustice is produced by a global system of border imperialism.The COVID‐19 syndemic has worked as a multiplier of border violences.The COVID‐19 has been a driver of grassroots solidarity and resistance led by people on the move.Community psychologists need to take a more vigorous stance against border imperialist regimes. [ABSTRACT FROM AUTHOR]

As the proliferation of new variations of COVID-19 (Coronavirus Disease 2019) continues to increase, it is evident that the COVID-19 pandemic is not over. Indeed, we are living in a world of interrelating and overlapping pandemics—a syndemic. A syndemic accelerates the polarization of access to health care, financial support, and education opportunities in marginalized communities, and the polarization breeds social injustice, violence, and ignorance. What, then, is the Gospel the Church proclaims for those who have experienced the pandemic and are now facing a syndemic? As part of a liturgical response, this paper proposes preaching as a praxis of the ecclesiological Gospel. The ecclesiological Gospel is a term I suggest to highlight the contextual, sacramental, and communal aspects of the Gospel. Highlighting God's holistic work for salvation represented in baptism and the eucharist, the ecclesiological Gospel yearns to form a church that baptizes people in diversity, that severs evil interconnections, and that welcomes people to the table of hospitality that forms a new covenantal relationship. This paper examines the concept of a syndemic and its significance for preaching in marginalized communities. It contrasts a holistic Gospel perspective with a narrow view, proposes preaching as praxis of the ecclesiological Gospel, and illustrates its application within a particular context in responding to syndemic conditions. I hope this work offers a chance to reorient the meaning of the Gospel and the identity of the Church for people living in fear, grief, and hopelessness, while encouraging them with the unwavering hope revealed in Christ's suffering, death, and resurrection. [ABSTRACT FROM AUTHOR]

Quilombola communities have felt the effects of racism deepened by COVID-19, whose repercussions are amplified in contexts of racial inequalities, characterizing it as a syndemic. The term refers to the synergy of biological, economic, environmental, political, and social elements that enhance coexisting conditions and states, impacting life and affecting health. Thus, our study seeks to analyze the repercussions of the COVID-19 syndemic based on the perceptions of quilombola community leaders in Mato Grosso, Brazil. In a qualitative study, three leaders were interviewed in May 2022, using a semi-structured script and treating the data through thematic analysis. The COVID-19 syndemic highlighted the structural precariousness of transport, roads, sanitation, and access to water, food, and health services. Isolation, deaths, and fears had psychosocial repercussions, but little attention was paid to mental health. Anti-racist proposals call for: repairing precariousness by recognizing the State's debt to the black population; valuing experiences, way of life, cosmovision, and Afro-centered ancestral civilizational values. Finally, the aim is to strengthen, reaffirm, and implement anti-racist actions, such as the Statute of Racial Equality and the PNSIPN, in all possible spaces, policies, and institutions. [ABSTRACT FROM AUTHOR]

Very little research has examined suicidal ideation or the factors associated with contemplating suicide among older transgender adults. This paper examines whether or not there is evidence of syndemic effects influencing suicidal ideation among transgender persons aged 50 or older. Data from the 2015 U.S. National Transgender Survey were used to examine five domains of potentially-syndemic effects (workplace issues, interactions with professionals, using public services, personal safety, and socioeconomic disadvantages) in a sample of 3,724 transgender Americans aged 50 or older. A dichotomous measure of suicidal ideation during the past year was the main outcome measure. The odds of contemplating suicide increased anywhere from 96% to 121% among people experiencing any of the problems under study, and anywhere from 258% to 1,552% (depending upon the syndemic effect domain in question) when they were faced by all of the experiences included in any particular domain. When all items were combined, exposure to any of the domains' problems elevated the risk of contemplating suicide by 276% and exposure to all of the problems examined increased the risk by 861%. The syndemic effects measure remained significant in multivariate analysis controlling for the influence of other potentially-relevant factors. Considerable evidence for the presence of syndemic effects was found, demonstrating that the more different types of adverse conditions that older transgender person's face, the more likely they are to experience to contemplate suicide. There is evidence that these effects diminish with advancing age. [ABSTRACT FROM AUTHOR]

We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people. [ABSTRACT FROM AUTHOR]

While the repercussions of the novel Coronavirus or COVID-19 have been felt across the world over the past few years, the impact has not been consistent. Instead, it has been mediated by the systemic ways in which existing social and structural disparities have failed vulnerable populations globally. Drawing on document analysis and fifteen in-depth interviews (n=15) conducted among the key stakeholders in the city of San Antonio, South Central Texas, this paper reveals how structural violence worsened during the COVID-19 pandemic resulting in making it a syndemic pandemic of high rates of deaths and illnesses among the most vulnerable and disadvantaged groups. A grounded theory approach particularly revealed themes of social suffering such as low income and pre-existing medical conditions that contributed to higher mortality rates, the presence of racism and misinformation, the importance of trustworthy communication channels, and streamlined collaborative partnerships with clear and effective communication through all levels of the government, especially when communicating scientific information.

The article discusses the rising rates of syphilis in the United States despite efforts to eliminate the disease. It highlights a report that examines syphilis treatment and prenatal care among pregnant individuals. The report reveals that a significant portion of the cohort received inadequate treatment for syphilis, particularly among those who reported substance use, history of homelessness, incarceration, and underinsurance. The article emphasizes the need for innovative partnerships and community engagement to address the syndemic of congenital syphilis, along with efforts to improve accessibility to prenatal care, syphilis testing, and substance use treatment. [Extracted from the article]

Objective. Synthesize the approaches used to study the convergence between cardiometabolic and infectious diseases in adults from a syndemic perspective based on the scientific evidence available to date worldwide. Methods. Scoping review that follows the recommendations of the PRISMA statement. The protocol was registered in INPLASY202150048. The search for studies was carried out in MEDLINE, LILACS, Web of Science and Scopus. Results. Since the COVID-19 pandemic, there has been an increase in studies in the field of convergence between cardiometabolic and infectious diseases from a syndemic perspective, but only three studies were classified as true syndemics. There are weaknesses in the adherence to the elements of the syndemic theory, given a low incorporation of population measurements, and until now it has not been possible to find convincing empirical evidence that supports the bio–bio interface. Quantitative methods predominated through models focused on “sum scores”. Conclusions. Future studies should comprehensively address the elements of syndemics, review discrepancies between additive analyses versus other modeling, and incorporate the influence of large-scale social forces. The lack of these aspects distances studies from the notion of syndemic, bringing them closer to comorbidity or multimorbidity approaches.

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer’s minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.

Syndemics theory has been applied to study interactions between biomedical and social factors leading to the clustering of diseases. Because syndemics theory focuses on interactions that enhance risk, the concept of vulnerability is central to this approach. We conducted a scoping review to better understand how this theoretical framework helped to define, operationalize, and tackle issues of vulnerability during the COVID-19 pandemic. Original research, reviews, and opinion pieces elaborating on syndemics, vulnerability, and COVID-19, published between December 2019 and October 2022 and available from PubMed, were eligible. We analyzed 40 records and identified three framings of syndemics operating during this period: (1) interactions between COVID-19, diseases/health conditions, and specific social factors; (2) interactions between COVID-19 and social determinants of health; and (3) impacts of COVID-19 on specific populations. Emerging conceptualizations described vulnerability to COVID-19 as a systemic issue, explained the impact of COVID-19 control measures on increased vulnerability, and presented COVID-19 as a syndemic on its own. However, this theory’s potential for deepening our understanding of vulnerability during this pandemic was constrained by superficial explorations of the interactions between biomedical and social spheres, and insufficient theoretical and methodological support from the social sciences.

This commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID-19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID-19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID-19 alongside marginalized communities; support real-time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating directly with mental health clinicians and the public can contribute to knowledge specifically through direct program development and implementation of interventions designed to improve mental well-being. Innovating to find impactful solutions in response to the unprecedented mental health challenges exacerbated by the COVID-19 pandemic has the potential to promote more equitable recovery around the world.

Introduction: Racism, a known social determinant of health, affects the mental health and well-being of pregnant and postpartum women and their children. Convincing evidence highlights the urgent need to better identify the mechanisms and the ways in which young children's development and mental health are adversely impacted by their mothers' experiences of racism. With the additional stressor of the COVID-19 pandemic, the criticality of improving knowledge of these domains has never been starker. The proposed project will address these questions and move the field forward to create targeted, culturally informed preventative interventions, thus achieving mental health equity for all children and families. Methods: This prospective research is a cohort study that will longitudinally observe the outcomes of a cohort of mothers and their children recruited during the initial phase of the COVID-19 pandemic. Data will be parent/caregiver questionnaires assessing mental health, racism, support, and resilience at multiple time points with the first beginning at 24months, clinical interviews with mothers, electronic medical records of mothers, and videotaped dyadic interactions at child age 24 and 48months. A subset of Black participants will be asked to participate in qualitative interviews at child age 36months. Results: Analyze will be performed within and across Black and Non-Latino/a/e/x white (NLW) groups, and comparing mothers and fathers/secondary caregivers. Descriptive and multivariate analyzes will be run to better characterize how young children's development and mental health may be adversely impacted by their caregiver's experiences of racism. Discussion: This prospective longitudinal mixed-methods study evaluates the simultaneous effects of the COVID-19 pandemic and racism on mothers and their developing children to characterize cross-racial differences, providing insight into risk and resilience factors in early development and the peripartum period. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease. [ABSTRACT FROM AUTHOR]

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning (LGBTQ+) are at greater risk of poorer COVID‐19 prognosis due to higher levels of chronic disease and a greater impact on mental health from pandemic mitigation strategies due to worse pre‐pandemic mental health. We examine how a hostile social system contributes to LGBTQ+ people's negative health experiences during the pandemic through adopting a syndemic framework and using data from The Queerantine Study, a cross‐sectional, web‐based survey (n = 515). Identification of a health syndemic is based on depressive symptoms, perceived stress and limiting long‐term illness. We used Latent Class Analysis to identify latent classes based on experiences of a hostile social system. A syndemic was identified among a third of respondents (33.2%), with transgender/gender‐diverse and younger participants at higher risk. Latent Class Analysis identified five groups based on experiences of hostile social systems using psychosocial and socioeconomic indicators. Classes reflecting psychosocial hostility were predictive of a health syndemic and worsening health. This study emphasises (i) mental and physical health issues are intertwined among LGBTQ+ people; (ii) experiences of hostile social systems can account for part of variation in health across LGBTQ+ groups; (iii) that psychosocial hostility continued and was exacerbated throughout the pandemic, and (iv) experiences of psychosocial hostility in particular were associated with a greater likelihood of experiencing a syndemic. [ABSTRACT FROM AUTHOR]

Synergistic associations between social inequities and HIV vulnerabilities – known as a syndemic – are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16–24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16–24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities. [ABSTRACT FROM AUTHOR]