Search

Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs), and proposes a model to measure the extent of such interaction. The article seeks to: (1) examine the potential syndemic between FI and DRCDs; (2) illustrate how the incorporation of Life History Theory (LHT), into a syndemic framework can help to highlight critical lifeperiods when FI-DRCD interactions result in adverse health outcomes; (3) discuss the use of mixed methods to identify and measure syndemics to enhance the precision and predictive power of ST; and (4) propose an analytical model for the examination of the FI-DRCD syndemic through the life course. The proposed model is more relevant now given the significant increase in FI globally as a result of the ongoing COVID-19 pandemic. The differential impact that the pandemic appears to have among various age groups and by other demographic factors (e.g., race, gender, income) offers an opportunity to examine the potential FI-DRCD syndemic under the lens of LHT.

Beta-blockers (BBs) remain underused in elderly patients with reduced ejection fraction (REF). Our aim was to determine the prognostic impact of different doses of BB in this setting.A single-center observational study was conducted. Inclusion criteria were age≥75 and EF≤0.35. Six months after diagnosis, patients were divided into 3 groups depending on BB dose: no BB (NBB), low dose (50% of the target dose) (LD), and high dose (≥50%) (HD). Two different analytical approaches were employed: multivariate Cox model and propensity-score (PS) matching. Outcomes were all-cause death and heart failure (HF) admission. We included 559 patients (134 NBB, 259 LD, and 166 HD) with median follow-up of 29.9months. There were 212 deaths (NBB: 70 (52.2%); LD: 94 (36.3%); and HD: 48 (28.9%)) and 171 HF admissions (NBB: 42 (31.3%); LD: 85 (32.8%); and HD: 44 (26.5%)). On multivariate analysis, both LD and HD were associated with improved survival, with no differences between them (HD vs. NBB=0.67, 95% CI=[0.46-0.98], p=0.037; HD vs. LD=1.03, 95% CI=[0.72-1.46], p=0.894; and LD vs. NBB=0.65, 95% CI=[0.48-0.90], p=0.009). However, BB therapy failed to show benefits in HF admissions (p=NS, for each comparison). PS-matched analysis included 198 patients, with similar results to those mentioned above.BB therapy was associated with a significant reduction in mortality among elderly patients with REF, regardless of dose. Nevertheless, it was not associated with a decrease in HF admissions. Further studies are needed to determine the optimal BB dose in these patients.

Drawing on a review of the existing literature and on the knowledge derived from many years of direct work with sex workers in the inner city, we conceptualize the mutually reinforcing relation that exists among violence, drug use, and risk for HIV/AIDS among women involved in street-level prostitution. While recognizing the centrality of violence victimization, we call attention to the need to examine exposure to indirect (or witnessed) violence (when the person is the witness rather than the direct victim of violence) as a factor that increases drug- and sex-related HIV risk in this population. Specifically, we hypothesize that the emotional sequela that results from continued exposure to indirect violence has a direct effect on patterns of drug use (including drug use initiation, relapses, and changes in quantity, frequency, and mode of ingestion), and increases women's vulnerability to sexual transmission of HIV by making them more vulnerable to sexual attacks, and less able to demand use of condoms. The impact of indirect violence is especially detrimental when the woman witnesses serious violent acts against other sex workers.

The purpose of this study was to develop a bilingual, user-friendly food label (UFFL) for low-literacy audiences. The UFFL developed was based on (a) a quantitative and qualitative needs assessment of Food and Drug Administration (FDA) food label understanding and use, (b) the development of a UFFL, and (c) a qualitative evaluation of the UFFL. Subjects consisted of a convenience sample (N = 150) of low-income Latino caretakers living in Hartford with children under 6 years of age, who were recruited from local community agencies.The primary outcomes measured in this study were food label use, knowledge, and understanding. Chi-square analyses were conducted to determine relationships between subjects’ socioeconomic status and demographic characteristics with food label use, knowledge, and understanding. Although 96% of respondents were familiar with the FDA food label, only 30% used it routinely when grocery shopping. FDA food label knowledge was positively associated (p ≤ .05) with younger age, level of education, and being an English speaker. A UFFL was developed that included color coding, bilingual text, and a shaded Food Guide Pyramid. Results indicated that participants found the UFFL easy to understand. The UFFL can be used as a nutrition education tool and the methodology developed may help food policy makers to improve the nutrition education value of the FDA food label.