Exploring syndemic vulnerability across generations: A case study of a former fishing village in the Netherlands.

This qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income neighborhood, we explored salient themes between and across families and generations. Elderly community members (>65 years) were interviewed to map village history and explore how contextual factors have affected family life, health, and wellbeing since the 1940s. We systematically traced and compared processes leading to or from syndemic vulnerability by studying seven families across three generations. Adults with at least one of clustering diseases, their parents (when possible), and their children participated in semi-structured life-course interviews. A complex interaction of endemic social conditions, sociocultural normative processes, learned health behaviors, and disheartening life events shaped families' predispositions for a syndemic of psychological distress, cardiometabolic conditions, and musculoskeletal pain. Educational attainment, continued social support, and aspirational capabilities emerged as themes related to decreasing syndemic vulnerability. This study demonstrates that syndemic vulnerability is potentially intergenerational and reveals the need for culturally sensitive and family-focused syndemic interventions. Future longitudinal research should focus on unravelling the pathogenesis of the clustering of psychological distress, cardiometabolic conditions, and musculoskeletal pain among young people.

The Evaluation of a Family-Engagement Approach to Increase Physical Activity, Healthy Nutrition, and Well-Being in Children and Their Parents.

Prevention programs often are directed at either parents or children separately, thereby ignoring the intergenerational aspect of health and well-being. Engaging the family is likely to improve both the uptake and long-term impact of health behavior change. We integrated an intergenerational approach into a frequently used shared assessment tool for children's care needs. The current study's aim was 2-fold: to monitor this family-engagement tool's effects on both children and their parents' health behaviors and well-being, and to examine the different dynamics of health behavioral change within a family. Method: We followed 12 children ages 10-14 years and their parents for 12 weeks using an explanatory mixed-methods design comprising interviews, questionnaires, and an n-of-1 study. During home visits at the beginning and end of the study, we interviewed children and their parents about their expectations and experiences, and measured their height and weight. Furthermore, we collected secondary data, such as notes from phone and email conversations with parents, as well as evaluation forms from professionals. In the n-of-1 study, families were prompted three times a week to describe their day and report on their vegetable intake, minutes of exercise, health behavior goals, and psychosomatic well-being. The interviews, notes, and evaluation forms were analyzed using qualitative content analyses. For the n-of-1 study, we performed multi-level time-series analyses across all families to assess changes in outcomes after consulting the family-engagement tool. Using regression analyses with autocorrelation correction, we examined changes within individual families. Results: Five child-mother dyads and three child-mother-father triads provided sufficient pre- and post-data. The mean minutes of children's physical activity significantly increased, and mothers felt more energetic, but other outcomes did not change. In consultations related to overweight, the family-engagement tool often was used without setting specific or family goals. Conclusions: The family-engagement approach elicited positive effects on some families' health and well-being. For multifaceted health problems, such as obesity, family-engagement approaches should focus on setting specific goals and strategies in different life domains, and for different family members.

Negotiating ADHD: Pragmatic medicalization and creolization in urban India.

Although a growing number of studies have demonstrated differences in responses to ADHD-like behaviours, very few studies have focused on theorizing diversity in the way ADHD is framed and approached globally. To contribute to the study of medicalization in a global context, this study examines the discursive field in which care professionals explain and treat ADHD among children in metropolitan India and addresses the need for an analytic framework to grasp the variations in the way ADHD is understood and approached. Building on the concepts of pragmatic medicalization and creolization, we study ADHD discourses in India asking 'What is at stake' and 'What matters most'? In this mixed methods study, 64 care professionals regularly involved in assessing ADHD-like behaviour completed an online Q-sort, and 21 professionals participated in face-to-face interviews. The Q-data were subjected to factor analysis. The interviews were analyzed using qualitative content analyses. Our study identified six distinct ADHD discourses, which showed that care professionals combine explanatory and treatment models. Professionals adapt their explanations and treatments of ADHD to parents' worries regarding academic performance, family prestige, stigma and side effects of allopathic medicine. Our findings indicate that an awareness of local concerns and adjustments to structural opportunities can diversify how ADHD-like behaviour is framed and responded to. This study demonstrates that medicalization operates between the emerging institutions of care and the everyday concerns of families and care professionals and reveals the need to examine conflicting stakes as drivers of diverse responses to ADHD diagnosis and treatment in India and the rest of the world.

Psychological distress, cardiometabolic diseases and musculoskeletal pain: A cross-sectional, population-based study of syndemic ill health in a Dutch fishing village.

BACKGROUND: Disease clustering is a growing public health concern and is increasingly linked to adverse socioeconomic conditions. Few population-based studies have focussed on interaction between non-communicable diseases. In this cross-sectional study, we examine clustering of, and synergistic interactions between, frequently occurring non-communicable diseases in Katwijk, a former fishing village in the Netherlands. Additionally, our study identifies contextual variables associated with these clusters of non-communicable diseases. METHODS: In a survey among adults (>19 years) living in the former fishing village Katwijk, Netherlands, were asked about non-communicable diseases, psychological distress, self-rated health scores and contextual factors, eg, socio-demographic, psychosocial and health behavior characteristics. Interaction was measured on the additive and the multiplicative scale. We used generalized ordered logistic regression analysis to examine associations with contextual variables. RESULTS: Three disease clusters were found to be most prevalent among the study participants (n = 1408). Each cluster involved a combination of frequently occurring conditions in this population: psychological distress (n = 261, 19%), cardiometabolic diseases (n = 449, 32%) and musculoskeletal pain (n = 462, 33%). These three diseases interact synergistically on the additive scale to increase the odds of reporting a low self-rated health. None of the disease clusters showed a statistically significant positive interaction on a multiplicative scale. Multiple contextual factors were associated with these disease clusters, including gender, loneliness, experiencing financial stress, and a BMI≥30. CONCLUSION: Our findings imply that psychological distress, cardiometabolic diseases and musculoskeletal pain synergistically interact, leading to a much lower self-rated health than expected. Several contextual factors are related to this interaction emphasizing the importance of a multicomponent, ecological approach.