About

Ricardo Hernandez is an Associate Professor in the Department of Horticultural Science at NC State University, located in Kilgore Hall. He holds a PhD in Plant Physiology/Control Environment Agriculture from The University of Arizona, a Master’s degree in Biological Control and Integrated Pest Management from Texas A&M University, and a Bachelor’s degree in Agronomy/Crop Consultation from New Mexico State University. His research focuses on plant physiology, sustainable agriculture, and organic production, with particular interest in horticultural crop production and management. Hernandez's work includes investigating the effects of light spectra on plant growth and secondary metabolite production, optimizing land use efficiency in agrivoltaic systems, and improving micropropagation techniques for cannabis sativa. His contributions aim to enhance sustainable practices in horticulture and crop management.

Research topics

• Computer Science
• Political Science
• Internet privacy
• Public relations
• Nursing
• Psychology
• Medicine

Selected publications

• 798: CAREGIVER PERCEPTIONS OF HEALTH DISPARITIES IN PEDIATRIC REHABILITATION AFTER CRITICAL ILLNESS

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• The Somatic Mosaicism across Human Tissues Network

  Nature · 2025-07-02 · 39 citations

  reviewOpen access
  PublisherOA PDFDOI

• Implementing Social Media Strategies in Community-Partnered HIV Research: Practical Considerations From 3 Ongoing Studies (Preprint)

  2025-03-01

  article

  <sec> <title>BACKGROUND</title> In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States. </sec> <sec> <title>OBJECTIVE</title> This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua. </sec> <sec> <title>METHODS</title> Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research. </sec> <sec> <title>RESULTS</title> The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research). </sec> <sec> <title>CONCLUSIONS</title> As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic. </sec>

  PublisherDOI

• Language Access to Language Justice: Strategies to Transform Pediatric Research and Health Care

  PEDIATRICS · 2025-11-05 · 3 citations

  articleSenior author

  People who use languages other than English (LOE)1 comprise around 8% of the US population2 and experience health inequities.3 In pediatrics, language-related inequities include lower health care quality and less access to care,4 increased adverse medical events,5 and higher readmission rates.6 Federal policies, including the Culturally and Linguistically Appropriate Services (CLAS) Standards and Section 1557 of the Affordable Care Act outline, as a civil right, the provision of language services, including interpreting, translation, and access to qualified bilingual or multilingual (hereafter described as multilingual) practitioners.7 Despite these long-standing policies, people who use LOE have inconsistent access to interpreting during health care visits, particularly during interactions with non–practitioner-allied health care staff (eg, pharmacist, registration).8 Additionally, the emergence of telemedicine and patient portals has led to increased opportunity for written communication. Although helpful to some, these innovations have created new barriers when hospital and research systems lack resources to provide access to written documents.9,10 Although research is a fundamental component of pediatric academic health care and often interwoven with clinical care, people who use LOE are largely excluded from pediatric research11,12; when included, they may have a suboptimal experience.13In this article, we describe a novel, systems-level approach to promote health equity. Note that although this approach was developed for people who use spoken, signed, and written LOE, these principles also apply to people who are deaf and hard of hearing who use signed languages. Therefore, we always use the term “spoken and signed.” However, we also recognize that there are unique best practices for using signed interpretation. Future work should collaborate with people who are deaf and hard of hearing to adapt and refine the checklists described below.Language justice is a systems-level transformative approach to ensure a seamless language experience for pediatric patients and caregivers who use LOE. We define language justice as promoting the right for individuals to communicate in their preferred language to better address power imbalances and advance equity and social justice.3,14 Language justice differs from language access, with the latter defined more narrowly as language services being available in clinical and research settings. Core principles of language justice include (1) shifting the responsibility of providing linguistically equitable services from the patient to the health care or research system; (2) providing language services throughout the health care or research experience; (3) convening a multidisciplinary language team to develop and implement processes; and (4) using strengths-based, affirming language, which celebrates the beauty of linguistically diverse communities and values all languages equitably (Table 1). The language justice framework robustly aligns with bioethical principles applied to clinical care and research, including respect for persons (ie, limiting risks for coercion and assuring that participants can provide informed consent), beneficence (ie, minimizing psychological harm that can occur with power imbalance related to language dominance), and justice (assuring that research knowledge and benefits do not exclude people who use LOE and that people who use LOE can equitably access clinical care).15The use of checklists to improve patient safety and quality has been widely accepted, particularly as a strategy toward shifting culture within academic organizations.16 To support a shift toward a language justice approach, we have created checklists for clinical (Supplemental Material 1) and research (Supplemental Material 2) teams that provide stepwise guidance for implementing language justice strategies. Table 2 includes key definitions related to the distinct roles of interpreting, translation, and qualified multilingual team members discussed in the following paragraphs.We recommend first convening a language team comprising a multidisciplinary group invested in language services. Clinical language teams may include professional interpreters and translators (ie, professionally trained and preferably credentialed by a national certification organization, if a certification exam is available in their language; see Table 2), qualified multilingual clinical staff or researchers (ie, having job-related proficiency in English and another language, assessed through an organizational qualification process), health informaticists, and practice managers. Research language teams may include regulatory experts, qualified multilingual research staff and investigators, and professional interpreters and translators. Language teams should include patients and caregivers who use LOE with attention to ensuring that their voices are centered.After convening the language team, we recommend a comprehensive review of the language-related policies that exist within a health care or research system. Next, we recommend experience mapping, where the team considers and describes all interactions a patient or caregiver may have during a clinical workflow or research study (Figures 1 and 2 provide examples). Experience mapping can help identify and address gaps in language services across the care spectrum.After developing the experience map, we recommend reviewing spoken, signed, and written communication separately. For spoken and signed communication, consider how to provide a qualified multilingual team member or a professional interpreter. A robust body of literature has shown that patient outcomes are improved when a professional interpreter is available17,18 and that involving family members or staff as interpreters (ie, ad hoc interpreter; see Table 2) is not appropriate.19 The language team can also help determine whether spoken or signed communication will be better served through consecutive or simultaneous modes of interpreting (Table 2).Multilingual practitioners (eg, someone who fluently uses English and the non-English language) are also acceptable for use in patient care; however, it is critical for any multilingual individual to undergo qualification testing to assess their language capabilities in medical and research settings.20 Since there are no national professional certification options for multilingual health care practitioners or researchers, qualification, where it exists, typically occurs at the organizational level. Additionally, qualified multilingual staff are typically qualified to communicate directly with people who use LOE, not to interpret on others’ behalf. Commonly cited challenges to providing adequate language services, including lack of time, access, and knowledge,10,21,22 can be mitigated with a proactive and comprehensive language justice strategy.Core to a language justice approach is ensuring equitable access to spoken, signed, and written communication. Written communication is common in both research (eg, consent forms, recruitment materials, surveys) and clinical care (eg, questionnaires, text message reminders, patient education, discharge instructions). We recommend that language teams use the experience map to determine when written communication is used and how translation services might be applied. Translation services can be time-consuming and costly, with limited availability of real-time translation options.9 This barrier has led to underuse of translation in health care and research settings. The appearance and rapid evolution of artificial intelligence presents new possibilities for quick, inexpensive translation, but accuracy varies depending on the language and information translated.23 Emerging technologies must therefore be used with caution in accordance with institutional policies and in tandem with human translators as organizations define how this technology can advance equity while maintaining quality and safety.24,25 Written communication must also be made accessible through images and multimedia support for those who are preliterate in their language (ie, do not read). Some potential examples are using infographics or instructional videos in the consent process.Next, it is important to plan for universal assessment and documentation of language preference, without which patients or caregivers who use LOE can be misidentified until they are already partway through a clinical or research workflow. We recommend implementing a reliable, universal process to assess language preferences of all patients or participants at the beginning of the workflow. In the pediatric setting, language teams must consider that language preferences may differ within a family, requiring assessment and documentation for each caregiver and the child.26 Because people may also have different preferences regarding spoken, signed, and written language, language preference assessment should include all types of communication. Language preferences may change over time, so documentation should be verified periodically. Electronic medical record data on language preferences in pediatrics typically do not include the nuance described previously, leading to possible inaccuracy.27,28 We recommend working with informaticists to include, in the electronic health record, language preference (spoken, signed, and written) for the child (patient) and all caregivers and developing a workflow for periodic reassessment of language preferences.Our proposed checklists provide tools for integrating a language justice approach into clinical or research workflows. However, institutional- and policy-level changes are also needed. Institutions can develop comprehensive language centers or programs, which provide guidance to clinical and research teams on using language justice checklists to optimize their workflows, offer supervision and education for interpreters and translators, set multilingual qualification criteria for practitioners and staff, and offer training for medical staff and researchers. One example is the Program for Language Equity at Boston Children’s Hospital, which works with the hospital’s Language Services Department and focuses on integrating language equity into research, clinical care, education, and advocacy. Clinical and Translational Science Institutes, which provide support, resources, and services for researchers conducting clinical and translational science, can serve as a hub for research-related language justice services.29 Clinical and Translational Science Institutes or institutional language centers can also potentially provide research pilot funding for teams who include participants who use LOE, which can support participant incentives and cover translation and interpreting costs.From a policy perspective, Medicaid reimbursement for interpreter and translation services is essential. Interpreter services are not uniformly reimbursable through Medicaid across states, and, to our knowledge, translation services are not reimbursable in any state despite federal requirements.30 Protecting Medicaid funding is particularly critical in the current policy environment and is essential for promoting language justice. Further advocacy is also needed among payors, including commercial insurance, to reimburse for language services and to implement billing systems that allow practitioners to report extra time with a patient due to use of interpreter services. Finally, cross-sector collaborations between health care/research settings and other systems such as legal, education, and social services are needed to ensure that people who use LOE can access all communication during institutional interactions. These checklists may also be adapted for other settings.Language justice is a systems-level approach with the goal of transforming pediatric health care and research to become inclusive and affirming toward people who use LOE. Use of checklists can facilitate implementation of a language justice approach to advance equity in pediatric clinical care and research.We would like to thank Casey Lion, MD, and Lisa DeCamp, MD, for reviewing and providing feedback on the checklists.

  PublisherDOI

• Characterisation of Post-COVID-19 Sequelae in a Primary Care Setting: A Cross-sectional Study

  Current Journal of Applied Science and Technology · 2025-05-19

  articleOpen access

  Aims: The aim of this study is to describe the population experiencing post-COVID-19 sequelae within a primary care setting. By characterising the demographic, clinical, and symptomatic features of these patients, the study seeks to enhance understanding of long COVID in the context of first-level healthcare. Study Design: A single-centre, retrospective, and cross-sectional study was conducted. Place and Duration of Study: Family Medicine Unit. The study was conducted from January 1st, 2023, to March 31st, 2025, with COVID-19 Mexican patients attending outpatient consultations in the Epidemiology Department of Family Medicine Unit No. 57, from the Mexican Institute of Social Security (IMSS), in Puebla, Mexico. Methodology: Data on clinical and sociodemographic variables were collected through medical records, such as age, sex, weight. height, Body Mass Index (BMI), comorbidities and COVID-19 vaccination status. Categorical variables were performed using Yates’ corrected chi-square or likelihood ratio test. A 95% confidence interval (CI95%) was included. Quantitative variables were compared by Mann-Whitney U or Student’s t-test, as appropriate. AsStatistical significance was set at P &lt; 0.05 (two-tailed). Results: A total of 138 patients with long COVID-19 were included in the study. The mean age was 48.19 years old (Standard Deviation [SD] = 16.542), with a median of 45.05 years (Interquartile Range [IQR] = 36.8–58.32). The median age was slightly higher in females (45.07 years, IQR = 38.05–57.11) than in males (44.09 years, IQR = 34.08–62.07), though this difference was not statistically significant (p = 0.726). The most common comorbidities observed were hypertension (n = 36; 26.1%, 95% CI: 18.1–33.3), type 2 diabetes (n = 23; 16.7%, 95% CI: 10.9–23.2), and chronic obstructive pulmonary disease (COPD) (n = 4; 2.9%, 95% CI: 0.7–6.5). The five most frequently reported post-COVID-19 sequelae were cough (n = 60; 43.5%, 95% CI: 35.5–52.2), odynophagia (n = 22; 15.9%, 95% CI: 10.1–22.4), headache (n = 18; 13.0%, 95% CI: 8.0–18.8), myalgia (n = 17; 12.3%, 95% CI: 7.2–18.1), and both rhinorrhoea and pulmonary fibrosis (n = 14 each; 10.1%, 95% CI: 5.1–15.2). The vaccination history was significantly associated with the presence of post-COVID-19 cough (Odds Ratio [OR] = 2.254, 95% CI: 1.100–4.619, p = 0.026) and showed a protective association against post-COVID-19 dyspnoea (OR = 0.154, 95% CI: 0.032–0.745, p = 0.020). Conclusion: In patients with long COVID-19 in primary care, the most common sequelae was respiratory symptoms, particularly persistent cough and odynophagia. Vaccination appeared to offer protection, notably against symptoms such as dyspnoea. These findings highlight the value of sustained vaccination efforts and the need for tailored post-COVID follow-up based on individual risk and sociodemographic factors.

  PublisherDOI

• Molecular detection of carbapenemases in critical microorganisms since the onset of the COVID-19 pandemic in Peru

  JAC-Antimicrobial Resistance · 2025-10-30

  articleOpen access

  Abstract Objective Identify and characterize carbapenemase genes in bacterial isolates of Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa collected through the National Surveillance of Antimicrobial Resistance (AMR) Program during the COVID-19 pandemic in Peru. Methods This retrospective, observational study analysed 2049 submitted due to suspected portability of carbapenemase genes, collected between January 2020 and August 2022. Samples were obtained from 61 hospitals in 18 of the 25 regions of Peru (72%) that participated in the National Surveillance AMR Program. Results Among the isolates, 860 were Enterobacterales, 771 were A. baumannii, and 418 were P. aeruginosa. Carbapenemase genes were detected in 1735 isolates (84,6%). The most prevalent genes identified were blaNDM (561, 78.13%) in Enterobacterales, blaOXA-24-like (488, 67.8%) in A. baumannii, and blaIMP (188, 63.3%) in P. aeruginosa. Notably, rare occurrences of blaNDM were identified in P. aeruginosa (5, 1.7%). Combinations of carbapenemase genes were identified including blaIMP + blaVIM in P. aeruginosa, with a rising trend, but also blaKPC + blaNDM (7, 1%) blaNDM + blaOXA-48-like (1, 0.14%), blaNDM + blaIMP (2, 0.3%), and blaNDM + blaVIM (2, 0.3%) in Enterobacterales; and blaOXA-23 + blaOXA-24-like (11, 1.5%), blaNDM + blaOXA-24-like (2, 0.3%), and blaNDM + blaOXA-58-like (1, 0.1%) in A. baumannii. Conclusion This study highlights the significant detection of carbapenemase genes and their combinations in Peru during the COVID-19 pandemic. These findings underscore the urgent need for enhanced AMR surveillance, antimicrobial stewardship, and targeted infection control strategies to address this critical public health threat.

  PublisherDOI

• Oral microbiome composition is associated with depressive symptoms during pregnancy

  Brain Behavior & Immunity - Health · 2025-03-22 · 12 citations

  articleOpen access

  Oral microbiome dysbiosis has been linked to systemic disease with an underlying inflammatory etiology. However, the possible association of the oral microbiome in antenatal depression has received little attention. Participants were pregnant women in the PREDICT prenatal cohort study (n = 400) who provided saliva during pregnancy. Using 16S rRNA sequencing, we determined the association between composition of the salivary microbiome and a continuous measure of depressive symptoms (Center for Epidemiological Studies-Depression Scale (CES-D): 0–60) as well as clinically significant depressive symptoms during pregnancy (CES-D score> 16, n = 46) compared with women without clinically significant symptoms (n = 327). CES-D scores were associated with differences in bacterial levels in the salivary microbiome. Women with clinically significant depressive symptoms (CES-D≥16) had significantly lower abundance in nine bacterial taxa, including the Neisseria genus, which has previously been positively associated with oral health and negatively correlated with pro-inflammatory cytokines, mental health, and infant birth weight. Findings were not explained by body mass index, smoking, antibiotic administration, oral health problems, or gestational week. Prediction tools based on 16S sequences indicated that significantly lower levels of several pathways related to the biosynthesis of Menaquinol, Ectoine biosynthesis, and D-glucarate degradation, were associated with women with depressive symptoms. Our findings underscore the potential relationship between the oral microbiome and antenatal depression, highlighting microbiome measures as a promising source of biomarkers for maternal mental health. This study suggests previously unexplored aspects for understanding the microbiome's composition in women with mental health problems, emphasizing the need for further longitudinal investigations to elucidate the temporal dynamics of the oral microbiome in pregnancy. • Changes in the oral microbiome associate with antenatal depression. • The oral microbiome is dynamic and changes during pregnancy. • Neisseria genus may be protective and correlated negatively with depression.

  PublisherDOI

• Implementing Social Media Strategies in Community-Partnered HIV Research: Practical Considerations From 3 Ongoing Studies

  JMIR Public Health and Surveillance · 2025-09-10 · 1 citations

  articleOpen access

  BACKGROUND: In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States. OBJECTIVE: This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua. METHODS: Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects' social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research. RESULTS: The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research). CONCLUSIONS: As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

  PublisherDOI

• PedBE age and age acceleration in umbilical vein endothelial cells: an examination of infant birth outcomes

  Journal of Developmental Origins of Health and Disease · 2025-01-01 · 2 citations

  articleOpen access

  Abstract The current study examines the application of the Pediatric-Buccal-Epigenetic (PedBE) clock, designed for buccal epithelial cells, to endothelia. We evaluate the association of PedBE epigenetic age and age acceleration estimated from human umbilical vein endothelial cells (HUVECs) with length of gestation and birthweight in a racially and ethnically diverse sample (analytic sample n = 333). PedBE age was positively associated with gestational age at birth ( r = 0.22, p &lt; .001) and infant birth weight ( r = 0.20, p &lt; .001). Multivariate models revealed infants with higher birth weight (adjusted for gestational age) had greater PedBE epigenetic age acceleration ( b = 0.0002, se = 0.0007, p = 0.002), though this effect was small; findings were unchanged excluding preterm infants born before 37 weeks’ gestation. In conclusion, the PedBE clock may have application to endothelial cells and provide utility as an anchoring sampling point at birth to examine epigenetic aging in infancy.

  PublisherOA PDFDOI

• POS0435 MEASUREMENT OF SYNDEMICS OF RHEUMATIC AND MUSCULOSKELETAL DISEASES IN MAYAN-YUCATECAN INDIGENOUS COMMUNITIES: A NETWORK ANALYSIS

  Annals of the Rheumatic Diseases · 2025-06-01

  articleOpen access

  <h2>Abstract</h2><h3>Background:</h3> Syndemic theory explores how disease interactions are exacerbated by social, economic, and political disadvantages, leading to poor health outcomes. Rheumatic and musculoskeletal diseases (RMDs), particularly in Indigenous Mayan communities in Yucatán, Mexico, are often associated with comorbidities like diabetes and hypertension. These co-occurrences, combined with poor healthcare access, poverty, and structural discrimination, create syndemics that worsen health and quality of life. <h3>Objectives:</h3> This study aimed to quantify the syndemic burden of RMDs using a syndemic index, and analyze the interplay between biological, social, and economic factors through network analysis. <h3>Methods:</h3> A cross-sectional study was conducted among four Indigenous communities using the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD). Identifying and treating RMD is part of the program through household surveys, clinical assessments, diagnostic and therapeutic evaluations. Sociodemographic, clinical, and socioeconomic data were collected. A syndemic index was constructed using logistic regression to identify negative factors associated with RMDs and comorbidities. Network analysis and clustering techniques were applied to reveal patterns of disease aggregation and contextual vulnerabilities. The network was analyzed using Gephi software. <h3>Results:</h3> The study included 508 participants. 69.29% were women, with differences across communities in language proficiency, education, income, and comorbidities (Table 1). The identified variables in the regression included in the syndemic index were history of pain, education years, family history of RMDs, hypercholesterolemia, depression, pain self-report, disability measured with HAQ and comorbidities. Patients with RMDs had a higher syndemic index (mean 0.346, SD 0.127) than those without RMDs (mean 0.121, SD 0.133, p < 0.005), indicating more negative health effects and contextual factors in these patients. Network analysis (Figure 1) identified 22 clusters, with RMD cases dispersed across distinct groups. Typical combinations like low educational level, family history of RMD and historical pain were found in the network (Figure 1). This suggests that the impact of RMDs varies across the population, influenced by vulnerabilities and disease interactions. Figure 1<b>Visualization of clustered data or network components.</b> Each colored cluster represents interconnected patients or nodes, grouped by variable similarity in the syndemic index. Larger, denser clusters indicate higher similarity among patients. Cluster positions reflect their degree of similarity—closer clusters are more similar. Node size indicates disease status, with larger nodes representing patients with rheumatic and musculoskeletal diseases. a) Cluster membership, showing overall network structure. b) Family history of rheumatic disease (green: "Yes," pink: "No"). c) Historical pain reports (green: "Yes," pink: "No"). d) Report of pain in the EuroQoL index (green: "Yes," pink: "No"). Various patterns are visible across combinations. <h3>Conclusion:</h3> The syndemic framework and network analysis revealed complex disease interactions driving health disparities in Mayan Indigenous communities. The variation in the distribution and impact of RMDs underscores the need for tailored interventions. Strategies should focus on the vulnerabilities of each cluster, addressing cultural, social, and economic factors to mitigate the syndemic burden of RMDs and improve quality of life. <h3>REFERENCES:</h3> [1] Singer M, Bulled N, Ostrach B, et al. Syndemics and the biosocial conception of health. The Lancet 2017; 389(10072):941-950. https://doi.org/10.1016/S0140-6736(17)30003-X. Table 1Descriptive Statistics: Sociodemographic, Clinical, Functional, and Economic Characteristics.Xcopteil n=179Xkalakdzonot n=212Yaxunah n=117p value~Socio-demographicGender (female) n (%)131 (73.18%)142 (66.98%)79 (67.52%)0.371Age (years) Me (SD)49.72 (16.69)49.58 (17.45)50.55 (16.58)0.856Years of education Me (SD)5.69 (4.53)5.73 (4.44)6.44 (3.79)0.021*Spanish speakers n (%)140 (78.21%)173 (81.6%)106 (90.6%)0.021*Mayan speakers n (%)172 (96.09%)206 (97.17%)116 (99.15%)0.290ClinicWeight (kg) Me (SD)59.86 (15.78)64.73 (12.79)65.31 (15.47)<0.005*Height (m) Me (SD)148.51 (91.83)148.94 (8)128.18 (50.79)<0.005*Glucose (mg/dl) Me (SD)155.49 (82.77)154.11 (204.48)163.47 (112.15)0.684Pain medication usage n (%)55 (30.73%)94 (44.34%)52 (44.44%)0.010*Family history of Rheumatic Disease n (%)27 (15.08%)24 (11.32%)28 (23.93%)0.010*Historic pain n (%)60 (33.52%)86 (40.57%)40 (34.19%)0.292Acute pain n (%)33 (18.44%)59 (27.83%)42 (35.9%)<0.005*Diabetes n (%)45(25.14%)41(19.34%)16(13.68%)0.051Hypertension n (%)39(21.79%)55(25.94%)18(15.38%)0.086Anxiety n (%)6(3.35%)19(8.96%)12(10.26%)0.038*FunctionalityFunctional capacity (HAQ) – With impairment n (%)15 (8.38%)18 (8.49%)16 (13.68%)0.242Self-reported state of health (EQ5D) - Bad health state n (%)35(19.55%)61(28.77%)52(44.44%)<0.005*EconomicHours of work per day8.89 (3.72)7.62 (2.98)8.78 (3.99)<0.005*Weekly Income (USD) Me (SD)23.49 (37.70)24.90 (35.59)32.58 (39.76)0.047*Transportation Cost (USD) Me (SD)1.86 (8.08)2.47 (10.37)5.03 (13.23)<0.005*~ Statistical tests: categorical variables (X²), continuous variables (Kruskal-Wallis).* Statistically significant difference (<i>p value < 0.05</i>)Abbreviations: Me: mean, SD: standard deviation, HAQ: Health Assessment Questionnaire, EQ5D: Euro-Qol 5D-3L questionnaire. USD: US dollars of 2023. <h3>Acknowledgements:</h3> Partial funding from the Marista University of Merida. CONAHCYT (CVU 671018 and CVU1145201). <h3>Disclosure of Interests:</h3> <b>None declared</b>. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

  PublisherDOI

Frequent coauthors

• Darcy A. Thompson

  University of Colorado Anschutz Medical Campus

  72 shared

• John D. Cowden

  Research Triangle Park Foundation

  62 shared

• Stephen D. Sisson

  Johns Hopkins University

  55 shared

• Margaret Moon

  Johns Hopkins University

  55 shared

• Ernest K. Amankwah

  Johns Hopkins All Children's Hospital

  51 shared

• Dennis T. Brown

  Massachusetts General Hospital

  42 shared

• Akshata Hopkins

  Johns Hopkins All Children's Hospital

  40 shared

• Sara B. Johnson

  29 shared

Education

• MPH

  Johns Hopkins University Bloomberg School of Public Health

  2009