[Manfred Pflanz (1923-1980) - A key Protagonist for the Institutionalization of Social Medicine and Medical Sociology in Germany]. / Manfred Pflanz (1923­1980) ­ zentraler Akteur bei der Institutionalisierung von Sozialmedizin und Medizinsoziologie.

Manfred Pflanz, an internist with his focus on social medicine, medical sociology and epidemiology, (1923-1980) played a key role in the institutional integration of social science expertise into medicine in the Federal Republic of Germany during the 1960s and 70 s. The present study, a biographic sketch of Pflanz, describes his work, his programmatic ideas on social medicine and medical sociology, and his activities as an expert consultant in public health for various political entities. This should enable getting an insight into the origins and ramifications, as well as the contemporary programs and international embeddedness of the overlapping fields of social medicine and medical sociology in Germany.

Chevalier Jackson: father of endoscopic surgery, and champion of women in medicine, social justice, and public health.

BACKGROUNDS: Chevalier Jackson (1865-1958) was a pioneering force in the medical world, whose extraordinary contributions to surgery and public health have left an indelible impact. He developed the endoscope and perfected the bronchoscope, and his mastery of these tools enabled him to transform the prognosis of foreign body aspiration from 98% mortality to 98% survival. He was also a passionate advocate of public health chairing the national committee on lye legislation, which culminated in the Caustic Poison Act, responsible for poison and antidote labels. Yet Jackson's accomplishments were not limited to these. The aim of this manuscript was to shed light on Chevalier Jackson's lesser-known contributions to surgical science and culture, and to celebrate and honor the life of this remarkable surgeon. METHODS: Digital and physical historical records from the National Library of Medicine, Smithsonian Institution, Heinz History Center in Pittsburgh PA, and Sunrise Mill Museum, Montgomery County PA were reviewed for Chevalier Jackson's scientific, cultural, and social contributions to the field of surgery. RESULTS: Among his lesser-known contributions, Chevalier Jackson was the first to describe erosive esophagitis. He developed the first standardized tracheotomy procedure, still in use today. He was ahead of his time in many ways, pioneering a multidisciplinary approach to medicine, advocating for patient-centered care, and advancing the inclusion of women in the medical profession. CONCLUSION: Chevalier Jackson's legacy extends far beyond the tools and techniques he invented. He was a champion of social justice, a protector of patients, and an inspiration to medical professionals across the globe.

Gunnar Inghe: A founding father of Scandinavian social medicine and still highly relevant.

Gunnar Inghe (1910-1977) was a founding father of Scandinavian social medicine and the first editor of the Scandinavian Journal of Social Medicine. He worked as a physician for social care clients in Stockholm from 1944 to 1961 and was professor in social medicine from 1961 to 1975. We (F.D. and U.J.) were his last two PhD students. As we were recollecting the 50-year history of the Scandinavian Journal of Public Health in 2022, it became evident to us how relevant Gunnar Inghe's work, 45 years after his death, still is for today's social medicine, population health research and policy in Scandinavia. We shall explain why with five examples of Inghe's work: reproductive health, health of paupers, foundation of the discipline, international solidarity and collaboration between medical and social care.

The social medicine specialty in southern Sweden.

AIMS: This article discusses the situation of the social medicine specialty in Skåne, southern Sweden with the aim of understanding the long-term trends of this medical specialty in Skåne and its relation to research in social medicine. RESULTS: In the 1950s to 1980s, there was a balance between clinical and preventive practice, and research. This balance was maintained in the 1980s to early 2000s as the medical specialty and the research moved 'upstream' in the chain of causality to psychosocial, socio-economic and contextual determinants of health. The increasingly 'upstream' character of the specialty and particularly its new position in the regional organisation since 2010 may have made it more vulnerable to general executive-level reorganisations. CONCLUSIONS: The specialty should maintain its 'upstream' focus but regain its proximal scope in prevention, epidemiology and health equity. It should regain its place in the health-care system organisation or alternatively become a state-based instead of regional specialty.

Empowering communities through experiential learning: the 'Enhance' program in Leadership and Social Medicine.

INTRODUCTION: Social determinants of health cause disparities in health and life expectancy in the UK1, especially in rural populations. Communities must be empowered to control their health2, alongside clinicians being more generalist and holistic. Health Education East Midlands is pioneering this approach, creating the 'Enhance' program. From August 2022, up to 12 Internal Medicine Trainees (IMT) will start the 'Enhance' program. They will spend 1 day per week learning about social inequalities, advocacy, and public health, before undertaking experiential learning with a community partner, working together to create and implement a Quality Improvement (QI) project. This will integrate trainees into communities, and help communities utilise assets to create sustainable changes. This longitudinal program will span over all 3 years of IMT. METHODS: After conducting a detailed literature search into experiential learning and service learning programs in medical education, virtual interviews were held with researchers worldwide to discuss how they created, implemented, and evaluated similar projects. The curriculum was created using Health Education England's 'Enhance' handbook, the IMT curriculum, and relevant literature. The teaching program was created with a Public Health specialist. RESULTS: The program commences in August 2022. Evaluation will commence thereafter. DISCUSSION: This will be the first experiential learning program of this scale in UK Postgraduate medical education, with future expansion focusing specifically on rural communities. Afterwards, trainees will understand the social determinants of health, health policy creation, medical advocacy, leadership, and research including asset-based assessments and QI. Trainees will be more holistic and generalist, working with and empowering their local communities. Future work will evaluate the program after commencement.References1 Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot Review ten years on. London: Institute of Health Equity, 2020. Available at https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on2 Hixon AL, Yamada S, Farmer PE, Maskarinec, GG. Social justice: the heart of medical education. Social Medicine 2013; 3(7): 161-168. Available at https://www.researchgate.net/publication/258353708_Social_Justice_The_Heart_of_Medical_Education.

[Social medicine: places, collaborations, human-centered practices]. / Médecine sociale : des lieux, des collaborations, des pratiques centrées sur l'humain.

People in complex social situations are often confronted with multiple health problems related to their living conditions, pathologies, addictions and other co-morbidities. They need multi-professional support, while respecting the ethics of care, and in coordination with social partners. Various dedicated services exist, in which nurses are very present.

[From social medicine to the management of precariousness in health]. / De la médecine sociale à la prise en charge de la précarité en santé.

A review of the history leading from the creation of social medicine to the management of precariousness in the health field. We will define the main concepts (precariousness, poverty, social inequalities in health) and indicate the main barriers to access to care for people in precarious situations. Finally, we will give some guidelines for the healthcare community in order to improve care.

Fifty years of Nordic social medicine and public health: snapshots of a journal.

We revied articles published in the Scandinavian Journal of Public Health in a 50 years perspective. Papers reflect development of public health research, policy and debate over the years. Several papers describe early phases of Nordic population based studies that came to have major importance.

Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study.

PURPOSE: Rehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students' knowledge changes after social medicine training. METHODS: This quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons. RESULTS: All groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities. CONCLUSIONS: Social medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups' knowledge levels.

[Physicians and Society: On the Change in the Occupational Profile of Physicians in the Mid-19th Century, a Socio-Medical Concept by Salomon Neumann]. / Arzt und Gesellschaft: Zum Wandel des Berufsbildes Arzt in der Mitte des 19. Jahrhunderts, ein sozialmedizinisches Konzept von Salomon Neumann.

The medical profession is not a trade, it is by its nature a free profession (Federal Doctors' Ordinance). The medical practice as an institution and the medical profession are, however, subject to current social conditions, currently particularly shaped by the rules of health economics and digitization. Salomon Neumann, who, along with Rudolf Virchow, is considered the founder of social medicine in Germany, published the vision of liberating academically trained doctors from the trade regulations applicable to craftsmen and other professions in 1847. On the basis of law and reason that applies to public action, he conceived the establishment of an association, a new professional representation of the previously isolated doctors in freedom, solidarity and self-administration. The failure of the bourgeois revolution in 1849 with subsequent social restoration delayed innovative developments. The professionalization of the medical profession begins with the formation of a unified medical status in 1852, the formation of medical associations in the 1860s, the establishment of the German Association of Physicians in 1872 as an umbrella organization and the establishment of state medical associations in 1948 as public corporations.

Protagonist der Sozialepidemiologie: Laudatio zu Ehren von PD Dr. PH Thomas Lampert ­ Träger der Salomon-Neumann-Medaille 2022.

The Salomon Neumann Medal of the German Society for Social Medicine and Prevention (DGSMP) honours individuals and institutions who have made special contributions to preventive and social medicine. In 2022, the medal was awarded to PD Dr. Thomas Lampert, Robert Koch Institute, who has been a strong advocate for reporting on health inequalities in Germany for many years. His extensive work provides a precise cartography of the social determinants of health in Germany after the turn of the millennium.

Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence.

AIMS: Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions. METHODS: We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns. RESULTS: Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps. CONCLUSIONS: Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.

The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study.

BACKGROUND: Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. METHODS: Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. RESULTS: For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from - 0.0636 (95 % CL: -0.0846, - 0.0430) before the policy to - 0.0457 (95 % CL: -0.0684, - 0.0229) after it. In addition, the horizontal inequity index decreased from - 0.0284 before the implementation of the policy to - 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from - 0.0532 (95 % CL: -0.0868, - 0.0196) before the policy was implemented to - 0.1105 (95 % CL: -0.1333, - 0.0876) afterwards; the horizontal inequity index of IHSU increased from - 0.0066 before policy implementation to - 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. CONCLUSIONS: The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy's original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage.

A new roadmap for social medicine curriculum design based on mixed methods student and faculty evaluations of the preclinical curriculum.

BACKGROUND: To support the development of social medicine curricula that empower medical school graduates to redress health inequities, we conducted a mixed methods student and faculty evaluation of an expanded and innovative preclinical social medicine curriculum. METHODS: We implemented a longitudinal, interactive preclinical social medicine curriculum that was closely integrated with foundational science teaching then conducted a survey-based mixed methods student and faculty curriculum evaluation. Based on these results, we propose a novel conceptual roadmap for social medicine curriculum design. RESULTS: Student and faculty evaluations of an expanded and innovative longitudinal preclinical social medicine curriculum were strongly favorable. Both student and faculty respondents indicated a particular desire for deeper coverage of race and poverty among other social medicine domains. Qualitative student evaluations highlighted the importance of faculty champions to social medicine teaching as well as the educational impact of stories that exemplify the practical impact of the social determinants of health on specific patient experiences. Qualitative faculty evaluations pointed to the challenges of curriculum integration and the need for faculty career development in social medicine teaching. CONCLUSIONS: Based on mixed methods student and faculty curriculum evaluation data, we propose a novel conceptual roadmap for the design of social medicine curricula at other institutions.

The design and implementation of a longitudinal social medicine curriculum at the University of Vermont's Larner College of Medicine.

BACKGROUND: Despite an abundant literature advocating that social determinants of health (SDH) be taught during undergraduate medical education, there are few detailed descriptions of how to design and implement longitudinal core curricula that is delivered to all students and accomplishes this goal. METHODS: In this paper, we describe the design and implementation of a social medicine curriculum at the University of Vermont's Larner College of Medicine (UVM Larner). Using Kern's principles, we designed a longitudinal curriculum that extends through both preclinical and clinical training for all students and focused on integrating SDH material directly into basic science and clinical training. RESULTS: We successfully developed and implemented two primary tools, a "Social Medicine Theme of the Week" (SMTW) in preclinical training, and SDH rounds in the clinical setting to deliver SDH content to all learners at UVM Larner. CONCLUSIONS: Extensive student-faculty partnerships, robust needs assessment, and focusing on longitudinal and integrated SDH content delivery to all students were key features that contributed to successful design and implementation.

Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents.

BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work. METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1-15 months from the experience. RESULTS: 46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine. CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.

Society as Cause and Cure: The Norms of Transgender Social Medicine.

This article analyzes how trans health was negotiated on the margins of psychiatry from the late 1970s and early 1980s. In this period, a new model of medical transition was established for trans people in Norway. Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease. By using archival material, medical records and oral history interviews with former patients and health professionals, I demonstrate how social aspects not only underpinned diagnostic evaluations but were an integral component of the entire therapeutic regime. Sex reassignment became an integrative way of imagining and practicing psychiatry as social medicine. The article specifically unpacks the social element of these diagnostic and therapeutic approaches in trans medicine. Because the locus of intervention and treatment remained the individual, an approach with subversive potential ended up reproducing the norms that caused illness in the first place: "the social" became a conformist tool to help the patient integrate, adjust to and transform the pathology-producing forces of society.

[Laudation to Prof. Karl Lauterbach Sc.D. on the Occasion of the Award of the Salomon Neumann Medal sponsored by the DGSMP]. / Laudatio für Prof. Karl Lauterbach Sc.D. anlässlich der Verleihung der Salomon Neumann Medaille der DGSMP.

The contribution contains the laudation on behalf of the award of the Salomon-Neumann-Medal 2020 of the German Society for Social Medicine and Prevention to Prof. Karl Lauterbach.

Addressing the health advocate role in medical education.

The health advocate role is an essential and underappreciated component of the CanMEDs competency framework. It is tied to the concept of social accountability and its application to medical schools for preparing future physicians who will work to ensure an equitable healthcare system. Student involvement in health advocacy throughout medical school can inspire a long-term commitment to address health disparities. The Social Medicine Network (SMN) provides an online platform for medical trainees to seek opportunities to address health disparities, with the goal of bridging the gap between the social determinants of health and clinical medicine. This online platform provides a list of health advocacy related opportunities for addressing issues that impede health equity, whether through research, community engagement, or clinical care.First implemented at the University of British Columbia, the SMN has since expanded to other medical schools across Canada. At the University of Ottawa, the SMN is being used to augment didactic teachings of health advocacy and social accountability. This article reports on the development and application of the SMN as a resource for medical trainees seeking meaningful and actionable opportunities to enact their role as health advocates.

[Autonomy and Participation As Common Goals of Nursing, Therapy and Social Medicine: Proposal for an Organizational Configuration Model on the Basis of Service Blueprinting]. / Selbstbestimmung und Teilhabe als gemeinsame Ziele von Pflege, Therapie und Sozialmedizin: Entwurf eines Organisationsmodells auf Basis einer Kontaktpunktanalyse.

BACKGROUND: Every person who is in the need of long-term care (according to German Social Code SGB XI §14) fulfills the requirements of disability according to German Social Code SGB IX, § 2. The right of participation and autonomy must be specially protected and realized for persons with long-term care needs because these persons have a limited capacity to advance their interests. The rights of people in the need of long-term care or assistance are protected not only by the national constitution but also by the UN Disability Rights Convention. Participation is an important principle of these extra-statutory regulations and has an extraordinary significance and individual meaning for quality of life. For concretizing the aim of participation and for realizing participation in daily practice, the following question arises: How must organizations be configured to achieve individual aims of participation for persons with long-term care need, complex health care needs and with potential for rehabilitation across sectoral, disciplinary and professional borders? This analysis focuses on people older than 70 years with geriatric-relevant multimorbidity and with potential for rehabilitation. AIM: The aim of this study was to create a configuration model for the organization of interdisciplinary cooperation in rehabilitation out of a case study and on the basis of the service blueprinting method [1]. In a next step this configuration model can be evaluated concerning its effectiveness for achieving individual participation goals and quality of life of persons with long-term care need and with potential for rehabilitation. METHOD: For creating the configuration model, the service blueprinting method [1] on the basis of Dervin's sense making theory [11] was applied to a case vignette of geriatric rehabilitation against a background of organization theories and nursing science concepts. With the case study the configuration model can be applied exemplarily at the setting of restorative care, therapy and rehabilitation. With the service blueprinting method, the rehabilitation process is aligned onto the geriatric patient's individual health care needs, perceptions of participation and quality of life. RESULTS: As a result of the sequencing and service blueprinting process we offer a dynamic model for the coordination of responsibility of interdisciplinary rehabilitation teams with a user-centered alignment. Its effectiveness (and side-effects) for interdisciplinary cooperation and for patient's individual goals of participation and quality of life must be evaluated in further studies. A mixed-method design should be used to evaluate objective outcome parameters such as dependency on nursing care, hospital admission rates and subjective outcome parameters such as patient's perception of participation, autonomy and quality of life. IMPLICATIONS FOR HEALTHCARE PRACTICE: The configuration model can be used for evaluating already implemented geriatric rehabilitation processes and organizations. The configuration model can be used in health care research or organizational research. After more evidence for desirable effects, it can be implemented into the health care system. Side effects should be monitored.This paper was written in cooperation with the working group "Nursing", department "Practical Social Medicine and Rehabilitation" of the German Society of Social Medicine and Prevention (Deutsche Gesellschaft für Sozialmedizin und Prävention DGSMP e.V.).