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Gesundheitswesen ; 82(1): 107-116, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31634963


BACKGROUND: In 2010, the ICF working group of Faculty II "Applied Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP proposed a classification of personal factors (PF) for the German-speaking area. Meanwhile, the International Classification of Functioning, Disability and Health (ICF) and WHO's bio-psycho-social model were increasingly integrated into the German Social Code (Book IX for Rehabilitation and Participation). It was a legislative decision that the needs assessment for the rehabilitation process must be "comprehensive". AIM: This publication aims to present an updated classification of PF to support the socio-medical assessment. For this purpose other published papers proposing a classification of PF were analyzed, especially the publication of Geyh et al. METHODS: The multiprofessional working group re-examined the basic structure, consistency and selection of factors of the 2010 classification using a qualitative approach and modified them if meaningful and necessary. The principles for the selection of factors were the same as in the 2010 publication (comprehensive, manageable, universal, impartial, relevant, unambiguous, focusing on finality, not regarding causality and non-discriminatory). RESULTS: A fundamental revision was not necessary; the basic structure remained primarily unchanged. Some items were included, excluded, summarized, shifted and editorially or content-related altered. Legal expertise shows that the classification of PF and their individual use for the socio-medical assessment, if necessary for the individual rehabilitation allocation, incur no problems with regard to data-protection regulations. PERSPECTIVES: The revised classification is ready to support users to describe and document relevant influences of the life background of individuals in a structured manner. Thus, influences on functioning and participation can be described comprehensively and transparently based on the bio-psycho-social model. A justiciable allocation of benefits for persons with disabilities is facilitated.

Pessoas com Deficiência , Medicina , Medicina Social , Avaliação da Deficiência , Alemanha , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Determinação de Necessidades de Cuidados de Saúde
Gesundheitswesen ; 81(12): 963-966, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31816644


The German Society for Social Medicine and Prevention (DGSMP) confers the Salomon Neumann Medal for outstanding merit in the field of Preventive and Social Medicine. The Salomon Neumann Medal 2017 was awarded to Gerhard Trabert, founder and chairman of the association "Poverty and Health in Germany" and professor for social medicine und social psychiatry at the RheinMain University of applied sciences in Wiesbaden. It honours a physician in the field of social medicine, whose personality and activity as "doctor for the poor of today", carries the sociopolitical engagement of Salomon Neumann, fittingly to the 200th birthday of the award's name giver, into our time.

Distinções e Prêmios , Médicos , Medicina Social , Alemanha , História do Século XX , Humanos , Medicina Social/história , Sociedades Médicas
Gesundheitswesen ; 81(12): 1091-1100, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31816646


The essay "The issue of syphilis in Berlin. A contribution to public health in Berlin" highlights the importance of Salomon Neumann as an initiator of social medicine and a promoter of the communal medical statistics in the middle of the 19th century. Being a physician-member of the Berlin Health Care association and a doctor for the poor, he provides a sociomedical report on the interaction between syphilis as a disease and society with its regulatory measures (vice squad, public administration) and the deficient hospital and ambulatory care structures for the poor in Berlin in the middle of the 19th century, both with a prospective orientation.

Medicina Social , Sífilis , Berlim , Feminino , Alemanha , História do Século XIX , Humanos , Masculino , Estudos Prospectivos , Medicina Social/história , Sífilis/história
Tidsskr Nor Laegeforen ; 139(15)2019 10 22.
Artigo em Norueguês | MEDLINE | ID: mdl-31642627


BACKGROUND: The policy on drug use is currently undergoing significant change. This article examines how the view of addiction to illegal drugs changed in the first 30 years after the advent of 'the drug problem' in Norway. MATERIAL AND METHOD: We performed a search in Oria, and various databases on the history of illegal drugs in Norway, with an emphasis on the period from 1960-90, with white papers from 1976 and 1986. RESULTS: Until the mid-1960s, Norway had very few opiate abusers. This generally concerned abuse of medically prescribed drugs, and was perceived as an internal problem for the health services. The youth counterculture in the late 1960s brought the recreational use of illegal substances to Norway, leading to major concern on the part of the public authorities. 'The drug problem' was now perceived as a significant societal problem, with social and societal causal explanations, and was therefore the subject of a white paper (1976). The next white paper (1986) put forward the ideal of a 'drug-free society' for the first time, with the purpose of general deterrence and strict sentencing as important instruments. INTERPRETATION: From the early 1960s until the late 1980s, the 'drug problem' was perceived in different ways. At the start of the period, it was formulated primarily as a medical problem. From the late 1960s, it was seen first and foremost as a social problem caused by changes in society, whereas from the late 1970s until the late 1980s, control measures constituted the most important instrument to address the problem.

Transtornos Relacionados ao Uso de Substâncias/história , Direito Penal/história , Usuários de Drogas/história , Política de Saúde/história , História do Século XX , Humanos , Noruega , Transtornos Relacionados ao Uso de Opioides/história , Medicina Social/história
PLoS Negl Trop Dis ; 13(7): e0007094, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260444


BACKGROUND: Salt fortified with the drug, diethylcarbamazine (DEC), and introduced into a competitive market has the potential to overcome the obstacles associated with tablet-based Lymphatic Filariasis (LF) elimination programs. Questions remain, however, regarding the economic viability, production capacity, and effectiveness of this strategy as a sustainable means to bring about LF elimination in resource poor settings. METHODOLOGY AND PRINCIPAL FINDINGS: We evaluated the performance and effectiveness of a novel social enterprise-based approach developed and tested in Léogâne, Haiti, as a strategy to sustainably and cost-efficiently distribute DEC-medicated salt into a competitive market at quantities sufficient to bring about the elimination of LF. We undertook a cost-revenue analysis to evaluate the production capability and financial feasibility of the developed DEC salt social enterprise, and a modeling study centered on applying a dynamic mathematical model localized to reflect local LF transmission dynamics to evaluate the cost-effectiveness of using this intervention versus standard annual Mass Drug Administration (MDA) for eliminating LF in Léogâne. We show that the salt enterprise because of its mixed product business strategy may have already reached the production capacity for delivering sufficient quantities of edible DEC-medicated salt to bring about LF transmission in the Léogâne study setting. Due to increasing revenues obtained from the sale of DEC salt over time, expansion of its delivery in the population, and greater cumulative impact on the survival of worms leading to shorter timelines to extinction, this strategy could also represent a significantly more cost-effective option than annual DEC tablet-based MDA for accomplishing LF elimination. SIGNIFICANCE: A social enterprise approach can offer an innovative market-based strategy by which edible salt fortified with DEC could be distributed to communities both on a financially sustainable basis and at sufficient quantity to eliminate LF. Deployment of similarly fashioned intervention strategies would improve current efforts to successfully accomplish the goal of LF elimination, particularly in difficult-to-control settings.

Dietilcarbamazina/economia , Erradicação de Doenças/economia , Filariose Linfática/tratamento farmacológico , Filaricidas/economia , Medicina Social/economia , Cloreto de Sódio na Dieta/administração & dosagem , Administração Oral , Análise Custo-Benefício , Dietilcarbamazina/administração & dosagem , Erradicação de Doenças/métodos , Filariose Linfática/prevenção & controle , Filaricidas/administração & dosagem , Haiti , Recursos em Saúde/economia , Humanos , Administração Massiva de Medicamentos , Modelos Teóricos , Doenças Negligenciadas/tratamento farmacológico , Medicina Social/métodos , Cloreto de Sódio na Dieta/economia
Rev Chil Pediatr ; 90(3): 351-355, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31344197


Although public health and social medicine have a long history in Latin America going back to Co lonial times, their relevance has ebbed and flowed as a result of the development of a variety of social and political movements. The Mexican Revolution accelerated implementation of public health po licies in Mexico and resulted in the creation of the Mexican Institute of Social Security to serve the health and social security needs of the country's population. Construction of the Hospital La Raza and its embellishment by the mural paintings of Diego Rivera and David Alfaro Siqueiros correspon ded to the heyday of public health ideas in Mexico. This is clearly reflected in Rivera's mural painting from 1953, The History of Medicine in Mexico: People's Demand for Better Health. The left side of the painting, representing the history of modern medicine in Mexico, exemplifies the tensions between individuals and social groups demanding the fruits of modern medicine and public health, and en trenched bureaucracy and private interests resisting their demands. Rivera's artistry illustrates this tension by depicting urban social groups and a family with a pregnant mother and children reques ting medical attention on one side of the main panel, facing condescending physicians, bureaucrats and upper society gentlemen and ladies on the other side. The importance of social movements to the development of public health policies illustrated by Rivera in 1953 continues to be relevant in Latin America today where increasing millions still lack the benefits of health care and social security.

Política de Saúde/história , Pinturas/história , Saúde Pública/história , Pessoas Famosas , História do Século XX , Humanos , México , Medicina Social/história
Artigo em Espanhol | PAHO-IRIS | ID: phr-50749


[RESUMEN]. Objetivo. Describir cómo se ha aplicado el enfoque de la determinación social de la salud en los estudios sobre malaria en el mundo. Métodos. Revisión sistemática de los estudios originales publicados entre 1980 y 2018. Se emplearon seis estrategias de búsqueda en diez bases de datos multidisciplinarias, y en las bibliotecas y los repositorios de siete universidades de Brasil, Colombia, Ecuador y Perú. Se siguió la guía PRISMA; la calidad metodológica se evaluó según los criterios de STROBE y se realizó la síntesis cualitativa de los resultados. Resultados. Diez estudios publicados entre 1984 y 2017 cumplieron con los criterios de inclusión y exclusión preestablecidos; se identificaron 33 determinantes sociales de la malaria. De los determinantes individuales se halló mayor riesgo de malaria en adultos, personas con hábitos nocturnos y sin prácticas preventivas; de los intermedios, fueron las viviendas con mala infraestructura física y sanitaria, hacinamiento, ubicadas en áreas boscosas y con animales. De los socioeconómicos, el mayor riesgo correspondió a personas con actividades agroforestales, migrantes, y con bajos ingresos y escolaridad. La malaria ocasionó elevadas pérdidas económicas y generó pobreza y retardo educativo. Conclusión. No se hallaron estudios con los enfoques de la Medicina Social Latinoamericana ni que aplicaran el análisis jerárquico y multinivel para los determinantes individuales, intermedios y estructurales, de la Organización Mundial de la Salud. No se ha logrado avanzar en el análisis de categorías sociales —territorio, clase social, género, etnia, políticas macroeconómicas— u otras características socioeconómicas que determinan el riesgo de enfermar o morir de malaria.

[ABSTRACT]. Objective. Describe how the ‘social determination of health’ approach has been applied in malaria studies around the world. Methods. Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. Results. Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. Conclusion. No studies were found that used Latin American social medicine approaches or that applied the World Health Organization’s hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories—territory, social class, gender, ethnic group, macroeconomic policies—or other socioeconomic characteristics that determine risk of illness or death from malaria.

[RESUMO]. Objetivo. Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. Métodos. Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. Resultados. Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. Conclusão. Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Determinantes Sociais da Saúde , Malária , Medicina Social , Determinantes Sociais da Saúde , Medicina Social , Determinantes Sociais da Saúde , Malária
Metas enferm ; 22(3): 66-71, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183530


Objetivo: determinar el efecto de una intervención educativa en el aprendizaje de la salud colectiva. Método: estudio cuasiexperimental. Los sujetos de estudio se reclutaron entre todos los alumnos inscritos en el turno de mañana que cursaban el segundo semestre de la asignatura de Salud Colectiva de la Escuela Nacional de Enfermería y Obstetricia de la Universidad Nacional Autónoma de México. La asignatura consta de una parte teórica y otra práctica. Se incluyeron 85 estudiantes en el grupo control (GC: práctica según modelo tradicional) y 47 en el grupo intervención (GI: se realizó una intervención educativa por parte del docente, basada en el aprendizaje situado y cooperativo). El aprendizaje se midió con la Escala de Aprendizaje de Salud Colectiva en Enfermería mediante la técnica de encuesta autoaplicada. Se llevó a cabo un análisis descriptivo con media y desviación estándar (DE) y análisis comparativo entre GC y GI mediante t de Student para muestras relacionadas. La significación estadística se estableció para p< 0,05. Se utilizó el programa SPSS versión 21.0. Resultados: en el pretest, tanto el GC como el GI tienen puntaciones medias (DE) similares en la Escala de Aprendizaje de Salud Colectiva en Enfermería: GC 158,7 (14,3) y GI 161,9 (15,3) (p= 0,007). Sin embargo, en el postest, la puntuación media (DE) del GC disminuye 151,8 (14,3) y la del GI aumenta 166,0 (14,3) (p= 0,001). Los estudiantes del grupo intervención mejoraron en tres de las cinco dimensiones del instrumento respecto al pretest y al grupo control; pero en las otras dos dimensiones exploradas: aprendizaje conjunto y aprendizaje significativo y reflexivo no hubo diferencia con significancia estadística. Conclusiones: la enseñanza situada mejora el nivel de aprendizaje sobre Salud Colectiva, y tiene mejores resultados que la enseñanza tradicional; sin embargo, es conveniente cambiar las estrategias de aprendizaje para fortalecer las habilidades del aprendizaje autónomo y conjunto

Objective: to determine the impact of an educational intervention on learning Collective Health. Method: a quasi-experimental study, with subjects recruited among all the students enrolled in the morning shift, on their second semester of the Collective Health subject at the National School of Nursing and Obstetrics from the Universidad Nacional Autónoma of Mexico. The subject consisted of a theoretical part and another practical part; 85 students were included in the Control Arm (CA: practice according to the traditional model), and 46 in the Intervention Arm (IA: an educational intervention was conducted by their teacher, based on situated and cooperative learning). Learning was measured with the "Collective Health Learning Scale in Nursing", through the self-applied survey technique. A descriptive analysis was conducted, with mean and standard deviation (SD) and a comparative analysis between CA and IA through Student's t test, for paired samples. Statistical significance was determined for p< 0.05, and the SPSS program version 21.0 was used. Results: in the pre-test, both the CA and the IA had similar mean scores (SD) in the Collective Health Leaning Scale in Nursing: CA 158.7 (14.3) and IA 161.9 (15.3) (p= 0.007). However, in the post-test, the mean score (SD) of the CA was reduced to 151.8 (14.3), and the IA increased to 166.0 (14.3) (p= 0.001). The students in the Intervention Arm improved in three of the five dimensions of the instrument compared with the pre-test and the Control Arm; but there was no statistical significance difference in the other two dimensions explored: joint learning, and significant and reflective learning. Conclusions: situated teaching improves the level of learning on Collective Health, and presents better results than traditional learning; however, it is convenient to change the learning strategies in order to strengthen the skills of autonomous and joint learning

Humanos , Saúde Pública/educação , Aprendizagem , Educação em Enfermagem/métodos , Medicina Social , Estudantes de Enfermagem/estatística & dados numéricos , México
Rev Epidemiol Sante Publique ; 67(2): 106-113, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30733052


BACKGROUND: The French public health medical residency was created in 1984 to train medical public health specialists. Knowledge was lacking on the career of the trained practitioners, with the sole study dating from 1995. In this study, the French national association of medical public health residents aimed to describe the training and career of all medical public health specialists since the inception of the residency. METHODS: An online survey took place during the first semester of 2012 to collect information on all medical public health specialists graduated from the French public health medical residency. Descriptive analysis of the collected information was performed. RESULTS: Replies from 563 graduated medical public health residents were collected from all over the country and years since the inception of the training. Ninety-eight percent of the informants were in activity. They mostly worked in public healthcare facilities (56%) and public administration (16%). Their main areas of practice were: epidemiology, clinical research, biostatistics (37%); health management information system (19%); health policy (14%). Eighty-eight percent of the respondents held a master degree, 29% a PhD. Practical training during the medical residency was deemed as very useful or needed by 73% of the informants, theoretical training by 43%. Sixty-eight percent of informants were very or fully satisfied by their carrier, 29% rather satisfied. CONCLUSION: This is the first study to achieve coverage of more than 45% of all medical public health specialists graduated since the inception of the public health medical residency. Full employment, wide-range activities, evolving carriers can explain the high satisfaction rates. The public health medical residency being the main access point to the public health medical specialty, the impact of the initial training on the career should lead to rethink the design of the public health medical residency to fulfil the needs in the public health sector.

Escolha da Profissão , Educação de Pós-Graduação em Medicina , Internato e Residência , Saúde Pública/educação , Medicina Social/educação , Especialização , Adulto , Mobilidade Ocupacional , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Medicina Social/estatística & dados numéricos , Especialização/estatística & dados numéricos