[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.

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.

Pandemia, ignorancia y sufrimiento evitable / Pandemic, ignorance and avoidable suffering

La pandemia de la COVID-19 ha dejado lecciones relevantes que van a marcar, durante años, nuestra experiencia individual y colectiva.Son lecciones tanto prácticas como de orden moral. Pero la pandemia ha dejado también un rastro de experiencias pobremente ela-boradas que conducen, con cierta premura, al silencio forzado y a la cancelación del trauma. El propósito de este trabajo fue mostrarla compleja relación que, en condiciones de incertidumbre, se establece entre conocimiento e ignorancia, tanto en la perspectivade los expertos, como en la de los políticos e incluso de los ciudadanos corrientes, víctimas o no del virus SARS-CoV-2. Para ello sedistingue entre tres diferentes niveles de análisis (de la agencia, de las instituciones y de los marcos ideológicos subyacentes) y seargumenta que los desajustes que se producen en cada uno de estos niveles, y entre ellos, son fuente de sufrimiento evitable. Elpropósito del trabajo fue, por tanto, sacar a flote, con los instrumentos conceptuales de la epistemología política, tanto los principalesperfiles que siguen sin ser adecuadamente elaborados en esta experiencia traumática como los factores que hacen posible unamayor resiliencia, para los individuos y las sociedades, a la hora afrontar las consecuencias dramáticas de la pandemia.(AU)

COVID-19 pandemics gave us relevant lessons that are going to leave a durable mark in our individual and collective experience. Thoselessons are both practical and endowed with a moral import. But the pandemic has left a trail of experiences poorly elaborated thatleads, with some urgency, to forced silence and to the cancellation of emotional trauma. The aim of this paper was to disentanglethe complex relationship that arises, under conditions of uncertainty, between knowledge and ignorance, both from the perspectiveof experts and of policy makers, and even of the ordinary people, struck or not by the SARS-CoV-2 virus. To that end, I distinguishbetween three different levels of analysis (agency, institutions, and ideological frameworks) so to argue that the mismatches thatoccur in all of them, and between them, are sources of avoidable harm. The purpose of this exploration was, therefore, to bring tothe floor, relying on the conceptual tools of the political epistemology, both the aspects of the traumatic experience that still lack anadequate elaboration and the features that provide an improved resilience for individuals and societies in tackling with the frightfulconsequences of the pandemic.(AU)

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.

Thinking with and Against the Social Determinants of Health: The Latin American Social Medicine (Collective Health) Critique from Jaime Breilh.

The concept of the social determinants of health has become increasingly accepted and mainstream in anglophone public health over the past three decades. Moreover, it has been widely adopted into diverse geographic, sociocultural, and linguistic contexts. By recognizing the role of social conditions in influencing health inequalities, the concept challenges narrow behavioral and reductive biological understandings of health. Despite this, scholars and activists have critiqued the concept of the social determinants of health for being incomplete and even misrepresenting the true nature of health inequities. Arguably, these critiques have been most thoroughly developed among those working in the Latin American social medicine and collective health traditions who formulated the "social determination of health" paradigm and the concept of interculturality decades prior to the advent of the social determinants of health. We draw on Jaime Breilh's main works, with a focus on the recently published book, Critical Epidemiology and the People's Health, to (1) provide a broad overview of the social determination of health paradigm and its approach to interculturality and (2) clarify how these ideas and the broader collective health movement challenge assumptions within the social determinants of health concept.

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.

[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.

Asociación entre el entorno de práctica de actividad física y los hábitos de vida e indicadores de salud física y psicosocial / Association between the physical activity practice environment and lifestyle habits and indicators of physical and psychosocial health

Fundamentos: Las características del entorno de residencia parecen estar estrechamente relacionadas con el estado de salud de sus residentes, pudiendo tener, la infraestructura vinculada a la práctica de actividad física, una influencia directa sobre la salud. El objetivo del estudio fue analizar el entorno de práctica de actividad física, evaluando en adolescentes su relación con diversos hábitos de vida e indicadores de salud física y psicosocial, rendimiento académico, así como la influencia de diversas variables sociodemográficas. Métodos: El estudio se llevó a cabo en una muestra de 761 estudiantes (14,51±1,63 años) de 25 centros educativos de una región del norte de España. Se valoró el entorno para la práctica de actividad física, el nivel de actividad física, las horas de sueño nocturno, la adherencia a la dieta mediterránea, el consumo máximo de oxígeno,el índice de masa corporal, la calidad de vida relacionada con la salud, la autoestima, el rendimiento académico y diversos factores sociodemográficos. Resultados: La residencia en entornos más favorables para la realización de actividad física se asoció con índices más altos de actividad física, adherencia a la dieta mediterránea, consumo máximo de oxígeno, autoestima y calidad de vida relacionada con la salud. Además, las tasas de residencia en entornos más favorables para la realización de actividad física eran menores por parte de los migrantes y aquellos con bajo/medio nivel socioeconómico. Conclusiones: La infraestructura vinculada a la práctica de actividad física se asocia con el bienestar de sus residentes, por lo que las intervenciones dirigidas a la salud infantojuvenil deberían tener en cuenta la promoción de espacios residenciales que faciliten el acceso dicha práctica.(AU)

Background: The characteristics of the residence environment seem to be closely related to the healthstatus of its residents, and the infrastructure linked to thepractice of physical activity may have a direct influenceon health. The objective of the study was to analyze thephysical activity practice environment, evaluating in adolescents their relationship with various lifestyle habits andindicators of physical and psychosocial health, academicperformance, as well as the influence of various sociodemographic variables.Methods: The study was carried out in a sampleof 761 students (14.51±1.63 years) from 25 educationalcenters in a region of northern Spain. The environmentfor the practice of physical activity, physical activity engagement, the hours of night sleep, the adherence to theMediterranean diet, the maximum oxygen uptake, thebody mass index, the healthrelated quality of life wereassessed, selfesteem, academic performance and varioussociodemographic factors.Results: The residence in more favorable environments for the realization of physical activity was associatedwith higher physical activity engagement, adherence to theMediterranean diet, maximum oxygen uptake, selfesteemand healthrelated quality of life. In addition, the rates of residence in more favorable environments for the realizationof physical activity were lower on the part of migrants andthose with low/medium socioeconomic status.Conclusions: The infrastructure linked to the practice of physical activity is associated with the wellbeing ofits residents, so interventions aimed at child and adolescent health should take into account the promotion of residential spaces that facilitate access to said practice.(AU)

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.

Retraso diagnóstico en enfermedades raras: revisión sistemática / Diagnostic delay in rare diseases: systematic review

Fundamentos: Según el Consorcio Internacional para la Investigación de Enfermedades Raras (IRDiRC) el diagnóstico de una enfermedad rara (ER) conocida debería hacerse en el plazo de un año. El objetivo de esta revisión sistemática fue identificar las evidencias científicas sobre el tiempo que transcurre hasta obtener el diagnóstico en pacientes con ER y conocer si se produce retraso, conforme al objetivo del IRDiRC (más de un año). Métodos: Se realizó una revisión sistemática según criterios PRISMA en las bases de datos PubMed, Scopus y Web of Science (WoS). Se valoró la calidad de los estudios incluidos conforme a la declaración STROBE. Resultados: Se incluyeron 17 artículos orientados a ER específicas, principalmente metabólicas, neurológicas y trastornos que afectan a la inmunidad. Los diseños fueron fundamentalmente transversales, aunque también se incluyeron dos de cohorte retrospectivos. La mayoría de los estudios reflejan que se emplea más de un año en obtener el diagnóstico de estas ER. Conclusiones: La literatura científica que cuantifica el tiempo hasta el diagnóstico en ER es aún escasa y ningún estudio se orienta a estas enfermedades en su conjunto. Según el objetivo del IRDiRC, existe un evidente retraso en el diagnóstico de ER, ya que en la mayoría de los casos se requiere de un tiempo superior a un año. Por tanto, son necesarios nuevos avances en campo de las ER para contribuir a la reducción del tiempo desde la aparición de los síntomas hasta el diagnóstico adecuado.(AU)

Background: The aims of the International Consortium for Rare Diseases Research (IRDiRC) include that the diagnosis of a known rare disease (RD) must be made within a year. The objective of this systematic review was to identify the scientific evidence about the time to diagnosis in patients affected by RDs and also to know if there is a diagnostic delay (more than one year) according to the objective set by the IRDiRC. Methods: A systematic review was carried out according to PRISMA criteria in the PubMed, Scopus and Web of Science (WoS) databases. The quality of the articles was assessed using the STROBE statement. Results: 17 articles were included. They were devoted to specific RDs, most of them metabolic diseases, neurological and disorders that affect immunity. The study designs were mainly cross-sectional, and two retrospective cohorts were also included. Most articles showed that it takes more than a year to get a diagnosis for these RDs. Conclusions: Scientific literature quantifying the time to diagnosis is still scarce and no study addresses RDs as a whole. In most cases, it takes more than one year to obtain a diagnosis of a RD, so there is an obvious delay accordingto the objective set by the IRDiRC. Therefore, new advances in the RD field are necessary to reduce the time from the onset of symptoms to the accurate diagnosis.(AU)