bluuebunny/crossref_metadata_2025 huggingface dataset:
The privatization of health and the defense of the public system in Quebec, Canada
Authors: Forti Silvana
Published: January 2025

The Canadian health care system – known as “Medicare” or “Assurance-maladie” in Quebec – was created to ensure Canadians free access to health care services and medications. The health system is both publicly funded and administered. It has been built on five principles laid out in the Canada Health Act (1984); these are: Public Administration, Comprehensiveness, Universality, Portability, and Accessibility. In sum, the right to health has been at the organizational core of the Canadian health system.
Provinces and territories administer and deliver most of the health services in Canada. This is done through provincial and territorial health insurance plans which are required to follow the national principles set out in the Canada Health Act. Since its creation, the Canadian health care system has undergone important changes and reforms. However, until a few years ago each major reform of the system retained the principles of justice and equity as core values.

Quebec adopted the Health and Social Services Act in December 1971. The Quebec health care system was established with a mandate to maintain, improve, and restore the health and well-being of the entire Quebec population, making health and social services accessible to all. Health and social services in Quebec are administered jointly. This specificity, which has been adopted by other health care systems, has the advantage of allowing a comprehensive response to the health and social needs of the population. Since the 80s there has been a worldwide trend towards the privatization of public services.

In order to describe developments in the Quebec health care system, we interviewed Dr Marie-Claude Goulet (M-CG), chair of the organization Médecins québécois pour le régime public (MQRP) [Quebec Physicians for a Public System] , an organization campaigning against the commercialization of health care in Quebec. The MQRP is an umbrella organization made up of various groups from Quebec province; it is part of the larger Canadian Doctors for Medicare (CDM) network. CDM was created in May of 2006 because of physician concerns about the trend towards privatization of the country’s health care services.

As a member of ALAMES North America, I was interested in hearing the perspective of a Latin American working in the Quebec health care system. How did the experience of privatization in a Latin American country compare to what is currently taking place in Quebec? To this end I interviewed Dr Fernando Álvarez (FA), an Argentinian pediatrician who had worked in the Children’s Hospital in Buenos Aires. For the past 18 years he has been part of the Quebec health system and is currently head of Gastroenterology, Hepatology, and Nutrition services at Montreal University’s Sainte-Justine Hospital.
Determinants of Health Status among UNISALUD Patients with Osteoarthritis of the Knee: An Examination Using the Lens of Critical epidemiology
Authors: Camargo Rojas Diana , Mena Bejarano Beatriz
Published: January 2025

Determinants of Health Status among UNISALUD Patients with Osteoarthritis of the Knee: An Examination Using the Lens of Critical epidemiology
After the revolution: a Fantasied Model of Health Care
Authors: Dumont Matthew
Published: January 2025

After the revolution: a Fantasied Model of Health Care
Guatemala: An analysis of Obstacles to Universal Access: Hundreds of PLWA Fall Between the Cracks Each Month
Authors: Stern Richard , Lopez Tocon Lidice
Published: January 2025

This is the first of two articles that describe the situation of ARVT access in Guatemala. The second will focus on drug procurement processes, prices, and other related topics.

The response to the HIV epidemic in Guatemala has grown considerably over the past five years. This is not just about national efforts, but also international assistance, particularly The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The response during this period has increased both prevention efforts and medical attention to PLWA . Nonetheless, current data shows the response has yet to reach the required level for halting the spread of the epidemic, particularly in terms of delivering antiretrovirals and comprehensive health care.
As reported in the last UNGASS country progress report (Dec. 2009), 10,362 PLWHA (768 children and 9594 adults) were receiving ARVs in Guatemala.
On the “hitherto untried process of giving doctors adequate training” in preventive medicine and public health
Authors: Litsios Socrates
Published: January 2025

On the “hitherto untried process of giving doctors adequate training” in preventive medicine and public health
Issues for consideration at the WHO Executive Board
Authors: Serag Hani
Published: January 2025

The People’s Health Movement (PHM) has created a WHO Watch “directed to changing the patterns of global decision making and implementation in matters which affect the global health crisis.” The need for such a Watch has been heightened by moves within the WHO to create an additional governing structure “that will bring together Member States, global health funds, development banks, partnerships, nongovernmental organizations, civil society organizations, and the private sector to address issues critical to global health.” The private sector (which in practical terms means agribusiness, big pharma, and the interests of the medical-industrial complex) already has vast influence over health policy and it is entirely unclear why they need yet one more forum. We present here comments by the PHM on the agenda prepared by the WHO Executive Board prior to the World Health Assembly held in January 2011. They provides some ideas for an alternative health agenda.
The Roles of Mothers and Fathers in Health Care: Social Representations and Healing Practices in Paraíso del Grijalva, Chiapas, Mexico
Authors: Balderas Correa María Eugenia , Huicochea Gómez Laura , Evangelista García Angélica Aremy
Published: January 2025

The fact that fathers play a minimal—or even non-existent—role in the processes of health and disease care has been observed in multiple studies (Browner, 1989; Dean, 1986; Litman, 1979, in Osorio 2001). Mothers typically are the first people to diagnose and triage primary health problems in the family, particularly for the youngest children. (Osorio, 2001). Across social sectors, the father/husband is either absent or has limited participation in health care of the family; often due to the division of labor within the family (Menéndez, 1993:139). However, there has been no research that examines the degree to which these social roles are inflexible; or if nuances exist based on the diverse contexts in which health and illness occur.

This study was conducted in Paraíso del Grijalva, a community located in the Venustiano Carranza municipality, in the State of Chiapas, Mexico. According to official statistics, Venustiano Carranza has a total population of 49,675. 10,355 inhabitants speak an indigenous language, most commonly Tzotzil (n = 6558 or 63.3%) (INEGI II, Conteo 2005).

We conducted interviews with seventy-five mothers and fathers about the causes of health and disease, symptoms, health care seeking behavior, and the health care they received. In several cases we recorded the family’s social representations, perceptions and healing practices. Both qualitative and quantitative information was obtained. This data was supplemented by drawings done by six children aged between 3 and 12 years, whose parents had been interviewed in depth. We chose younger children of both sexes because of their age, the time they spent with their parents, and their daily activities which nurtured the formation of close social bonds. The investigators’ familiarity with the young children in the study fostered trust and promoted natural responses from them.
The Rockefeller Foundation’s “Public Stewardship of Private Providers in Mixed Health Systems”: A Point-by-Point Critique
Authors: Schuftan Claudio , Unger Jean Pierre
Published: January 2025

The 2010 World Health Assembly (WHA) tabled, but did not manage to discuss, a resolution on regulating the private health care sector. 1  With hindsight, it seems fitting to thoroughly review an earlier 2008 Rockefeller Foundation (RF) report on the same issue: “Public Stewardship of Private Providers in Mixed Health Systems.” The key weakness of the RF document – and also of the above WHA draft resolution – is that both fail to provide the necessary empirical evidence to show that better ‘stewarding’ regulation in low and middle income countries (LMICs) has worked to provide quality, accessible, and affordable health care for all in mixed public-private health systems. In this article, we voice our skepticism about whether public stewardship can work in mixed systems in LMICs. Moreover, the RF report does not address the access to quality health care from a human rights perspective. The right to quality health care is simply overlooked.  The report prescribes “new solutions” to well known regulatory problems and fails to offer any evidence of their benefit. It argues that regulation of mixed public-private health systems can be successful without providing any evidence even at local level. This lack of evidence is striking since we have a good 20 years of experience with such regulation. We conclude that a) private providers will never be effectively controlled in LMICs with regulation alone, and b) that the report reflects RF’s ideological bias against single payer, universal coverage public health care systems. We argue that the “regulation alternative” is simply not a substitute for strengthening the public sector. Many of the measures proposed by the Rockefeller Foundation report are not necessarily wrong, but they are applied to a private sector enjoying an established position that has given them access to deliver health care as a privilege and not as a right. Indeed, we remain convinced that if some of the proposed measures were applied to the public health sector with adequate long-term government and donor financing, they would go a longer way to achieve Health Care For All. The past experiences of Costa Rica and Sri Lanka suggest that LMICs private health markets have only effectively been controlled in countries where the public sector was effective in competing with the private sector. A well organized and funded public health system, delivering comprehensive health care (not restricted to vertical disease control programs and not treating health as a commodity) is the only alternative to reign-in the excesses of LMIC private providers in mixed health systems.
Workplace Harassment (Mobbing) and Fibromyalgia
Authors: Fuentes Valdivieso Rocío , Lara Padilla Eleazar
Published: January 2025

The present study is the result of interdisciplinary research on the relationship between workplace harassment (or mobbing) and fibromyalgia (FM). Mobbing can cause emotional trauma due to the intense suffering that it provokes in the individuals who experience workplace harassment for a prolonged and recurrent manner. FM is a progressive disease that presents mainly in women and is characterized by generalized, debilitating pain, along with fatigue that does not resolve with rest. Because of studies suggesting an association between these two phenomena, we examined these two conditions in the context of our own country (Mexico).

The purpose of this study is to answer two questions:

1) Can workplace relationships exacerbate a pre-existing case of FM?

2) Can workplace harassment cause the development of a disease such as FM?
Experiences in Latin America, lessons from the Thumb of the Americas: the right to health is built through social movements
Authors: Méndez Sandoval Iván , Torres-Tovar Mauricio
Published: January 2025

Social movements in the defense of human rights have a long and important history. Since the days of the conquest, human rights have been central to Latin American demands. Looking back, one might even say that the struggle for human rights lies at the core of Latin American history. This makes it essential for us to understand the history of prior social movements that have either assured the fulfillment or human rights or – at least – prevented their violation. With respect to health, Latin America offers a variety of experiences showing how social mobilization can assist in creating health policies and health care systems that guarantee the right to health.

This article describes the journey that El Salvador (America’s “Tom Thumb”) began in the late 1990s. A broad coalition of social movements, community groups, unions, and citizens blocked reforms designed to privatize Salvadoran public health services. They also advanced a participative agenda to establish a national health system and promote pro-health social policies. Without question, this experience has much to teach us about the struggle for health rights in Latin America. One key lesson is that social organizations and movements can protect health rights while also promoting initiatives that change policy, systems, and institutions in a way that protects the universal right to health.
Social and Health Equity and Equality – The Need for a Scientific Framework
Authors: Correa Botero Adriana María , Arias Valencia María Mercedes , Carmona-Fonseca Jaime
Published: January 2025

Problem: Studies on health/disease often use concepts such as equity/inequity, equality/inequality, and social justice. These terms are not always clearly and precisely defined, nor are they used with the same meaning by different authors.

Objective: 1) To present and analyze the concepts used in the literature on living conditions, social justice, social and health equity and inequality, and 2) to offer a conceptual framework that allows these concepts to be used in a scientific manner.

Methodology: Literature review and comparison of terms used in both general and specialist dictionaries, articles, and books.

Results: Broad basic definitions of terms are presented. The approach used by Latin American Collective Health and Critical Epidemiology is based on understanding the social origins of equity/inequity and their visible manifestation in the determination of equality/inequality.

Conclusion: There is little agreement on the conceptualization of these terms. The critical realism developed by Latin American Collective Health and Critical Epidemiology examines equity/inequity as a social process that generates equality/inequality and enables a scientific approach to the study of both concepts.
Drug patents: the right policy for the wrong problem
Authors: Curcio Curcio Pasqualina
Published: January 2025

Knowledge, according to economic theory, is a public good: it is non-exclusive, which means that the private sector, whose aim is to maximize profits, has no incentive to produce it since it can neither recover its investment costs nor make a profit. Since private industry cannot recover the cost of producing new knowledge they have no motivation to invest in research and development (R&D).

Knowledge is also a non-rival good; the fact that a pharmaceutical company (public or private) uses and consumes a particular knowledge in the manufacture of a particular medication does not prevent other companies from also making use of the same knowledge to produce an identical product.

The existence of public goods creates what economy theory calls “market failures.” These are situations in which the market alone cannot efficiently allocate resources. When producers cannot force consumers to pay for the consumption of a good they cannot recover their production costs, much less maximize their profits (in the case of private producers). The resulting incomplete markets are a failure from the economic point-of-view. To overcome market failures, an external agent is required to intervene. In the case of public goods, the state must create public policies that reduce or eliminate market failures by supplementing the market through a guaranteed supply of these goods.
Howard Waitzkin’s Medicine and Public Health at the End of Empire
Authors: Anderson Matthew
Published: January 2025

I first heard Howard Waitzkin’s thesis that “US capitalism as we have known it has ended, and em-pire in its previous form has ended” at the Interna-tional Association of Health Policy in Europe (IAPHE) conference in Ankara, Turkey on Sunday, October 2, 2011. I must admit I was skeptical of these ideas. Certainly, only the previous year the Obama administration had stepped in to massively subsidize the US financial sector and take over two major US automobile manufacturers; this clearly had nothing to do with the declared rules of a capitalist economy. However, public subsidization of private enterprises has been common throughout US history. True, there was evidence that the US empire has been weakened, yet were we not still involved in a massive war on terror that seemed to have no discernible end? Was it really time to speak of an end of capitalism and empire?
The role of research in the right to health and the universal provision of health care
Authors: Torres Tovar Mauricio , De Paepe Pierre
Published: January 2025

It is common for governments to promise universal health care coverage during electoral campaigns; indeed, it is something that hardly anyone could not aim for.

Research can play a major role in the evaluation of health systems. Research thus contributes to the public debate regarding the health and wellness ef-fects of different systems as well as the degree to which different systems realize the universal right to health. Research can be used both by policy makers concerned with achieving effective coverage as well as by social movements interested in fostering public debate and social mobilization to demand governmental enforcement and protection of the universal right to health enshrined in international human rights law.
Staging a conference to frame war as a public health problem
Authors: Bartlein Rebecca , Kanter Evan , Wade Daren , Hagopian Amy
Published: January 2025

“War & Global Health: Transforming Our Professions, Changing our World,” a conference organized at the University of Washington in the spring of 2010 by the Department of Global Health in the School of Public Health and Physicians for Social Responsibility, aimed to promote a public health approach to war and frame the prevention of war as a legitimate and imperative academic endeavor. The conference planners drew on substantial, yet under-acknowledged, work on the health consequences of war in both research and practice. They considered historical lessons on how a human behavior with negative consequences—generated by political and economic forces—can be framed as a health issue by health professionals. Key elements in the planning and execution of the conference were a strategic partnership between an academic department and an activist organization and the harnessing of considerable student energies. Conference organizers built on a policy statement adopted by the American Public Health Association in 2009 outlining the responsibility of public health professionals to prevent war. The authors document the important elements and the convergence of forces that resulted in a successful conference, examine the lessons learned, and offer a Web-based resource for those interested in staging a similar event.
Honoring Vic Sidel
Authors: Anderson Matthew , Smith Clyde Lanford (Lanny)
Published: January 2025

This issue of Social Medicine honors the work of Victor W. Sidel, MD. Most of the papers come from a symposium held in his honor at the end of 2012. Their publication in this journal seems especially fitting since Dr. Sidel wrote a paper titled “Social Medicine at Montefiore: A Personal View” for the first issue of this journal in 2006.

Dr. Sidel and many of the speakers at the symposium are responsible for the remarkable flowering of U.S. social medicine that occurred in the 1960s and 1970s. We are delighted that many of the papers in this journal capture a bit of that remarkable period. In this editorial we would like to examine the historical context for that flowering and consider what implications it might have for social medicine today.
The origins of Physicians for Social Responsibility (PSR) and International Physicians for the Prevention of Nuclear War (IPPNW)
Authors: Alexander Sidney
Published: January 2025

This article reviews the beginnings and history of the physicians’ antinuclear movement. The role of Victor W. Sidel, MD, is described, particularly his involvement with Physicians for Social Responsibility (PSR) and International Physicians for the Prevention of Nuclear War (IPPNW).
The Department of Social Medicine at Montefiore and Vic Sidel
Authors: Belmar Roberto
Published: January 2025

Montefiore’s Division of Social Medicine (DSM) (later a Department) was conceived and created by Martin Cherkasky, MD, in 1950 shortly before Cherkasky became the Director of Montefiore Hospital. As DSM’s first Chairman, Cherkasky understood health care as a social endeavor. The Department not only delivered first-class medical and health care, but understood the individual, the family, and the community as social entities involved in the creation of a more just and egalitarian society.
Working for social justice at Montefiore and Einstein
Authors: Paccione Gerald A.
Published: January 2025

Victor W. Sidel was the third head of Montefiore Medical Center’s Department of Social Medicine. Founded by Ephraim Bluestone and initially led by Martin Cherkasky and George Silver, the Department pioneered and implemented the vision of a “hospital without walls.” Sidel took that vision further by choosing to work primarily in health care rather than medical care, with the well rather than the sick, and with people rather than patients. The Department of Social Medicine of the 1970s created a discipline in “clinical public health” and landmark initiatives in the field: the Community Health Participation Program, the Child Care Health Project, the Addiction Services Agency Consultation and Training Project, methadone maintenance programs, prison health programs at Rikers Island, curricula in community and social medicine in universities across the New York City area, and international scholarship and advocacy, particularly involving China and Latin America. This article briefly describes these novel programs of the time and their descendants in the 21st century, emphasizing the formative impact of Sidel’s Department of Social Medicine of the 1970s and 1980s on Montefiore Medical Center/Albert Einstein College of Medicine’s work today, both in the Bronx and globally.
Poverty, social injustice, and health
Authors: Levy Barry S.
Published: January 2025

Approximately 46 million Americans live below the poverty line, and about 2.5 billion people globally live on less than $2 a day. Poor people have higher rates of morbidity, mortality, and disability, and less access to medical care and preventive services. They have more exposure to environmental health hazards. They are less likely to have access to healthful food. And they are more likely to be victims of violence. Much needs to be done to address the social injustices of poverty, including documentation and research, awareness-raising, and improved access to medical care, preventive services, education, job training, employment opportunities, and adequate housing. Health professionals must be culturally competent to address the medical needs of poor people, and socially and politically competent to address the social contexts that keep poor people poor. Victor W. Sidel, MD, has done important work to address poverty, and he has created a huge legacy for health, peace, and social justice.
Household characteristics and unintended pregnancy among ever-married women in Nigeria
Authors: Izugbara Chibuogwu
Published: January 2025

Unintended pregnancy is a worldwide problem. Unintended or unplanned pregnancy refers to the sum of mistimed and unwanted pregnancies. A woman is assumed to have a mistimed pregnancy if she became pregnant at a time when she did not want to. A woman is assumed to have an unwanted pregnancy if she did not intend to ever become pregnant or if the pregnancy occurred when she wanted to no more children. This study used data from the 2008 Nigeria Demographic and Health Survey (NDHS) to identify individual-level and household-level factors associated with unintended pregnancy among ever-married women in Nigeria. Unintended pregnancy was measured using Lightbourne method. Among the factors associated with higher rates of unintended pregnancies were female-headed households, households headed by older adults, family size, and poverty. Women from rich households were 21% less likely to have unintended pregnancies compared to women from poor house-holds. When all variables were controlled for simultaneously, age and sex of household head, house-hold size, and wealth index were significantly associated with unintended pregnancy. Findings suggest that tackling unintended pregnancy may require household-focused interventions.
Street Health: Cross-sectional study identifying social medicine issues amongst patients of the Health Center for Homeless in Berlin, Germany
Authors: Tinnemann Peter , Bauer Theresa E. S. , De la Torre Castro Jenny , Binting Silvia , Keil Thomas
Published: January 2025

Background: An estimated 265,000 people are homeless in Germany, with 10,000 in Berlin alone. Their physical and psychological health is particularly threatened by their living conditions. Access to health services is often difficult, sometimes impossible, for them. New approaches to care of the homeless offer multidisciplinary support, but systematic analysis of these are lacking. The aim of this study is to analyze socio-demographic and health characteristics of patients at the Berlin Health Center for Homeless (Gesundheitszentrum für Obdachlose), founded in 2006.

Methods: Retrospective analysis of primary care patient data from September 2006 to March 2008 regarding reasons for seeking care, existing health problems, and socio-demographic characteristics.

Results: Among a total of 440 homeless patients, 81% were male, with a mean age of 43.5 years (SD=13), 19% were female, with a mean age of 37.2 years (SD=12.8), 62% were single, 26% were foreigners (particularly from Eastern Europe), 71% had obtained a graduation certificate after at least 10 years of schooling, 16% had higher education, and 53% were without health insurance. 58% had a tobacco addiction and 43% an alcohol addiction. The most frequent health complaints were infectious diseases (16%), trauma (15%), respiratory diseases (14%), and skin diseases (9%).

Conclusions: Despite popular perceptions, homelessness in Berlin increasingly affects women, young adults, and better-educated patients. More systematic and longitudinal studies analyzing specific medical care for the homeless are urgently needed.
“For the good of mankind": The legacy of nuclear testing in Micronesia
Authors: Yamada Seiji , Akiyama Matthew
Published: January 2025

US government research on the health effects of exposure to radiation from nuclear weapons in-volved gross violations of the human rights of peo-ple in the Marshall Islands. In all likelihood, fallout from US nuclear weapons testing in the Pacific was deposited on other Micronesian islands. The US government should release the classified data it pos-sesses on the history of nuclear testing, fallout pat-terns, and the effects on the people of the Marshall Islands and the rest of Micronesia. Health workers should work to ensure that nuclear-armed states ful-fill their treaty obligations to pursue negotiations toward the elimination of nuclear weapons. As a matter of social justice, in order to ensure the human right to health, the federal government should ex-tend Medicaid eligibility to all Micronesian people from the Compact of Free Association nations.
Understanding the social determinants of health/disease: Intestinal parasites and malnutrition in the families of Urabá, Colombia
Authors: Correa Botero Adriana María , Carmona-Fonseca Jaime
Published: January 2025

Background: The triple burden of endemic pathogenic intestinal parasites (PIP), malaria, and hunger-malnutrition remains quite common in many countries of the Americas, Africa, and Asia.

Objective: The objective of this paper is to use the tools of critical epidemiology to examine the prevalence of PIPs and malnutrition and to describe the living conditions of children aged
The Chilean AUGE healthcare guarantees from a patient perspective: a survey of access to healthcare in rural central Chile
Authors: Schrepel Caitlin , Tanenbaum Eric , Paccione Gerald , Belmar Roberto
Published: January 2025

Objectives: In order to improve the care provided at a rural consultorio, we obtained patients’ perspectives on the successes and failures of the Chilean healthcare system under the AUGE (Acceso Universal de Garantías Explícitas, Universal Access with Explicit Guarantees) plan.

Background: In 2000, Chile’s AUGE Plan established a set of guarantees for specific medical conditions. All citizens are now guaranteed access to appropriate treatment, quality care, and financial protection for what are currently 80 conditions. All registered members can access either public or private healthcare; insurance payments are based on income. However, while Chile has been successful in increasing access to care, the system still faces challenges.

Methods: In order to understand the patient perspective on access to healthcare, a survey was administered in a rural general medical clinic in the public sector. The questions covered general demographic information, measures of health, satisfaction with care, and access to care.

Results: Fifty patients responded to the survey. 64% of patients reported not being able to afford their preferred treatments for their illness(es) and only 59% reported knowing their rights under the national health plan. 61% reported having a doctor who knows them well. Patients reported not taking their prescribed medications due to forgetfulness (42%), not feeling sick (34%), or a belief that they were not necessary (22%). Wait times for non-urgent specialist care of up to two years were reported. 8.8% of women reported not feeling comfortable discussing domestic abuse with their physician and/or felt they would have problems finding resources elsewhere. 84% of women age 21-75 reported receiving their screening Papanicolau smear and 80% of women between age 50-75 reported receiving their screening mammogram in accordance with government guidelines.

Discussion: The rural site studied has been successful at implementing women’s health screening, providing preventive care for chronic disease patients, and maintaining general patient satisfaction. However, despite explicit guarantees to quality medical care, many survey respondents indicated perceived deficiencies in the care they are receiving in the public sector clinic. Lack of patient education, preference for natural remedies, and long wait-times for specialist care appear to be challenges faced by this population. Work still remains in assuring the full delivery of AUGE’s promises and in increasing patient awareness of their rights under the national health plan.
Exploring the Hidden Curriculum of Global Health
Authors: Anderson Kelly Christine , Raza Danyaal , Philpott Jane
Published: January 2025

Universities are experiencing a hurried expansion of global health programs to accommodate interested trainees. A growing body of literature has addressed the practical and ethical considerations for singular global health experiences, and other articles have begun to tackle competencies for building global health curricula. However, standardized approaches to teaching global health are frequently absent, leaving learners to build their knowledge through a variety of avenues: formal coursework, informal reading, conferences, research, mentorship, and electives.

The hidden curriculum, described as “processes, pressures and constraints which fall outside…the formal curriculum, and which are often unarticulated or unexplored”, has been identified as a powerful force in medical education, affecting impressions, decisions, career paths and morale of trainees. Because global health education is evolving rapidly, is it possible it contains its own uncharted hidden curriculum influencing learners in unknown ways?

By investigating the contents of the hidden curricula, trainees have the opportunity to reframe and reconsider how it affects them, whether positively or negatively. But identifying and articulating hidden curricula or shared hidden perceptions is not an easy task. We offer four areas of hidden curriculum as opportunities for exploration.
Volviendo empleados a los doctores
Authors: Anderson Matthew
Published: January 2025

Mucho del debate en torno al “Programa Obamacare” (Ley para la Atención Médica Asequible y Protección al Paciente, ACA, por sus siglas en inglés, Patient Protection and Affordable Care Act) se da en torno a su financiamiento y a su intención de garantizar acceso universal a los servicios de salud a través del mercado, vía las aseguradoras privadas. Aparte de las historias sensacionalistas sobre los “Comités de la Muerte,” se ha prestado muy poca atención a las implicaciones reales de esta Ley para los servicios de salud. Este texto pretende contribuir a llenar este hueco.
What is a social medicine doctor?
Authors: Karnik Arati , Tscahnnerl Asiya , Anderson Matthew
Published: January 2025

Background: In 1970 Montefiore Medical Center created the Residency Program in Social Medicine (RPSM) to train physicians to provide care for the underserved. We investigated the characteristics identified by RPSM residents, faculty, and alumni to be those of a “social medicine doctor.”

Methods: Current residents, faculty, and alumni of the RPSM were eligible to participate in the survey, which was sent via email. The survey had seven items: status (resident, faculty, or alumni); specialty (Family Medicine, Internal Medicine, Pediatrics); the role of social medicine in their clinical practice, how social medicine doctors differed from other primary care physicians (PCP), and questions regarding the RPSM curriculum. Demographic data was tabulated, and comments were grouped into themes and investigated via textual and qualitative analysis.

Results: The survey was completed by 173 respondents (29% of 590 potential participants). Forty-seven percent were in Family Medicine, 30% in Internal Medicine, and 24% in Pediatrics. Fifty-four percent were alumni, 28% were faculty, and 22% were current residents. There were three main themes: social medicine doctors have a broad knowledge of the social determinants of health, they have the ability to translate this broad knowledge of health into a specific treatment plan, and they promote social justice in their work. Sub-themes provided a richer description of social medicine concepts and how social medicine practice contrasted with the practice of other primary care physicians.

Conclusions: Within the model adopted by the RPSM social conditions are seen as integral to clinical care. This model was viewed as fundamentally different from the practice of other primary care physicians.
Universal health coverage in Latin America?
Authors: Laurell Asa Cristina
Published: January 2025

This Medicina Social/Social Medicine issue includes, among others, two articles critical of so-called Universal Health Coverage (UHC), one by Mishra and Seshadri and another by Waitzkin. The debate surrounding UHC has been around for a while in Latin America, where progressive governments have worked towards guaranteeing the universal right to health through a single, free, public health system, whilst neoliberal governments have implemented policies based on public-private insurance schemes and competition between public and private health service providers. The debate therefore swings between two different and opposing perspectives based on different views of the world and society where the competition between public and private insurance forms part of the neoliberal doctrine and the single, free, public health system is linked to the welfare state. The doctrinal and ideological nature of the neoliberal approach is demonstrated by the fact that it is modeled on the most expensive and inefficient health system in the world: that of the US. ...
A systematic review of longitudinal cohort studies on the health of migrant populations
Authors: Hernando C. , Sabidó M. , Ronda E. , Ortiz-Barreda G. , Casabona J.
Published: January 2025

Background: Interest in research on migrant health is increasing. The aim of this study is to review sample characteristics, study design, and outcomes (participation and retention rate) of longitudinal studies of the health of migrant populations, and to evaluate whether there are differences in outcomes related to study populations and methodology.

Methods: A literature search of prospective longitudinal studies on migrants’ health was performed in Medline and Web of Science, with 545 articles retrieved. Key informants were contacted when needed. After identification, screening, and eligibility, nine articles were included.

Results: The most commonly studied topics were occupational and mental health (44.4%). Two studies had sample sizes of >5000 subjects, and 4 studies recruited families. One study targeted undocumented workers. Study duration was 2 years in 4 studies with 1 follow up wave. Two studies collected biological samples, and 2 used incentives. Higher participation (PR) and retention (RR) rates were found in studies of families, studies of groups perceived to be at high risk, studies where the researchers had close community ties, and studies where complete contact information had been obtained by the researchers. Lower PR and RR were associated with large time delays between waves and targeting irregular workers. Respondent driven sampling (RDS) was successful in reaching hidden populations.

Conclusions: Identification of documented migrants through governmental records, early follow up, use of a variety of strategies (including digital technologies) to locate participants and maintaining personal relationships are the main factors influencing PR and RR. It is essential to consider them when planning research and to foresee and plan for the difficulties that might arise during a longitudinal study.
On Technological Interventions in Food for Hunger and Malnutrition
Authors: Prasad Vandana , Holla Radha , Sinha Dipa , Dand Sejal , Gupta Arun , Shatrughna Veena , Dreze Jean , Singh Devika , Jain Sachin
Published: January 2025

This position paper has been drafted by the members of the Working Group for Children Under 6 [of Jan Swasthya Abhiyan (People’s Health Movement India) and the Right to Food Campaign]. It was published in abridged form as a letter to the editor in Economic and Political Weekly, January 2, 2016;Vol 2, No 1 under the title Hunger and Structural Inequality
The role of women in Nicaraguan history and their relationship to the Nicaraguan state
Authors: Hamlin-Zuniga Maria , Quirós Víquez Ana
Published: January 2025

The struggle between the state on one hand, and democracy and society on the other, reflects the ongoing conflict between the rulers and the ruled, between governing and dialoguing, and especially the conflict between the government and its female citizens, between the government and those autonomous social movements, which are not bound to any party, religious, or similar interests. This paper discusses how Nicaraguan women from such autonomous movements have managed to live and survive in the midst of these contradictions.

To govern people without regard to their sex, gender, race or ethnicity is to ignore the needs of specific social groups and their ways of relating to power. This shortcoming has been recognized and efforts made to integrate this understanding into public policy. The majority of the theories about the State, however, are gender-blind. By not recognizing that women have needs that transcend class, ethnicity, and social group, “gender-blind” policies act as an instrument to reproduce discrimination and oppression of women.

Liberal doctrines conceive of the state as a “neutral arbitrator between competing interests” with a clear separation between the public and private (family, personal) spheres. This is within these spheres where demands for better educational opportunities, better work, women’s suffrage, equality in marriage and property rights for women are decided. However, this approach ignores the fact that women have different needs and required specific conditions in to access and exercise their rights as citizens.

Marxists see the state as a “tool of domination and repression” controlled by capitalist classes, but do not take into account gender, nationality, or ethnicity dimensions; they are only interested in social class. The oppression of women is under-stood as a consequence of their class position, lack of property and exclusion from the production process; gender is not taken into account.

In this paper, we will use Connell’s definition of the state as “an important vehicle for regulating sexual and gender oppression,” which is a “pro-cess” linked to social structures and not a static mechanism. Its institutional structure is recognized as a “part of a larger social structure of gender relations.” It views the State not as an actor outside the prevailing gender structure, but as the very embodiment of those gender structures. The state plays a key role in perpetuating gender relation-ships and the centerpiece of that control is the exercise of power.
UROLOGISTS’ KNOWLEDGE AND PERCEPTIONS ABOUT MANAGEMENT OF INFECTIONS AND ANTIBIOTIC RESISTANCE
Authors: Medina-Polo José , Arroyo Mario Hernández , Arrébola-Pajares Ana , Pérez de la Blanca Rocío Santos , Antolín Alfredo Rodríguez
Published: January 2025

OBJECTIVE. The correct management of infections is a point of paramount importance. Therefore, evaluating the degree of knowledge of all these factors and analysis of possible issues of improvement will result in better health care. We aimed to assess the perceptions about antibiotics prescription and bacterial resistance among urologists.
MATERIALS & METHODS. A self-administered questionnaire designed to evaluate the degree of knowledge in the antibiotic treatment of infections. We adapted a questionnaire developed by Pulcini and modified by Navarro-San Francisco. Most of the questions were assessed with a 5-point Likert-style scale with response options from very unhelpful/unimportant/ unconfident to very helpful/important/confident.
RESULTS. The survey was completed by 176 urologists. Only 4.5% (8) have been training in an infectious diseases department, and 80.1% prescribed more than three antibiotics per week. Although most the urologists feel confident about the antibiotic selection (97,7%), the percentage that was not confident about interactions with other drugs was 41,7%. Most responders perceived antimicrobial resistance as a significant problem (99.4%). The local prevalence of E. coli resistance to quinolones was not accurately known by 31% of the responders. Moreover, 35% of the responders considered that the percentage of patients where the selection of empirical antibiotics was not adequate in 11–20% of the prescriptions and 37% in >21% of the prescriptions.
CONCLUSIONS. Although the confidence among urologists in the management of infection is high, several points require attention, such as measures for better training regarding prescription and prevention of multidrug-resistant microorganisms.
O Acolhimento De Pacientes Em Surto Psicótico Nos Serviços De Urgência: Desafios E Estratégias
Authors: Madureira Emanuella da Silva , Freitas Talita Ferreira Lima , Evangelista Ellen Márcia Fontes , Moura Ivana Fraga Teixeira de , Vieira Nara Louise Moreira Souza , Rocha Lays Ferraz da Silva , Silva Rubia dos Santos , Silva Hêlia Patrocínio dos Santos , Santos Valdijane Souza
Published: January 2025

Receiving psychotic patients in emergency services is a complex process that requires technical preparation, sensitivity and institutional support. This study aims to identify effective strategies for managing these patients, exploring humanized practices, safety and integration with the Psychosocial Care Network (RAPS). To this end, an integrative literature review was carried out, including articles published between 2019 and 2023, available on the PUBMED/MEDLINE, SciELO and LILACS databases. The selection followed strict inclusion and exclusion criteria, resulting in a final sample of six articles. The results pointed to significant challenges, such as the lack of continuous professional training, the social stigma associated with mental disorders and the lack of physical and human resources in emergency services. On the other hand, effective strategies stood out, including the continuous training of health teams, the use of active listening, the adoption of harm reduction practices, the standardization of care protocols and coordination with other services in the health network. We conclude that the reception of psychotic patients in emergency services requires an interprofessional and humanized approach that is capable of guaranteeing comprehensive care, promoting patient safety and strengthening mental health services.
MEMBAUR DALAM KEBERAGAMAN: IMPLEMENTASI MODERASI BERAGAMA DALAM MENGENDALIKAN FANATISME
Authors: Badruddin
Published: January 2025

Moderasi Beragama merupakan sikap toleransi antar sesama umat beragama dalam rangka menciptakan keamanan, kedamaian, dan ketentraman dalam kehidupan. Maka dari itu sudah sepantasnya antara satu umat Islam dengan umat Islam lainnya untuk menjadi contoh bagi umat lainnya dalam hal toleransi. Namun demikian yang terjadi pada masa sekarang adalah sebaliknya dimana satu golongan Islam merasa mereka yang paling benar diantara golongan lainnya sehingga menyebabkan timbulnya fanatisme dalam beragama. Fanatisme sangat berbahaya dalam kehidupan karena dapat merusak berbagai keanekaragaman yang ada di Indonesia. Penelitian ini menggunakan library reaserch yang kemudian data sekunder yang digunakan dianalisa menggunakan metode analisis isi. Hasil penelitian menunjukkan bahwa fanatisme dapat terjadi karena disebabkan beberapa faktor seperti kondisi sosial yang fanatik, berdebat demi popularitas, cinta berlebihan kepada ulama, kekuasaan otoriter yang mengintervensi kehidupan beragama,, tidak mengoreksi pendapat yang salah, dan sebagainya. Maka dari itulah moderasi beragama adalah solusi yang sangat tepat untuk mengendalikan fanatisme dengan cara menimplementasikan nilai-nilai dasar moderasi beragama.
PET/CT Imaging in Cardiac Sarcoidosis
Authors: Gümüş Adil , Özcan Pınar Pelin , Koç Zehra Pınar , Süleymanoğlu Mahmut , Sağlam Zeynep Selcan
Published: January 2025

Sarcoidosis is a systemic granulomatous disease of unknown cause. The most commonly affected structures are the thoracic lymph nodes and the lungs, but any organ can be involved . In sarcoidosis, the heart can be affected both due to lung involvement and direct disease involvement. Clinically detected cardiac involvement is around 5%; However higher rates are reported in autopsy series. Endomyocardial biopsy, which is the definitive diagnostic method, is difficult and has low diagnostic value. Effective and reliable advanced cardiac imaging methods are needed in cardiac sarcoidosis . As well as the diagnosis of cardiac sarcoidosis, it is also important to determine disease activation, determine the treatment strategy, evaluate the severity, estimate the prognosis, and adjust steroid therapy . The most commonly used molecular imaging method in clinical practice for these purposes is Fluorodeoxyglucose (FDG) PET/CT imaging labeled with Fluorine-18 (F-18). Increased uptake in the myocardium on F-18 FDG PET/CT imaging is considered an important finding reflecting the activity of inflammation in cardiac sarcoidosis. In this report, two patients whose sarcoidosis diagnosis was confirmed histopathologically and who underwent PET CT examination due to cardiac sarcoidosis in our department are presented.