Sir Marc Armand Ruffer, MD: The early years, 1878-1896.

A founder of paleopathology, the study of disease in ancient human remains, Sir Marc Armand Ruffer, MD (1859-1917) served in Egypt, from 1896 to 1917, as a public-health administrator, epidemiologist, and pathologist. He was professor of Bacteriology at the Cairo Medical School, President of the Sanitary, Maritime, and Quarantine Council, member of the Indian Plague Commission, and author or co-author of 40 papers in palaeopathology. However, little is known of his early professional life, which encompassed his education, medical training, and research in England and France. The pre-Egyptian period, 1878 to 1896, was a time of extraordinary activity. Acquiring four academic Degrees at Oxford University and clinical experience at the University College Hospital, London (1878-1889), he was the clinical assistant of Louis Pasteur during the anti-rabies campaign (autumn 1889), interim President of the British Institute of Preventive Medicine (1893-1896), and immunology researcher (1890-1895), in London and Paris, under the guidance of Élie Metchnikoff (1845-1916). Ruffer developed the diphtheria antitoxin in Britain. In addition to a dissertation on hydrocephalus, he composed or co-authored 34 papers. A prolific writer, linguist, clinician, and administrator, he explored several medical sub-disciplines before concentrating on palaeopathology.

The First 75 Years Timeline of United States Army Preventive, Occupational and Environmental Medicine, and Public Health History.

In 2017, the US Army Public Health Center (USAPHC) at Aberdeen Proving Ground, Maryland, celebrated its 75th Anniversary. The organization began in 1942 at The Johns Hopkins University School of Hygiene and Public Health in Baltimore, Maryland, as the US Army Industrial Hygiene Laboratory to provide Occupational Medicine, Industrial Hygiene and other Occupational Health services in support of the World War II military industrial base. In 1945, the organization moved to the Edgewood Area of Aberdeen Proving Ground and underwent organizational changes, mission changes and name changes. In 1960 it was renamed the US Army Environmental Hygiene Agency or AEHA, and under that name was widely recognized for significant accomplishments in Occupational and Environmental Health. In 1994, it became the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) and took on an expanded role in Public Health. A later reorganization brought in Veterinary services. In 2015, it became the USAPHC. This publication provides a timeline of important accomplishments, mission modifications, administrative changes, challenges and threats in the organization's first 75 years. To help readers put these events in perspective, abbreviated timelines of significant events in military and civilian Preventive, Occupational and Environmental Medicine and Public Health history, legal and regulatory actions related to Public Health and US military history are also included.

The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: A modelling study.

BACKGROUND: Women with HIV have an elevated risk of HPV infection, and eventually, cervical cancer. Tanzania has a high burden of both HIV and cervical cancer, with an HIV prevalence of 5.5% in women in 2018, and a cervical cancer incidence rate among the highest globally, at 59.1 per 100,000 per year, and an estimated 9,772 cervical cancers diagnosed in 2018. We aimed to quantify the impact that interventions intended to control HIV have had and will have on cervical cancer in Tanzania over a period from 1995 to 2070. METHODS: A deterministic transmission-dynamic compartment model of HIV and HPV infection and natural history was used to simulate the impact of voluntary medical male circumcision (VMMC), anti-retroviral therapy (ART), and targeted pre-exposure prophylaxis (PrEP) on cervical cancer incidence and mortality from 1995-2070. FINDINGS: We estimate that VMMC has prevented 2,843 cervical cancer cases and 1,039 cervical cancer deaths from 1995-2020; by 2070 we predict that VMMC will have lowered cervical cancer incidence and mortality rates by 28% (55.11 cases per 100,000 women in 2070 without VMMC, compared to 39.93 with VMMC only) and 26% (37.31 deaths per 100,000 women in 2070 without VMMC compared to 27.72 with VMMC), respectively. We predict that ART will temporarily increase cervical cancer diagnoses and deaths, due to the removal of HIV death as a competing risk, but will ultimately further lower cervical cancer incidence and mortality rates by 7% (to 37.31 cases per 100,000 women in 2070) and 5% (to 26.44 deaths per 100,000 women in 2070), respectively, relative to a scenario with VMMC but no ART. A combination of ART and targeted PrEP use is anticipated to lower cervical cancer incidence and mortality rates to 35.82 and 25.35 cases and deaths, respectively, per 100,000 women in 2070. CONCLUSIONS: HIV treatment and control measures in Tanzania will result in long-term reductions in cervical cancer incidence and mortality. Although, in the near term, the life-extending capability of ART will result in a temporary increase in cervical cancer rates, continued efforts towards HIV prevention will reduce cervical cancer incidence and mortality over the longer term. These findings are critical background to understanding the longer-term impact of achieving cervical cancer elimination targets in Tanzania.

[Series: Caries prevention in historical perspective. Education]. / Serie: Cariëspreventie in historisch perspectief. Voorlichting.

In the Netherlands, since the end of the nineteenth century, information has been given to the public about possible ways to prevent dental caries. This happened in the dental offices, in health centres where the parents of young children received advice, and in schools. From 1968 until the mid-1980s, large-scale information campaigns were organised in various municipalities and regions. The Ivory Cross, a Dutch society for oral health education, has been providing information on oral health and supporting the provision of information for, among others, dentists and dental hygienists by offering educational material. The understanding of the phenomenon 'information' has changed during the past century. By applying new insights, there is an increased chance to prevent caries by providing information.

Learning From Past Failures of Oral Insulin Trials.

Very recently one of the largest type 1 diabetes prevention trials using daily administration of oral insulin or placebo was completed. After 9 years of study enrollment and follow-up, the randomized controlled trial failed to delay the onset of clinical type 1 diabetes, which was the primary end point. The unfortunate outcome follows the previous large-scale trial, the Diabetes Prevention Trial-Type 1 (DPT-1), which again failed to delay diabetes onset with oral insulin or low-dose subcutaneous insulin injections in a randomized controlled trial with relatives at risk for type 1 diabetes. These sobering results raise the important question, "Where does the type 1 diabetes prevention field move next?" In this Perspective, we advocate for a paradigm shift in which smaller mechanistic trials are conducted to define immune mechanisms and potentially identify treatment responders. The stage is set for these interventions in individuals at risk for type 1 diabetes as Type 1 Diabetes TrialNet has identified thousands of relatives with islet autoantibodies and general population screening for type 1 diabetes risk is under way. Mechanistic trials will allow for better trial design and patient selection based upon molecular markers prior to large randomized controlled trials, moving toward a personalized medicine approach for the prevention of type 1 diabetes.

Strength in Numbers: Opportunities for Enhancing the Development of Effective Treatments for Type 1 Diabetes-The TrialNet Experience.

The early to mid-1980s were an inflection point in the history of type 1 diabetes research. Two landmark events occurred: the initiation of immune-based interventions seeking to prevent type 1 diabetes and the presentation of an innovative model describing the disorder's natural history. Both formed the basis for hundreds of subsequent studies designed to achieve a dramatic therapeutic goal-a means to prevent and/or reverse type 1 diabetes. However, the need to screen large numbers of individuals and prospectively monitor them using immunologic and metabolic tests for extended periods of time suggested such efforts would require a large collaborative network. Hence, the National Institutes of Health formed the landmark Diabetes Prevention Trial-Type 1 (DPT-1) in the mid-1990s, an effort that led to Type 1 Diabetes TrialNet. TrialNet studies have helped identify novel biomarkers; delineate type 1 diabetes progression, resulting in identification of highly predictable stages defined by the accumulation of autoantibodies (stage 1), dysglycemia (stage 2), and disease meeting clinical criteria for diagnosis (stage 3); and oversee numerous clinical trials aimed at preventing disease progression. Such efforts pave the way for stage-specific intervention trials with improved hope that a means to effectively disrupt the disorder's development will be identified.

WORLD AND NATIONAL EXPERIENCE IN ORGANIZATION OF PREVENTION OF CARDIOVASCULAR DISEASES.

The aim of the study was to examine the global, European and national experience in the implementation of preventive programs and to reveal their value in health, economy and social health development. The conducted research has found that the implementation of the national program, the correct methodological approach of the physician to evaluate risk factors, and implementing preventive measures of diseases of the circulatory system bring positive results (reduction of prevalence and incidence of cerebral stroke by 13,7% and 1,4%, respectively). The results of the analysis of the health care industry pointed out the possible directions of optimization of prevention of behavioral risk factors in the practice of family medicine as the first point of contact with the patient, where preventive measures are essential and effective. Summing up, it should be noted that at the level of primary health care, particularly family medicine, with effectively coordinated work and correctly set motivation, the preventive measures against risk factors of diseases of circulatory system can be quite effective.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea.

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.