A fetus in the world: Physiology, epidemiology, and the making of fetal origins of adult disease.

Since the late 1980s, the fetal origins of adult disease, from 2003 developmental origins of health and disease (DOHaD), has stimulated significant interest in and an efflorescence of research on the long-term effects of the intrauterine environment. From the start, this field has been interdisciplinary, using experimental animal, clinical and epidemiological tools. As the influence of DOHaD on public health and policy expanded, it has drawn criticism for reducing the complex social and physical world of early life to women's reproductive bodies as drivers of intergenerational ills. This paper explains this narrowing of focus in terms of a formative and consequential exchange between David Barker, the British epidemiologist whose work is credited with establishing the field, and the discipline of fetal physiology. We suggest that fetal physiologists were a crucial constituency of support for Barker's hypothesis about early life origins of disease. Their collaborations with Barker helped secure and sustain the theory amid considerable controversy. The trajectory of DOHaD and its focus on the maternal body can be understood, we argue, as a consequence of this alliance, which brought together two distinct conceptualizations of the intrauterine environment, one from epidemiology and the other from fetal physiology. Along the way, we trace the histories of these conceptualizations, both of which were products of mid-to-late twentieth century British science, and show how Barker's early emphasis on social and economic conditions was superseded by a narrower focus on physiological mechanisms acting upon the autonomous fetus.

Sustaining youth physical activity in times of challenge and change: lessons from COVID-19.

Physical activity (PA) is recognized as essential for positive physical and mental well-being in young people. However, participation in PA is known to decline as adolescents emerge into adulthood under the influence of complex social and structural factors. Globally, COVID-19 restrictions resulted in changes to PA and PA participation levels in youth populations, providing a unique opportunity for gaining insight into PA barriers and enablers in circumstances of challenge, limitation and change. This article details young people's self-reported PA behaviours during the 4-week 2020 COVID-19 lockdown in New Zealand. Taking a strengths-based view and drawing on the COM-B (capabilities, opportunity and motivation behaviour) model for behaviour change, the study explores factors enabling young people to sustain or increase PA during lockdown. Findings are drawn from qualitative-dominant mixed-methods analyses of responses to an online questionnaire: New Zealand Youth Voices Matter (16-24 years; N = 2014). Key insights included the importance of habit and routine, time and flexibility, social connections, incidental exercise and awareness of links between PA and well-being. Of note were the positive attitudes, creativity and resiliency demonstrated as young people substituted or invented alternatives to their usual PA. PA needs to change to adapt to new circumstances over the life course, and youth understanding and knowledge of modifiable factors may provide support for this. Thus these findings have implications for sustaining PA during late adolescence and emerging adulthood, a life phase that can be associated with significant challenge and change.

Understanding the importance of the early-life period for adult health: a systematic review.

Evidence clearly indicates that the nutritional and non-nutritional environment and level of physical activity during the early-life period from preconception through infancy has a lifelong impact on the child's health. However this message must be communicated effectively to parents and other stakeholders such as grandparents, health professionals, policymakers and the wider community in order for positive change to occur. This systematic review explores how both awareness and understanding of the long-term effects of the early-life environment have been measured in various populations and whether any patterns are evident. Ten articles were retrieved via a search of Embase, Medline and Scopus databases for peer-reviewed studies designed to assess participants' knowledge of the links between early-life exposures and adult health. Eligible articles spanned a wide range of countries, population groups and research methods. Three common themes were identified using thematic analysis: 1. a tendency for researchers to conflate participant understanding of the issue (the WHY) with a knowledge of key phrases and nutrition guidelines (the WHAT); 2. bias in both researchers and participants towards short-term thinking due to difficulty conceptualising long-term risk; and 3. challenges in comprehending the complexity of the evidence resulting in oversimplification and the overemphasis of maternal factors. Taken together these findings underscore the importance of a multi-level, whole-of-society approach to communicating the evidence, with the goal of influencing policy decisions as well as building a foundation of community support for parents and prospective parents to create a healthy early-life environment for the long-term wellbeing of all.

Towards Post-Pandemic Sustainable and Ethical Food Systems.

The current global COVID-19 pandemic has led to a deep and multidimensional crisis across all sectors of society. As countries contemplate their mobility and social-distancing policy restrictions, we have a unique opportunity to re-imagine the deliberative frameworks and value priorities in our food systems. Pre-pandemic food systems at global, national, regional and local scales already needed revision to chart a common vision for sustainable and ethical food futures. Re-orientation is also needed by the relevant sciences, traditionally siloed in their disciplines and without adequate attention paid to how the food system problem is variously framed by diverse stakeholders according to their values. From the transdisciplinary perspective of food ethics, we argue that a post-pandemic scheme focused on bottom-up, regional, cross-sectoral and non-partisan deliberation may provide the re-orientation and benchmarks needed for not only more sustainable, but also more ethical food futures.

Publicity, politics, and professoriate in fin-de-siècle Vienna: The misconduct of the embryologist Samuel Leopold Schenk.

This essay uses the case of the fin-de-siècle Vienna embryologist Samuel Leopold Schenk to analyze the factors at play in allegations of misconduct. In 1898, Schenk published a book titled Theorie Schenk. Einfluss auf das Geschlechtsverhältnis (Schenk's theory. Influence on the sex ratio). The book argued that, by changing their diet, women trying to conceive could influence egg maturation and consequently select the sex of their offspring. This cross between a scientific monograph and a popular advice book received enormous publicity but also spurred first the Vienna Medical Association and then the Senate of the University of Vienna to accuse Schenk of poor science, self-advertisement, quack medical practice, and wrong publisher choice. Formal proceedings against Schenk ended in 1900 with the unusually harsh punishment of early retirement. Schenk died two years later. I examine the elements of the case, from the science of sex determination and selection, to the growth of print media and advertising within the changing demographic and political landscape of Vienna. I argue that the influence of the public, via the growing media, upon science was the main driver of the case against Schenk, but also that the case would have had a more limited impact were it not for the volatile political moment rife with anti-Semitism, nationalism, and xenophobia. I draw the attention to the importance of setting cases of misconduct in the broader political history and against the key social concerns of the moment.

The Science and Politics of Naming: Reforming Anatomical Nomenclature, ca. 1886-1955.

Anatomical nomenclature is medicine's official language. Early in their medical studies, students are expected to memorize not only the bodily geography but also the names for all the structures that, by consensus, constitute the anatomical body. The making and uses of visual maps of the body have received considerable historiographical attention, yet the history of production, communication, and reception of anatomical names-a history as long as the history of anatomy itself-has been studied far less. My essay examines the reforms of anatomical naming between the first modern nomenclature, the 1895 Basel Nomina Anatomica (BNA), and the 1955 Nomina Anatomica Parisiensia (NAP, also known as PNA), which is the basis for current anatomical terminology. I focus on the controversial and ultimately failed attempt to reform anatomical nomenclature, known as Jena Nomina Anatomica (INA), of 1935. Discussions around nomenclature reveal not only how anatomical names are made and communicated, but also the relationship of anatomy with the clinic; disciplinary controversies within anatomy; national traditions in science; and the interplay between international and scientific disciplinary politics. I show how the current anatomical nomenclature, a successor to the NAP, is an outcome of both political and disciplinary tensions that reached their peak before 1945.

The laboratory and the asylum: Francis Walker Mott and the pathological laboratory at London County Council Lunatic Asylum, Claybury, Essex (1895-1916).

London County Council's pathological laboratory in the LCC asylum at Claybury, Essex, was established in 1895 to study the pathology of mental illness. Historians of psychiatry have understood the Claybury laboratory as a predecessor of the Maudsley Hospital in London: not only was this laboratory closed when the Maudsley was opened in 1916, but its director, Frederick Walker Mott, a champion of the 'German' model in psychiatry, was instrumental in the establishment of this institution. Yet, as I argue in this essay, for all the continuities with the Maudsley, the Claybury laboratory should not be seen solely as its predecessor - or as a British answer to continental laboratories such as Theodor Meynert's in Vienna. Rather, as I show using the examples of general paralysis of the insane and 'asylum colitis', the Claybury laboratory is best understood as an attempt to prevent mental illness using a microbiological model.

Food, growth and time: Elsie Widdowson's and Robert McCance's research into prenatal and early postnatal growth.

Cambridge scientists Robert McCance and Elsie Widdowson are best known for their work on the British food tables and wartime food rations, but it is their research on prenatal and early postnatal growth that is today seen as a foundation of the fields studying the impact of environment upon prenatal development and, consequently, adult disease. In this essay I situate McCance's and Widdowson's 1940s human and 1950s experimental studies in the context of pre-war concerns with fetal growth and development, especially within biochemistry, physiology and agriculture; and the Second World War and post-war focus on the effects of undernutrition during pregnancy upon the fetus. I relate Widdowson's and McCance's research on the long-term effects of early undernutrition to the concern with recovery from early trauma so pertinent in post-war Europe and with sensitive (critical) periods, a concept of high importance across different fields. Finally I discuss how, following a hiatus in which fetal physiology engaged with different questions and stressed fetal autonomy, interest in the impact of environment upon prenatal growth and development revived towards the end of the twentieth century. The new field of "developmental origins of health and disease", I suggest, has provided a context in which Widdowson's and McCance's work has regained importance.

How evolutionary principles improve the understanding of human health and disease.

An appreciation of the fundamental principles of evolutionary biology provides new insights into major diseases and enables an integrated understanding of human biology and medicine. However, there is a lack of awareness of their importance amongst physicians, medical researchers, and educators, all of whom tend to focus on the mechanistic (proximate) basis for disease, excluding consideration of evolutionary (ultimate) reasons. The key principles of evolutionary medicine are that selection acts on fitness, not health or longevity; that our evolutionary history does not cause disease, but rather impacts on our risk of disease in particular environments; and that we are now living in novel environments compared to those in which we evolved. We consider these evolutionary principles in conjunction with population genetics and describe several pathways by which evolutionary processes can affect disease risk. These perspectives provide a more cohesive framework for gaining insights into the determinants of health and disease. Coupled with complementary insights offered by advances in genomic, epigenetic, and developmental biology research, evolutionary perspectives offer an important addition to understanding disease. Further, there are a number of aspects of evolutionary medicine that can add considerably to studies in other domains of contemporary evolutionary studies.

Epigenetic mechanisms that underpin metabolic and cardiovascular diseases.

Cellular commitment to a specific lineage is controlled by differential silencing of genes, which in turn depends on epigenetic processes such as DNA methylation and histone modification. During early embryogenesis, the mammalian genome is 'wiped clean' of most epigenetic modifications, which are progressively re-established during embryonic development. Thus, the epigenome of each mature cellular lineage carries the record of its developmental history. The subsequent trajectory and pattern of development are also responsive to environmental influences, and such plasticity is likely to have an epigenetic basis. Epigenetic marks may be transmitted across generations, either directly by persisting through meiosis or indirectly through replication in the next generation of the conditions in which the epigenetic change occurred. Developmental plasticity evolved to match an organism to its environment, and a mismatch between the phenotypic outcome of adaptive plasticity and the current environment increases the risk of metabolic and cardiovascular disease. These considerations point to epigenetic processes as a key mechanism that underpins the developmental origins of chronic noncommunicable disease. Here, we review the evidence that environmental influences during mammalian development lead to stable changes in the epigenome that alter the individual's susceptibility to chronic metabolic and cardiovascular disease, and discuss the clinical implications.

Cultures of death and politics of corpse supply: anatomy in Vienna, 1848-1914.

Nineteenth-century Vienna is well known to medical historians as a leading center of medical research and education, offering easy access to patients and corpses to students from all over the world. The author seeks to explain how this enviable supply of cadavers was achieved, why it provoked so little opposition at a time when Britain and the United States saw widespread protests against dissection, and how it was threatened from mid-century onward. To understand permissive Viennese attitudes, we need to place them in a longue durée history of death and dissection and to pay close attention to the city's political geography as it was transformed into a major imperial capital. The tolerant stance of the Roman Catholic Church, strong links to Southern Europe, and the weak position of individuals in the absolutist state all contributed to an idiosyncratic anatomical culture. But as the fame of the Vienna medical school peaked in the later 1800s, the increased demand created by rising numbers of students combined with intensified interdisciplinary competition to produce a shortfall that professors found increasingly difficult to meet. Around 1900, new religious groups and mass political parties challenged long-standing anatomical practice by refusing to supply cadavers and making dissection into an instrument of political struggle. This study of the material preconditions for anatomy at one of Europe's most influential medical schools provides a contrast to the dominant Anglo-American histories of death and dissection.

Surgery and national identity in late nineteenth-century Vienna.

For historians of medicine, the professor Theodor Billroth of the University of Vienna was the leading European surgeon of the late nineteenth century and the personification of intervention by organ or body part removal. For social and political historians, he was a German nationalist whose book on medical education heralded the rise of anti-Semitism in the Austrian public sphere. This article brings together and critically reassesses these two hitherto separate accounts to show how, in a period of dramatic social and political change, Viennese surgery split into two camps. One, headed by Billroth, was characterized by an alliance with the German educational model, German nationalism leading to racial anti-Semitism and an experimental approach to the construction of surgical procedure, which heavily relied on the methods of pathological physiology. The other, which followed a long Austrian tradition, stood for a clinically oriented and strictly organized medical education that catered to an ethnically and socially diverse population and, simultaneously, for an anatomically oriented surgery, largely of the locomotor apparatus. This study shows how, in a major centre of medical education and capital of a multiethnic empire, surgical and national identities were forged together.

Medico-legal practices in the fifteenth century Dubrovnik.

We analyzed the beginnings of medico-legal practices in Dubrovnik, using the first eight books of criminal records series Liber de maleficiis from the early 15th century. We also looked into the mechanisms of individual and public control of the issues such as the patient-physician relationship and the control of epidemics. At that time, surgeons rather than physicians reported wounds to the court of justice and, in most cases, provided medical expertise when requested by the authorities. Cold steel weapons were the usual instruments of violent offences, and the most frequently harmed part of the body was the head. The expert testimonies formally satisfied the requirements laid down in Dubrovnik normative acts of the time, but their medical content was poor and the vocabulary was a mixture of lay and professional. Although Dubrovnik medical practitioners wrote simple expert testimonies and did not perform forensic autopsy, their involvement in the control of violence and development of the legal system corresponded to the role played by physicians and surgeons in the leading continental European centers of the period.

[Founding and activity of the Society of Physicians of the Kingdom of Croatia and Slovenia as reported in the newspapers from 1874 to 1875]. / Osnivanje i rad "Sbora liecnika kr. Hrvatske i Slavonije" u javnim glasilima u razdoblju 1874-1875.

The article presents the first active year of the Association of Physicians of the Kingdom of Croatia and Slavonia, today's Croatian Medical Association, (from February 26, 1874 until the annual assembly held on June 31, 1875), based upon the articles published in Zagreb daily newspapers Obzor and Narodne novine and a Zadar newspaper--Narodni list. The writings of these newspapers are situated in the spatial and temporal context based on data from secondary literature and Austrian daily newspapers. These articles were employed as historical sources, which we used to find answers to following questions: How did the Croatian public accept the foundation of the Association of Physicians of the Kingdom of Croatia and Slavonia? What did the public expect and what duties was this Association to fulfill according to the public? Finally, how did the public evaluate the results of the Association's work at the end of its first year of existence? The foundation of the Association of Physicians of the Kingdom of Croatia and Slavonia coincided with numerous initiatives on the Austro-Hungarian Monarchy level. Goal of these initiatives was to create a well ramified network of physicians' organisations that were to deal with issues related to the social status of physicians, such as fees for their professional services, retirement funds, pensions for family members etc. The first official "Rules of the Association of Physicians of the Kingdom of Croatia and Slavonia" from May 1874, puts promotion of scientific medicine and health improvement before the interests of the medical profession status. Croatian public expected that the newly founded Association would engage itself in matters such as improving medical practice, eradicating diseases, promoting foundation of a medical school in Zagreb, counselling political bodies on the health-related issues, and so on. Based on the newspaper articles, especially ones published at the end of the first year of the Associations' existence we can clearly notice discordance between public expectations and declared reasons.