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.

The Statesmanship of William Crawford Gorgas, M.D., Surgeon General, Medical Corps, United States Army.

If statesmanship can be characterized as a bed rock of principles, a strong moral compass, a vision, and an ability to articulate and effect that vision, then the fortitude, tenacity, imperturbability, and resilience of William Crawford Gorgas cannot be overestimated. As Chief Sanitary Officer in Cuba and as Chief Medical Officer in Panama, he actualized strategies to eradicate the vectors of yellow fever and malaria. His superiors initially pigeonholed his requisitions, refused to provide him with any authority, and clamored for his dismissal. Nevertheless, with dogged persistence he created a coalition of the willing, who eventually implemented those reforms. As Surgeon General in the United States Army, he organized and expanded the Active Duty and Medical Reserve Corps in anticipation of World War I. Skilled university affiliated surgeons and personnel from throughout North America, manned base hospitals in Europe. Those lessons impacted upon subsequent military and civilian surgical care-organizationally, logistically, and clinically. He was universally recognized for his bonhomie, savoir-faire, modesty, discretion, decorum, courtesy, and graciousness. To those attributes must be added his devotion to duty, discipline, integrity, and authenticity, which characterized his leadership and statesmanship. Those attributes are most worthy of emulation and perpetuation by clinicians, academicians, educators, and investigators.

[Reminiscence of the "Relief Houses" that operated in rural Chile between 1931 and 1945]. / Recuerdo histórico de las "Casas de Socorro" que funcionaron en el Chile rural entre 1931 y 1945.

In June 1929, the medical charity inspectors (Isauro Torres and Enrique Laval M.) submitted to the Direction of the Institution a plan for the normalization of all hospitals, which was approved by the Central Board at its meeting on 19 July of that year. The plan was to phase in the hospital action from the First-aid Posts or "Relief Houses" to the large referral hospitals. The "Relief House" would become the initial phase of hospital organization, located in rural areas. Finally, we emphasize that the Relief Houses were establishments for preventive and curative medicine in rural areas.

[Evolution of the theory and practices for the control of vector borne diseases]. / Evolución de la teoría y las prácticas en el control de las enfermedades transmitidas por vector.

The conceptual models of the public health have bonds with the advance in the knowledge of the VBDs. The establishment of the colonial empires, the sprouting of great scale sanitary interventions, the creation of tie international organisms dedicated to the promotion of the health, the participation of phylantropic institutions financing and organizing different health campaigns are only a few contributions to the field. This body of knowledge contributed to the birth and the progress of several medical disciplines, academic institutions and international organisms dedicated to the education of human resources, research and health services; establishing the production and reproduction bases of this intellectual field. The way that VBDs have been faced has also molded great part of the ideas and the practices in Public Health and its essence has been adopted to elaborate the prevention and control programs of other many problems of health.

Evolución de la teoría y las prácticas en el control de las enfermedades transmitidas por vector / Evolution of the theory and practices for the control of vector borne diseases

La configuración de los modelos conceptuales de la salud pública encuentran vínculos con el avance en el conocimiento de las ETV. El establecimiento de los imperios coloniales, el surgimiento de las intervenciones sanitarias a gran escala, la creación de organismos internacionales, la participación de sociedades filantrópicas en el financiamiento y organización de campañas de salud son sólo unas cuantas aportaciones al campo. Este cuerpo de conocimientos contribuyó al nacimiento y el progreso de varias disciplinas médicas, instituciones académicas y organismos internacionales dedicados a la formación de recursos humanos, la investigación y la prestación de servicios de salud, reconocidos como las bases de producción y reproducción de todo campo intelectual. La forma como se han enfrentado las ETV también ha moldeado el quehacer y las prácticas en salud pública, y su esencia ha sido adoptada para elaborar los programas de control y prevención de otros muchos problemas de salud.

The conceptual models of the public health have bonds with the advance in the knowledge of the VBDs. The establishment of the colonial empires, the sprouting of great scale sanitary interventions, the creation of tie international organisms dedicated to the promotion of the health, the participation of phylantropic institutions financing and organizing different health campaigns are only a few contributions to the field. This body of knowledge contributed to the birth and the progress of several medical disciplines, academic institutions and international organisms dedicated to the education of human resources, research and health services; establishing the production and reproduction bases of this intellectual field. The way that VBDs have been faced has also molded great part of the ideas and the practices in Public Health and its essence has been adopted to elaborate the prevention and control programs of other many problems of health.

Rodolfo dos Santos Mascarenhas: a pioneer of health history.

Studies on the work of Mascarenhas analyze his contribution to the history of health in Sao Paulo and the aspects of his work which place him in what is entitled the second generation of health workers of São Paulo state - being the first generation the one led by Emílio Ribas. This article recaptures these points and highlights his last works on preventive and community medicine. We argue that the conception of public health consolidated during his education was essential for his interest in the new model of medicine that was starting to spread in the country.

Rodolfo dos Santos Mascarenhas: a pioneer of health history / Rodolfo dos Santos Mascarenhas: pioneiro da história da saúde

Studies on the work of Mascarenhas analyze his contribution to the history of health in Sao Paulo and the aspects of his work which place him in what is entitled the second generation of health workers of São Paulo state - being the first generation the one led by Emílio Ribas. This article recaptures these points and highlights his last works on preventive and community medicine. We argue that the conception of public health consolidated during his education was essential for his interest in the new model of medicine that was starting to spread in the country.

Os estudos que comentam a obra de Mascarenhas analisam sua contribuição à história da saúde em São Paulo e os aspectos de seu trabalho que o enquadram no que se convencionou chamar de segunda geração de sanitaristas paulistas - a primeira seria liderada por Emílio Ribas. Esse artigo retoma esses pontos e destaca seus trabalhos mais recentes, relacionados à medicina preventiva e comunitária. Argumentamos que a concepção de saúde pública consolidada em sua formação foi central para seu interesse no novo modelo de medicina que começava a se difundir no país.

Ricardo Bruno: history, social processes and health practices.

This essay has the objective of revisiting the intellectual output of Ricardo Bruno Mendes-Gonçalves (1946-1996), Professor of the Department of Preventive Medicine of the Faculty of Medicine of the University of São Paulo and one of the theoreticians who participated in the construction of the field of Brazilian Collective Health during the years 1970-1990. On the basis of brief biographical and bibliographical information, as well as relevant aspects regarding the historical context in which his output is located, I examine the principal works of the author, their effects on the lines of investigation of investigation of his students and his legacy of contributions and challenges for Collective Health. I highlight the genesis and development of his Theory of the Health Work Process and its impact on the understanding and empirical investigation of the socio-historical dimensions of health practices and on the reconstruction of knowledge and technologies in the context of the Brazilian Health Sector Reform. In particular, I highlight his concern with the ethical perspective of academic praxis and in this sense, with hope as a human value which is historically objectified and intersubjectively constructed.

Ricardo Bruno: history, social processes and health practices / Ricardo Bruno: história, processos sociais e práticas de saúde

This essay has the objective of revisiting the intellectual output of Ricardo Bruno Mendes-Gonçalves (1946-1996), Professor of the Department of Preventive Medicine of the Faculty of Medicine of the University of São Paulo and one of the theoreticians who participated in the construction of the field of Brazilian Collective Health during the years 1970-1990. On the basis of brief biographical and bibliographical information, as well as relevant aspects regarding the historical context in which his output is located, I examine the principal works of the author, their effects on the lines of investigation of investigation of his students and his legacy of contributions and challenges for Collective Health. I highlight the genesis and development of his Theory of the Health Work Process and its impact on the understanding and empirical investigation of the socio-historical dimensions of health practices and on the reconstruction of knowledge and technologies in the context of the Brazilian Health Sector Reform. In particular, I highlight his concern with the ethical perspective of academic praxis and in this sense, with hope as a human value which is historically objectified and intersubjectively constructed.

Este ensaio tem como objetivo revisitar a produção intelectual de Ricardo Bruno Mendes-Gonçalves (1946-1996), professor do Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo e um dos teóricos que participou da construção do campo da Saúde Coletiva brasileira nos anos 1970-1990. Partindo de breves informações biográficas e bibliográficas, assim como de aspectos relevantes acerca do contexto histórico no qual se situa sua produção, examina-se os principais trabalhos do autor, seus desdobramentos nas linhas de investigação de seus alunos e seu legado de contribuições e desafios para a Saúde Coletiva. Destaca-se a gênese e o desenvolvimento de sua Teoria do Processo de Trabalho em Saúde e seus aportes para a compreensão e a investigação empírica das dimensões sócio-históricas das práticas de saúde e para a reconstrução de saberes e tecnologias no âmbito da Reforma Sanitária Brasileira. Ressalta-se, ainda, sua preocupação com a perspectiva ética da práxis acadêmica e, nesse sentido, com a esperança como valor humano historicamente objetivado e intersubjetivamente construído.

The role of international remittances in health outcomes in Ecuador: prevention and response to shocks.

This article evaluates the impact of remittances on health outcomes in Ecuador using an instrumental-variables approach. Although we do not find significant impacts on long-term child health variables, we find that remittances do have an impact on health expenditures, and on some preventive issues such as de-worming and vaccination. In addition, we find significant effects of remittances on medicine expenditures when illness occurs. In this regard, remittances are used for both preventive and emergency situations. Interestingly, we also find a significant and positive effect of remittances on health knowledge.

Cacophonies of aid, failed state building and NGOs in Haiti: setting the stage for disaster, envisioning the future.

The January 2010 earthquake in Haiti was a catastrophe not only for the loss of life it caused, but also because it destroyed the very thin layer of state administrative capacity that was in place in the country. This article argues that the fragility of the Haitian state institutions was exacerbated by international strategies that promoted NGOs as substitutes for the state. These strategies have generated a vicious circle that, while solving immediate logistical problems, ended up weakening Haiti's institutions. However, the article does not call for an overarching condemnation of NGOs. Instead, it explores two cases of community-based NGOs, Partners In Health and Fonkoze, that have contributed to creating durable social capital, generated employment and provided functioning services to the communities where they operated. The article shows that organisations that are financially independent and internationally connected, embrace a needs-based approach to their activities and share a long-term commitment to the communities within which they operate can contribute to bringing about substantial improvement for people living in situations of extreme poverty. It concludes that in the aftermath of a crisis of the dimension of the January earthquake it is crucial to channel support towards organisations that show this type of commitment.

Saúde e dietética na medicina preventiva medieval: o regimento de saúde de Pedro Hispano (século XIII) / Health and dietetics in medieval preventive medicine: the health regimen of Peter of Spain (thirteenth century)

Analisa o Livro sobre a conservação da saúde, obra médica preventiva, composta no século XIII pelo físico/médico português Pedro Hispano (1210-1277), que nos permite observar as concepções de saúde e higiene e compreender o papel social dos físicos universitários na medicina preventiva medieval. A obra mostra sempre a noção de equilíbrio na saúde corporal entre os elementos internos, as coisas naturais (compleição, por exemplo), e os externos, as coisas não naturais (ar, sono, exercício, alimentos, banhos, paixões da alma).

[Research and cure: knowledge and prophylaxis of endemic goiter in Argentina (1916-1958).]. / Investigar y curar: conocimientos y profilaxis del bocio endémico en la Argentina (1916-1958).

The present paper focuses on the reconstruction of the historical circumstances of knowledge production as well as and the debates about endemic goiter disease during the period 1916-1955 in Argentina. Taking into account the social, political and material dimensions, this text explores the re-signification of scientific and medical knowledge oriented to the prevention and health treatment, through the positioning of several social actors engaged all along the period, and the diverse historical and institutional contexts.

La experiencia de medicina preventiva integrada a la clínica: Hospital San Francisco de Borja 1963-1973 / Teaching preventive medicine in a clinical setting: San Francisco de Borja Hospital 1963-1973

Este trabajo intenta comprender la experiencia de medicina preventiva integrada a las clínicas, realizadas entre los años 1963 y 1973, en el Hospital San Francisco de Borja. El análisis busca conocer sus contenidos, su marco teórico, sus participantes, sus antecedentes y algunas de sus posibles implicancias para la salud pública actual. Como introducción al estudio mismo, realizó una revisión parcial de los vínculos entre historia y salud pública en el contexto americano y un recuento de las búsquedas historiográficas relevadas por el “giro lingüístico” y las tensiones entre memoria e historia. De esta revisión y recuento se da cuenta en otro artículo.

This paper attempts to understand the experience of integrated medicine clinics, between the years 1963 and 1973 in San Francisco de Borja Hospital. The analysis seeks to know its contents, its theoretical framework, its participants, their background and some of its possible implications for public health today. As an introduction to the study it conducted a partial review of the links between history and public health in the American context and an overview on historiographic controversy caused by “linguistic turn” and the tensions between memory and history. This review is the subject matter of another paper.