Explore the vast range of titles available.

Soldiers lay wounded or sick as both sides struggled to get them fit to return to battle. Winner, George Rosen Prize, American Association for the History of Medicine The Civil War was the greatest health disaster the United States has ever experienced, killing more than a million Americans and leaving many others invalided or grieving. Poorly prepared to care for wounded and sick soldiers as the war began, Union and Confederate governments scrambled to provide doctoring and nursing, supplies, and shelter for those felled by warfare or disease. During the war soldiers suffered from measles, dysentery, and pneumonia and needed both preventive and curative food and medicine. Family members—especially women—and governments mounted organized support efforts, while army doctors learned to standardize medical thought and practice. Resources in the north helped return soldiers to battle, while Confederate soldiers suffered hunger and other privations and healed more slowly, when they healed at all. In telling the stories of soldiers, families, physicians, nurses, and administrators, historian Margaret Humphreys concludes that medical science was not as limited at the beginning of the war as has been portrayed. Medicine and public health clearly advanced during the war—and continued to do so after military hostilities ceased.

Objective The commensal microbiota, host immunity and metabolism participate in a signalling network, with diet influencing each component of this triad. In addition to diet, many elements of a modern lifestyle influence the gut microbiota but the degree to which exercise affects this population is unclear. Therefore, we explored exercise and diet for their impact on the gut microbiota. Design Since extremes of exercise often accompany extremes of diet, we addressed the issue by studying professional athletes from an international rugby union squad. Two groups were included to control for physical size, age and gender. Compositional analysis of the microbiota was explored by 16S rRNA amplicon sequencing. Each participant completed a detailed food frequency questionnaire. Results As expected, athletes and controls differed significantly with respect to plasma creatine kinase (a marker of extreme exercise), and inflammatory and metabolic markers. More importantly, athletes had a higher diversity of gut micro-organisms, representing 22 distinct phyla, which in turn positively correlated with protein consumption and creatine kinase. Conclusions The results provide evidence for a beneficial impact of exercise on gut microbiota diversity but also indicate that the relationship is complex and is related to accompanying dietary extremes.

Black soldiers in the American Civil War were far more likely to die of disease than were white soldiers. In Intensely Human, historian Margaret Humphreys explores why this uneven mortality occurred and how it was interpreted at the time. In doing so, she uncovers the perspectives of mid-nineteenth-century physicians and others who were eager to implicate the so-called innate inferiority of the black body. In the archival collections of the U.S. Sanitary Commission, Humphreys found evidence that the high death rate among black soldiers resulted from malnourishment, inadequate shelter and clothing, inferior medical attention, and assignments to hazardous environments. While some observant physicians of the day attributed the black soldiers' high mortality rate to these circumstances, few medical professionals—on either side of the conflict—were prepared to challenge the biological evidence of white superiority. Humphreys shows how, despite sympathetic and responsible physicians' efforts to expose the truth, the stereotype of black biological inferiority prevailed during the war and after.

ObjectivesWhile diabetes prevention programmes (DPPs) effectively reduce the risk of type 2 diabetes, optimising referral to these programmes is challenging. Our prior research (a qualitative study on the pilot of the National Diabetes Prevention Programme (NDPP) and a systematic review) identified a range of barriers and facilitators to referral from healthcare workers’ perspectives. This study aims to gain consensus on the main factors influencing referral to a newly established NDPP and using the Behaviour Change Wheel (BCW) to select behaviour change techniques (BCTs) for an implementation strategy to improve referral to the programme in the future.DesignA two-round modified online Delphi survey prioritised 17 barriers and facilitators of the referral process, followed by a mapping exercise with the BCW, which guided the identification of techniques to change referral behaviour from general practice.SettingThe survey took place online with healthcare professionals working in the primary care setting in Ireland (April to June 2024). The NDPP was in the pilot phase and was not available in all areas. This study sought to learn from this pilot phase to inform the referral process, which was not yet fully established.ParticipantsHealthcare professionals eligible to refer or involved in referral to the NDPP in Ireland (general practitioners, practice nurses and dietitians delivering the NDPP) took part in the Delphi survey. Recruitment was through a number of gatekeepers, a health service manager and professional groups who shared invitations to participate with eligible healthcare professionals.Outcome measuresIn the Delphi survey round 1, respondents were asked to rate the importance of 17 factors (nine facilitators and eight barriers) influencing referral on a 5-point Likert scale (not important to very high importance) and an open text box captured other suggested important factors. Barriers included limited practical information about the availability of the programme, concerns about workload, competing priorities and concern about patient motivation, the time commitment for patients and referral delays. Facilitators included electronic referral and feedback, promotion of the programme by healthcare professionals and consultation with patients before referral. Consensus was defined as agreement of ≥70% for each factor in the combined categories of high importance/very high importance, low/moderate importance or not important. Factors not reaching consensus after the first round were included in round 2 with any new factors from round 1. Factors that did not reach consensus or reached consensus as not important or of low/moderate importance were excluded. Only factors reaching consensus as being of high importance/very high importance across the two rounds were included in the final prioritised list.ResultsThe Delphi survey had 37 responses to round 1 and 23 (62%) responses to round 2. 12 factors reached consensus as being of high/very high importance to improve referral. The 12 factors are mapped to seven intervention functions in the BCW and to nine key BCTs (feedback on the outcome of the behaviour, social support, instruction on how to perform a behaviour, information about the health consequences, information about social and environmental consequences, demonstration of the behaviour, prompts/cues, credible source and restructuring the physical environment). The strategy to improve referrals should include education delivered by educators to referrers, educational materials on the DPP and practical support to facilitate referrals. The health service should continue to provide electronic referrals and electronic prompts to refer could be considered as part of the electronic health record.ConclusionThis study systematically prioritises factors perceived to influence referral and identifies BCTs to improve referral to an NDPP. The BCTs are a starting point for a strategy to improve referral to DPPs. Further consultation with stakeholders is recommended to discuss the acceptability, feasibility and operationalisation of the BCTs in the Irish setting.

Vaccination has transformed public health, most notably including the eradication of smallpox. Despite its profound historical importance, little is known of the origins and diversity of the viruses used in smallpox vaccination. Prior to the twentieth century, the method, source and origin of smallpox vaccinations remained unstandardised and opaque. We reconstruct and analyse viral vaccine genomes associated with smallpox vaccination from historical artefacts. Significantly, we recover viral molecules through non-destructive sampling of historical materials lacking signs of biological residues. We use the authenticated ancient genomes to reveal the evolutionary relationships of smallpox vaccination viruses within the poxviruses as a whole.

Purpose - The research asked: How do daughters take the lead in their family businesses? What are the relevant issues that characterize the succession process for daughters, what are the attributes of daughter successors, and what, if any, features distinguish their leadership style?Design methodology approach - Qualitative research comprised reflective interviews with 14 daughter successors. Thematic data analysis was used to analyze data, build models and link to previous research.Findings - The shifting landscape of women's roles in family businesses is evidenced through the experiences of daughters who have taken over the top leadership positions in their family firms. Skill and commitment override gender in successor selection. The women were intrinsically motivated to take over their family businesses and owned significant shares in their firms. The findings confirm the centrality of the successor-incumbent relationship and reveal mentoring, frequently by the incumbent, as the principal vehicle for the transfer of business leadership. Emotional competence emerged as a key successor quality.Research limitations implications - This research is based on a single perspective, that of the successor. The accounts may include elements of performance, that is, selection of content based on the audience and the participant's desired results.Originality value - The paper provides an alternate view to female invisibility in the family business, and the practice of primogeniture. This is new research on succession and women's roles in family business.

The 1918 influenza pandemic was the deadliest in known human history. It spread globally to the most isolated of human communities, causing clinical disease in a third of the world's population, and infecting nearly every human alive at the time. Determination of mortality numbers is complicated by weak contemporary surveillance in the developing world, but recent estimates put the death toll at 50 million or even higher. This outbreak is of great interest to modern day epidemiologists, virologists, global health researchers and evolutionary biologists. They ask: Where did it come from? And if it happened once, could it happen again? Understanding how such a virulent epidemic emerged and spread offers hope for prevention and strategies of response. This review uses historical methodology and evolutionary perspectives to revisit the 1918 outbreak. Using the American military experience as a case study, it investigates the emergence of virulence in 1918 by focusing on key susceptibility factors that favored both the influenza virus and the subsequent pneumococcal invasion that took so many lives. This article explores the history of the epidemic and contemporary measures against it, surveys modern research on the virus, and considers what aspects of 1918 human and animal ecology most contributed to the emergence of this pandemic.

When the Civil War began, the U.S.pharmaceutical industry was concentrated almost exclusively in Philadelphia and was dominated by just a few major firms; when the war ended, it was poised to expand nationwide.

Four major diseases stigmatized the American South in the nineteenth and twentieth centuries: yellow fever, malaria, hookworm, and pellagra. Each disease contributed to the inhibition of economic growth in the South, and the latter three severely affected children's development and adult workers' productivity. However, all four had largely disappeared from the region by 1950. This paper analyzes the reasons for this disappearance. It describes the direct effects of public health interventions and the indirect effects of prosperity and other facets of economic development. It also offers insights into the invaluable benefits that could be gained if today's neglected diseases were also eliminated. [PUBLICATION ABSTRACT]

In addition Malaria: Poverty, Race, and Public Health in the United States argues that malaria control was central to the evolution of local and federal intervention in public health, and demonstrates the complex interaction between poverty, race, and geography in determining the fate of malaria.