Alessio Spalla, court surgeon of Christina of Sweden and his unknown Queen's autopsy report.

BACKGROUND: Queen Christina of Sweden, a prominent Early Modern European character, died in Rome on April 19th, 1689. The scarce literature published about her illness and death agrees about the cause of the death in the diagnosis of erysipelas, that did not appear externally with an ulcer, but became manifest in her blood, causing an inflammation of heart and lungs. The article underlines the essential contribution of the learned surgeons to the development of practical anatomy in the late Seventeenth century as illustrated by the specific case of the Queen's autopsy report by the court surgeon Alessio Spalla. METHODS: The study is based on the analysis of the published literature and the comparison of archival sources as the anonymous report of the Queen's autopsy, preserved in Vienna and the unknown autopsy by Spalla, discovered in a private archive. RESULTS: The comparison of Spalla's autopsy with the Viennese report of an anonymous practical doctor -suspected to be Marcello Malpighi-, who also participated in the Queen's dissection highlights how the two perspectives of investigation - the surgical-morphological and the medical-practical ones - are integrated in the theoretical and practical dimension of practical anatomy. CONCLUSIONS: The unpublished report of the surgeon Spalla integrates the knowledge of the queen's illness and death, stands as an example of a private autopsy performed by a court surgeon in the late Seventeenth-century Rome and as a case study on the development of new hybrid areas of knowledge, such as practical anatomy.

Novel Artificial Intelligence-Based Assessment of Imaging Biomarkers in Full-Thickness Macular Holes: Preliminary Data from a Pivotal Trial.

Artificial intelligence (AI)- and deep learning (DL)-based systems have shown significant progress in the field of macular disorders, demonstrating high performance in detecting retinal fluid and assessing anatomical changes during disease progression. This study aimed to validate an AI algorithm for identifying and quantifying prognostic factors in visual recovery after macular hole (MH) surgery by analyzing major optical coherence tomography (OCT) biomarkers. This study included 20 patients who underwent vitrectomy for a full-thickness macular hole (FTMH). The mean diameter of the FTMH was measured at 285.36 ± 97.4 µm. The preoperative best-corrected visual acuity (BCVA) was 0.76 ± 0.06 logMAR, improving to 0.38 ± 0.16 postoperatively, with a statistically significant difference (p = 0.001). AI software was utilized to assess biomarkers, such as intraretinal fluid (IRF) and subretinal fluid (SRF) volume, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, and retinal hyperreflective foci (HRF). The AI analysis showed a significant decrease in IRF volume, from 0.08 ± 0.12 mm3 preoperatively to 0.01 ± 0.01 mm3 postoperatively. ELM interruption improved from 79% ± 18% to 34% ± 37% after surgery (p = 0.006), whereas EZ interruption improved from 80% ± 22% to 40% ± 36% (p = 0.007) postoperatively. Additionally, the study revealed a negative correlation between preoperative IRF volume and postoperative BCVA recovery, suggesting that greater preoperative fluid volumes may hinder visual improvement. The integrity of the ELM and EZ was found to be essential for postoperative visual acuity improvement, with their disruption negatively impacting visual recovery. The study highlights the potential of AI in quantifying OCT biomarkers for managing MHs and improving patient care.

Women in the medical profession in 1900 from extended maternity to social equity. The life of Lucia Servadio.

The history of social medicine in Italy between the late nineteenth and early twentieth centuries was characterised by a marked presence of gender and the consequent commitment of women of Jewish origin to the issues of early childhood education, as well as safeguarding of work and motherhood and health prevention with regard to social and cultural fragility. Some of the roles of women engaged in social medicine campaigns have been widely studied in the historiography of medicine, having recognized their roles and commitment to attempting to create a fair society through their expertise in medicine and health. However, there are some biographies and professional lives that are still unpublished and worthy of attention by historical medical research. Lucia Servadio, who was of Jewish origin (1900-2006), was the youngest Italian doctor of the first twenty years of the twentieth century. She successfully worked, despite the degrading identification of women at the time, in the field of medicine and welfare, thanks to her qualified professional, cultural and social commitment. Dr Servadio's professionalism was constantly defined by a vision of health as a right that the doctor must protect by pursuing the goal of social equity. Precisely on the basis of these principles, solidified by the practical and social activism of women's groups of the time, Dr Servadio's professional and private life was continuously shaped between medicine and social activism. However, her story is also pervaded by the ambiguity of the role played by women, often highly educated and with considerable professional standing, engaged in forms of scientific intellectual collaboration of a conjugal nature.

History of medicine in medical education: new Italian pathways.

Objective: There is little doubt that there are currently obstacles in measuring the impact of the history of medicine within medical training. Consequently, there is a clear need to support a vision that can historicize Euro-Western medicine, leading to a greater understanding of how the medical world is a distinct form of reality for those who are about to immerse themselves in the study of medicine. Methods: History teaches that changes in medicine are due to the processes inherent to the interaction among individuals, institutions, and society rather than individual facts or individual authors. Results: Therefore, we cannot ignore the fact that the expertise and know-how developed during medical training are the final product of relationships and memories that have a historical life that is based social, economic, and political aspects. Conclusion: Moreover, these relationships and memories have undergone dynamic processes of selection and attribution of meaning, as well as individual and collective sharing, which have also been confronted with archetypes that are still able to influence clinical approaches and medical therapy today.

A possible case of "kissing" osteochondroma and multiple enchondromas in a medieval skeleton from the church of Sant' Agostino in Caravate (Northern Italy).

This work presents the neoplastic bone changes found in the lower limb of a medieval skeleton from the church of Sant' Agostino in Caravate (Northern Italy). After briefly assessing the individual's overall pathological picture, a differential diagnosis for the neoplastic changes is now proposed. These changes were analysed macroscopically and radiographically and subsequently evaluated considering the paleopathological and clinical literature available. The differential diagnosis allowed us to recognize a tibiofibular osteochondroma and some enchondromas in the medullary cavity of the tibia. The results presented here highlight the importance of radiological analyses in the recognition and study of bone neoplasms in the paleopathological field, further contributing to our knowledge of the presence of neoplasms in Medieval Northern Italy.

Measuring Disability among Migrants with Washington Group Tools: Reflections for Field Use.

Measuring disability among migrants is a significant challenge; however, there is no consensus on how to measure disability and functional limitations. The present study reports a methodological approach to measure disability in refugees and asylum seekers using Washington Group (WG) tools, namely the WG Short Set (WG-SS), the Short Set Enhanced (WG-SS-E), and the Extended Set on Functioning (WG-ES). We interviewed 161 migrants in different regions of Italy. The recommended threshold for each WG tool was used. We identified 13.7% of migrants with disabilities using the WG-SS, 21.7% using the WG-SS-E, and 31.6% using the WG-ES. Anxiety and depression were the main weights to identify migrants with disabilities (11.8%). The WG-SS does not measure mental health, and therefore we do not suggest its use in the field. However, the WG-SS-E, together with some questions on pain and fatigue, should be considered to identify migrants with a greater risk of disability.

Soft Skills Are Hard Skills-A Historical Perspective.

The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today's physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called "soft skills", whose acquisition is presented in literature as a quite recent addition to medical studies. Moreover, the historical investigation of deontological texts dating from the mid-nineteenth century back to the Hippocratic Oath shows that medicine has always discussed the need to integrate technical expertise in medicine with specific personal and relationship-based skills. Debates have often circled around whether these "soft skills" could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body.

Exploring global needs of migrants with disability within a community-based inclusive development perspective.

INTRODUCTION: Limited evidence exists on migrants with disability. A comprehensive assessment is mandatory required to organize specific services within the community and reception centers. The present study explores needs of refugees and asylum seeker within a community-based inclusive development framework. METHODS: To interview migrants, in this study we used the Community-Based Rehabilitation Indicators (CBR-Is) developed by the World Health Organization. RESULTS: The sample consisted of 41 people with disability and 59 without disability. Sample was homogeneous for gender and age. Our findings reveal how migrants with disability experienced poor outcomes in each domain of CBR-Is, namely health, education, livelihood, social end empowerment. CONCLUSION: Differences between migrants with and without disabilities have some distinctive features. However, both groups are influenced by the social determinants of health: in addition to health issues, challenges in social life, livelihood and empowerment also clearly emerge. Different stakeholders are invited to promote inclusive communities, facilitating access to social and health services.

Community-Based Rehabilitation Indicators: Validation and Preliminary Evidence for Disability in Italy.

Community-based rehabilitation (CBR) is a multi-sectorial community strategy for guaranteeing that people with disabilities enjoy the same rights and opportunities as all other community members. CBR is organized in a five-component matrix-namely, health, education, social, livelihood, and empowerment. To measure the effectiveness of CBR, the World Health Organization (WHO) has developed standardized indicators. The objective of the present study is to translate and validate the CBR indicators (CBR-Is), providing preliminary evidence of their use for disability in Italy. After obtaining permission from the WHO, the CBR-Is followed a process of translation and cross-cultural adaptation according to international guidelines. An examination of internal consistency and reliability was than performed. The intra-rater reliability was estimated using the Intraclass Correlation Coefficient with a 95% confidence interval. In order to measures the differences between people with and without disabilities, an independent sample t-test was used for quantitative indicators. The Italian version of the CBR-Is (IT-CBR-Is) was administered to 234 people. The internal consistency showed a good value, with a Cronbach's alpha coefficient of 0.862, and the intra-rater reliability analysis showed solid values for each domain (range: 0.723-0.882). Statistically significant differences between people with and without disabilities were found for each domain of the CBR matrix-namely, health, social, education, livelihood, and empowerment. The IT-CBR-Is are consistent and reliable measures when used to investigate disability in a community-based inclusive development perspective. National stakeholders can now have specific indicators to implement services and actions for people with disabilities.

Urban Health and Social Marginality: Perceived Health Status and Interaction with Healthcare Professionals of a Hard-to-Reach Community Living in a Suburban Area of Rome (Italy).

The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017-2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.

Lithographic lecture notes. A tool of forensic medicine teaching. Observation on the lessons of Paolo Pellacani (1884-1885), forensic physician at the University of Pavia.

We focus our attention on the use of lithographed lecture notes written by professors, or more often by students, in the teaching of medicine and surgery courses, between the late 19th and early 20th centuries, a period in which, to better understand the phenomena underlying life and death, collaboration between medical professionals and natural science researchers was intense (1). In particular, we analyzed the lithographed lecture notes of Professor Paolo Pellacani at the University of Pavia for the course of legal medicine.

Public hygiene and funeral rituals during the Risorgimento: mummies and ashes.

Starting in 1865, regulations pursuant to public hygiene issued by the Unitary Government provided for administrative and political control of the funerary practice. Specifically, they regulated the management of cemeteries and the burials, increasingly drawing the funeral rituals from the control of the Church and of Catholicism, therefore secularising death for the construction of a new political religion. Hygiene became fundamental in order to promulgate cremation as a system of preserving the integrity of the bodies, preserving the ashes as a tangible and indestructible product of body matter and as a measure to protect public health by eliminating the risk of miasmatic pollution of the air caused by the cadaveric fumes. In the early 1870s, the practice of cremation began to spread, especially in the territories of Lombardy-Veneto and Savoy, as an expression of the progressive policies of the new Italian state, antagonistic to the old Catholic religious traditions. This paper intends to highlight the key aspects of the political significance that the cremation took on during the Risorgimento period, while also illustrating the methods adopted by important authors from that time period regarding incineration techniques and cremation methods.

Do certain rituals adapt to psychology or does psychology adapt to rites? Post mortem photography: the last "picture of life" in "death".

In death and mourning, why should we think that rites adapt to psychology and not vice-versa? Or believe that psychological workings grow into a rite or ritual? When analysing practices related to rites of passage, death emerges as a rupture - or breakage - of social status.

[Urban health and inequalities in highly socially marginalised settings in Rome]. / Salute urbana e disuguaglianze a Roma in contesti a elevata marginalità sociale.

OBJECTIVES: to describe hospitalisation, access to emergency care, and mortality of people living in marginalized urban areas which include public housing buildings in the North-West suburb of Rome, and to compare the results with those observed among people living in the neighbouring area. DESIGN: cross sectional study. SETTING AND PARTICIPANTS: resident population in the XIII and XIV Municipality of Rome, subdivided into five urban areas, in 2011-2018. MAIN OUTCOME MEASURES: hospitalisation, access to emergency care, and mortality rates and rates ratios based on hospital discharges and emergency department visits derived from the Health Information Systems and from the Mortality Registry of Lazio Region (Central Italy), stratified by urban areas. RESULTS: the results show a higher use of hospital assistance and emergency care services as well a higher mortality among residents of urban areas characterized by marginalization and social disadvantage in the North-West suburb in Rome, compared to the surrounding area. The association is stronger for the residents of ex-Bastogi, a compound particularly marginalised and socially disadvantaged, where excesses in hospitalisation, emergency care admission, and mortality of +60%, +150%, and +140%, respectively, occurred. CONCLUSIONS: the excesses of hospital use, emergency care visits, and mortality observed among the residents of marginalized urban areas suggest the need to reorganize the preventive and primary care services considering the socioeconomic disadvantage in such housing contexts. The use of both qualitative and quantitative approaches allows to understand the complexity of such contexts.

Osteological evidence of metabolic diseases from a post medieval North Italy archaeological site.

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary's Nativity church (15th-18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases' effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

New shapes and original creations: the dependent nature of the individual in a Nahua community in Mexico.

BACKGROUND AND AIM OF THE WORK: Within of Nahua of Naupan, the impact of acculturation processes by the historical interconnection between different models of medicine has given rise to important revisions and reinterpretations of local medical culture. The main purpose of this article is the observation of dynamics and aspects related to processes of understanding, perception and management of diagnostic categories, as well as the local understanding of the person (the individual) in the rural district of Naupan, located in the North East part of Sierra de Puebla. METHODS: The analysis presented in this work is the result of an ethnographic study carried out at the Nahua community (1,614 people) residing in the rural town of Naupan (Huauchinango, Puebla, Mexico). RESULTS: The attention will be given to the synthetic analysis of the local conceptions of certain pathologies and how the individual is seen as an unstable and constantly changing aggregate, situated in a context where health-related issues are clearly linked to different levels of perceived reality. CONCLUSIONS: In settings where there are no systems of institutionalized medical knowledge, nosological concepts are seen in a subjective and indeterminate manner, due to the fact that in some cases they also vary considerably depending on the person. Faced with the choice of therapeutic options, the Naupeña population moves between integrating and rejecting medical concepts from different cultural horizons, through a continuous creation of knowhow that they see as more or less organized and transmissible knowledge about disease, treatments and methods of prevention and interpretation.

The space of man's death. A modern age secondary burial case in northern Italy.

Much of the recent archaeological and anthropological research on Italian modern age secondary burials has focused primarily on source analysis and the funerary context descriptions. To enable a clearer understanding of these atypical burials we need more archaeological data. To comprehend the mortuary practices it is necessary to investigate the surviving funeral monuments, burials and human remains. In fact, through the correct analysis of cultural material and human remains, it is possible to highlight the taphonomic changes of the corpse experiences during the entire ritual process. This will allow us to reconstruct the modality of body treatment in the funeral ritual. Now, we know partially the diffusion of the secondary burial ritual in southern Italy, but in northern Italy, it is lesser known. In this paper, we report the results of the archaeological and anthropological investigations conducted inside the Crypt of the Franciscan Monastery of Azzio (Varese, northern Italy). In the hypogeal funerary chamber, the corpses were temporarily deposed in seat-niches. This type of burial recalls the sitting colatois (masonry seat with a hole in the center), known in Naples as "cantarelle" and largely present in southern Italy. Throughout archaeological, anthropological and historical investigations, we tried to reconstruct the ritual adopted by the Friars and to better understand the ties with other northern and southern Italian testimonies. After our investigations, we received several notices of other similar funerary monuments in northern Italy that would be worth investigating.

Actuality and originality in the scientific thought of Enrico Morselli (1852-1929).

Enrico Morselli, a student of Carlo Livi, offered an original contribution to psychiatry of his time through a plurality of interests and in-depth medical, biological, neurological, anthropological and sociological knowledge. From his writings, the relevance of his theoretical reflection under different aspects emerged: epistemological, methodological and psychopathological and of humanization of the treatment of the mentally ill.

Osteoarchaeology and the History of Medicine in our experience.

The encounter between archaeology and medicine is no longer the result of sporadic or intermittent research. Stemming from different areas of expertise and training, as well as historical sciences, archaeology, biology and medicine, common investigative objectives must come together in a coordinated manner. However, defining the boundaries of different areas of work, collaboration, interferences and interconnections is not an easy task.

Cranial Trepanation: An Ancient Neurosurgical Therapy? Thoughts of a Follower of Positivist Medicine and Anthropology.

The authors' aim is to define a framework around the history of studies and analyses on cranial trepanation. In addition, based on the analytical approach of Abele de Blasio, the authors would like to reach an understanding of the various different interpretations of the origin and aetiology of the art of cranial trepanation, starting in the prehistoric era. In this brief study, historical discussions are intertwined with ethnoiatric and anthropometric techniques of the author, leading the reader into a fascinating discussion on the practice of trepanation in ancient populations.