Western medical rehabilitation through time: a historical and epistemological review.

Medical rehabilitation is the process targeted to promote and facilitate the recovery from physical damage, psychological and mental disorders, and clinical disease. The history of medical rehabilitation is closely linked to the history of disability. In the ancient western world disabled subjects were excluded from social life. In ancient Greece disability was surmounted only by means of its complete removal, and given that disease was considered a punishment attributed by divinities to human beings because of their faults and sins, only a full physical, mental, and moral recovery could reinsert disabled subjects back in the society of "normal" people. In the Renaissance period, instead, general ideas functional for the prevention of diseases and the maintaining of health became increasingly technical notions, specifically targeted to rehabilitate disabled individuals. The history of medical rehabilitation is a fascinating journey through time, providing insights into many different branches of medicine. When modern rehabilitation emerges, around the middle of the twentieth century, it derives from a combination of management approaches focusing on the orthopaedic and biomechanical understanding of patterns of movement, on the mastering of neuropsychological mechanisms, and on the awareness of the social-occupational dimension of everyday reality.

Calling the heart by name: distinguished eponyms in the history of cardiac anatomy.

Many outstanding scientists have given their names to anatomic structures through time. Recently the use of eponyms has been at the center of a very interesting debate in the columns of prestigious medical journals. Even if some authors have questioned their adoption, not only do the names of great figures in the history of medicine appear inextricably linked to human body structures but they also have been widely adopted. Eponyms enliven medical study and practice by representing major mnemonic aids for students and learners and opening intriguing scenarios on the history of health. Given that physicians frequently are unaware of exactly "who stands behind" a name, this article presents a reconstruction of how eponyms for cardiac structures have developed through time and provides scientific profiles of the personages after whom heart districts have been named. The article is offered in the awareness that scientists of different countries and different ages have contributed to the elaboration of the knowledge of cardiac anatomy, according to their personal skills and to the health technology available in their particular times and places.

Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up.

OBJECTIVE: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. DESIGN: Randomized trial, 12-month follow-up. SETTING: Outpatient rehabilitation department. PARTICIPANTS: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years. INTERVENTIONS: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week. OUTCOME: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. RESULTS: 205 patients completed the study. At discharge, disability score decreased by 3.7 +/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9 for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P < 0.001); pain recurrences and drug intake were also reduced compared to back school (P < 0.05) or individual physiotherapy (P < 0.001). CONCLUSIONS: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

[Perception, translation and current use of English terms on the part of Italian non-physician healthcare personnel: a qualitative and quantitative survey]. / Traduzione, percezione ed uso di terminologia inglese da parte di operatori sanitari italiani non medici. Una indagine quali-quantitativa propedeutica.

The study of the use of English for medicine has become a continual source of enquiry. Aim of this survey was the systematic evaluation of the qualitative and quantitative perception, translation and current use of English terms on the part of Italian health operators. Eight English terms directly connected with the health scenario or related to it compliance", "imaging", "likelihood", "odds ratio", "outcome", "stent", "test", "trial") were selected and, by means of a paper registration form, they were administered to forty Italian health professionals (non-physicians), already active in the health sector and attending specialised health degree courses. The participants were asked to furnish up to two translational proposals for every single English term, and, after the written registration, there followed a structured oral discussion of the translation, perception and everyday use of the English terms in the working reality of the participants. This survey provides a scientific "real world" experience, and its qualitative and quantitative findings are of use in evaluating the level of correction in the adoption of English language on the part of health operators.

[The role of the university in the critical evaluation of biomedical literature]. / La lettura critica delle riviste biomediche: il ruolo dell'Università.

British and US surveys document that the time dedicated weekly by physicians to the critical evaluation of biomedical journals is limited and should be expanded. This in the light of the fact that clinicians increasingly need controlled and updated medical information. The critical interest and competence in the evaluation of medical literature may be taught at the University. Universities, and in particular Medical Schools, include, among their tasks, education, research and health care. A modern and effective education in the critical analysis of biomedical journals should represent an important methodological feature of Medical Schools, given that it can constitute an instrument for the reasoned analysis of the profile of biomedical research and for the synthesis and incorporation of research results into daily clinical practice.

[A historical perspective on the evolution of the concepts of motor activity and physical exercise in medicine]. / Evoluzione dei concetti di attività motoria e di esercizio fisico in medicina. Una breve rassegna storica.

A historical analysis of Western medicine clearly indicates high attention to the body dimension and to corporeal functions. Even if what today may be defined "the science of physical exercise in medicine" goes back only to the last fifty years, the great Mediterranean cultures have always dedicated great care to the harmonic development of the human body. The importance of the role of physical exercise in maintaining an appropriate health status is mentioned in the Hippocratic Corpus (V-IV century before Christ). In the contemporaneous Hippocratic Oath one may read that the physicians of the Hippocratic School are called upon to "regulate the lifestyle of sick people in the light of their well being". At that time the prescriptions regarding patients' lifestyle, taking into account the limited effectiveness of therapeutic measures, were primarily concentrated on an appropriate diet and motor activity. This historical review describes the evolution of physical activity in medicine with regard to the current awareness of its relevance at every stage of life; the presentation of the historical roots of the concepts of motor activity and of physical exercise and of their progress through time aims at defining their current preventive, therapeutic and rehabilitative roles.

Coffee consumption and risk of coronary heart disease: a meta-analysis.

BACKGROUND AND AIMS: During the past three decades the relationship between habitual coffee drinking and coronary heart disease (CHD) has been assessed in numerous studies, with conflicting results. The aim of this study was to systematically examine the data published on the association between habitual coffee consumption and risk of CHD. METHODS AND RESULTS: Thirteen case-control and 10 cohort studies were included. Case-control studies incorporated 9487 cases of CHD and 27,747 controls, and cohort studies included a total of 403,631 participants that were followed for between 3 and 44 years. The summary of odds ratios (OR) for the case-control studies showed statistically significant associations between coffee consumption and CHD for the highest intake group (>4 cups/day), OR 1.83 (95% CI 1.49-2.24; P<0.0001), and for the second highest category (3-4 cups/day), OR 1.33 (95% CI 1.04-1.71; P<0.0001), while no significant association emerged for low daily coffee intake (< or =2 cups/day), OR 1.03 (95% CI 0.87-1.21; P=0.45). The analysis of long-term follow-up cohort studies did not show any association between the consumption of coffee and CHD, with a relative risk (RR) of 1.16 (95% CI 0.95-1.41; P=0.14) for the highest category, and 1.05 (95% CI 0.90-1.22; P=0.57) and 1.04 (95% CI 0.90-1.19; P=0.60) for the second and third highest categories, respectively. These results did not differ substantially when controlling for region of origin, fatal and non-fatal events, year of publication, and number of years of follow-up. CONCLUSIONS: Despite a significant association between high consumption of coffee and CHD reported among case-control studies, no significant association between daily coffee consumption and CHD emerged from long-term follow-up prospective cohort studies.

[Past, present and future of green tea: from pleasant beverage to drug in pills?]. / Storia ed attualità del tè verde: da bevanda voluttuaria a farmaco in compresse?

During the 17th century, new drinks entered the European market: wine and beer, which were largely widespread among the different European countries, were joined by coffee and tea; their consumption at was first limited to the higher classes, but they soon became popular at all levels of society. Even if their therapeutic effects were strongly stressed from different points of view, at first they encountered a certain resistance. Tea, in particular, represented a sort of compromise between a pleasant habit, bound to economic and social reasons, and a therapeutic scope. Green tea is unfermented tea. In Japan the most frequently used method of production is steaming, that deactivates the oxidase in tea leaves, determining the retention of a brilliant green colour. Its use has been proposed in a number of clinical conditions and pathologies, even if its putative therapeutic properties must be further assessed in rigorously designed and conducted clinical trials. Aim of this paper is to call needed attention to the potential role of green tea extracts in prevention and in therapy in relation to the scientific methodology of clinical research.

[Electronic search for the best biomedical evidence: tactics and strategy]. / La ricerca elettronica delle migliori evidenze biomediche: tattica e strategia.

The search for biomedical information arises largely from the need to find, on the part of health operators, reliable and updated answers to the questions elicited by their patients. Even if today technology makes available powerful electronic tools for health education and updating, the enormous quantity of health information remains a major issue for professionals looking for biomedical evidence. Health operators, wishing to quickly assess and effectively extract the pertinent and relevant evidence they are looking for, have, contemporaneously, limited time to dedicate to evidence searching and enormous amounts of non-homogeneous information to scan. Research tactics and strategies emerge from the correct formulation of health queries. Posing the appropriate questions is therefore the first step of the process of retrieving clear and exhaustive answers, derived from guaranteed sources of biomedical information. The process continues with the complete identification and application of the correct method of research and economic retrieval of evidence, as also with its critical evaluation, synthesis and implementation. Knowing where and how to look for biomedical evidence in electronic databases is consequently a fundamental step in tracking the solution of a clinical problem in the perspective of Evidence Based Medicine and of any other evidence based health discipline, including what we have called "Evidence Based History of Medicine".

Fat snorers and sleepy-heads: were many distinguished characters of the past affected by the obstructive sleep apnea syndrome?

The obstructive sleep apnea syndrome (OSAS) is a clinical condition characterized by the coexistence of irregular breathing at night with excessive daytime sleepiness, and it represents a major social health issue because of its high prevalence and of the growing public awareness of it. The XIX century description of "Fat Joe", the famous character of Charles Dickens's Pickwick Papers, is often retained the first presentation of a person affected by OSAS, since Joe was an obese individual who fell asleep during daytime while performing even extremely simple tasks. However, apart from the fact that Joe's Picwickian syndrome ("the obesity hypoventilation syndrome") needs to be differentiated from true OSAS, already in the Hippocratic Corpus (V-IV century BC) many clues regarding apnea and sleepiness are present, and in 79 AD the Roman author Pliny the Younger clearly reported the death of a man in whom obesity, sleepiness and snoring were co-present in a unique clinical picture. In this paper, elements suggesting OSAS are traced back and evidenced in the XIX and XX centuries in distinguished figures, including Emperor Napoleon Bonaparte, Queen Victoria and President Franklin D. Roosevelt. A posteriori reconstruction of the health status of characters of the past is difficult, and, to an extent, speculative, but the elements here provided appear relevant, since the possible presence of disabling OSAS in important personages of the past may have negatively influenced not only their health status, but also their social life and their work activity.

Clinical pictures of unknown origin in neurology: past, present and future usefulness of artificial intelligence.

Although, in the course of the last 50 years, the achievements in the medical field have been astonishing, at the beginning of the third millennium a number of clinical pictures are still left without a precise nosographic origin. In the past, the delay in scientific communication was the main explanation presented for the lack of understanding of clinical pictures of unknown nosographic origin. The history of medicine provides excellent examples of this dispersion of human capital, even if the history of clinical neurology presents "exceptions" (the pictures that we now call de la Tourette's syndrome and Parkinson's disease) that indicate that major clinical syndromes could be clearly detected and relatively rapidly diffused even in the 19th century. Contrary to the past, the delay in scientific communication no longer seems an obstacle to the sharing of medical knowledge. Nevertheless, the problem of the in-depth comprehension of clinical pictures of unknown nosographic origin still remains dominant, mainly because of the limited spread of ample and flexible online accessible databases of unknown nosographic origin clinical syndromes. The need for interactive electronic archives and other artificial intelligence resources in order to promote progress in clinical knowledge is discussed in this paper.

[Neoplastic angiogenesis and age-related macular degeneration: historic aspects of the microcirculation of new vessels]. / Angiogenesi neoplastica e degenerazione maculare legata all'età: aspetti storici del micro-mondo dei neovasi.

Angiogenesis is the process through which newly-formed vessels develop from pre-existing ones, following a series of sequential steps. The appearance of new vessels is essential in a number of physiological processes, but it is also associated with several pathological phenomena, such as arthritis, diabetic retinopathy and cancer. In the XIX century Rudolph Virchow ("Die Zellularpathologie", 1858) had already observed and described the rich vascularization which characterizes malignant tumors. This line of research was further developed by Goldman in the early XX century. With specific reference to the history of age-related macular degeneration, a disease model whose understanding is linked to the study of angiogenesis, in 1905 Oeller coined the definition "disciform macular degeneration", and twenty years later this expression was taken up by Kuhnt and Junius to describe disc-shaped lesions in the macula of elderly individuals. The historical evolution of the concept of angiogenesis, its characterizing evolutional steps and the most relevant scientific achievements in the field of macular degeneration up to the eighties of the XX century are here presented and discussed.

[Internal medicine: background, present status and perspectives]. / La Medicina Interna: storia, attualità, prospettive.

Internal Medicine is a very ancient branch of medicine furnishing unique opportunities for interchange and innovation, essential for the development and renovation of contemporary medicine. It is a fact that during the last twenty years a clear shift in clinical medicine towards extreme specialisation has occurred, but more recently the figure of the "clinician" has once again become central, since he/she is called upon to play a role of great importance in which knowledge of the complexity involved in the management of problematic diseases has to blend and integrate with the fundamental simplicity of the search for so-called "economy" in diagnostic hypotheses.

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review.

OBJECTIVES: To clarify the impact of multiple (covering the same population, intervention, control, and outcomes) systematic reviews (SRs) on interventions for myocardial infarction (MI). STUDY DESIGN AND SETTING: Clinical Evidence (BMJ Group) sections and related search strategies regarding MI were used to identify multiple SRs published between 1997 and 2007. Multiple SRs were classified as discordant if they featured conflicting results or interpretation of them. RESULTS: Thirty-six SRs (23.5% of 153 on the treatment or prevention of MI) were classified as multiple and grouped in 16 clusters [ie, at least two SRs with the same PICO (population, condition/disease, intervention, control) and at least one common outcome] exploring angioplasty, angiotensin-converting enzyme inhibitors, anticoagulants, antiplatelets, ß-blockers, and stents. Complete agreement on statistically significant differences between interventions was found in 7 of 10 clusters with a shared composite outcome. Agreement was reduced when single outcomes were considered. Despite substantial variation and limited agreement in reporting of major outcomes, SRs agreed in their conclusions on the superiority of either the intervention or control in 14 of 16 clusters. Sources of minor discrepancies were found in terms of study and outcome selection, subgroup analyses, and interpretation of findings. CONCLUSION: Multiple SRs agreed in their qualitative conclusions but not on reporting and on analyses of hard outcomes. Discordance on significance of treatment effects was due to a combination of variation in design with inclusion of different studies and lack of precision for single hard outcomes compared with a composite outcome. Such inconsistencies among SRs could potentially slow the translation of SRs' results to clinical and public health decision making and suggest the need for a broader methodological and clinical agreement on their design.

Morphologic changes in the microcirculation induced by chronic smoking habit: a videocapillaroscopic study on the human labial mucosa.

BACKGROUND: Cigarette smoking has been identified as a major risk factor for cardiovascular and pulmonary diseases. Although an impressive literature does exist on the subject, no evidence is available on morphologic changes induced with chronic smoking habit in the human microcirculation. SUBJECTS AND METHODS: One hundred healthy subjects, 50 smokers and 50 nonsmokers, underwent videocapillaroscopy of the labial mucosa. For each subject, the caliber of capillary loops, the number of visible capillary loops, the background optical transmittance, the tortuousness of capillary loops, the presence of microaneurysms, the presence of microhemorrhages, and the cumulative smoking habit (pack-year index) were noted. RESULTS: Smokers had a lower caliber of capillary loops (P <.001), with a higher number of visible capillary loops (P <.001), a lower background optical transmittance (P <.001), and a more marked tortuousness of capillary loops (P <.001). Microaneurysms and microhemorrhages were absent in nonsmokers, and 1 smoker of 3 had microaneurysms alone, and 1 smoker of 3 had both microaneurysms and microhemorrhages. A significant correlation was found between cumulative smoking habit and tortuousness of capillary loops (P <.001) and between cumulative smoking habit and total score (tortuousness score + microaneurysm score + microhemorrhage score; P <.005). CONCLUSION: Chronic smoking habit does induce significant morphologic changes in the microcirculation of the human labial mucosa, and these changes can be easily and comfortably recorded with videocapillaroscopy.

The evolution of the concept of 'fever' in the history of medicine: from pathological picture per se to clinical epiphenomenon (and vice versa).

The medical concept of 'fever' has undergone profound changes throughout the centuries. Galen of Pergamon considered fever as a systemic disease in itself, and it was only between 17th and 18th century that Hermann Boerhaave provided a more careful evaluation of the clinical phenomena related to fever. Apart from incorrect theories, a major obstacle to the development of a rational study of fever has been the lack of appropriate instruments of measurement; in effect, the clinical thermometer was not diffusely used in everyday medical practice until the mid 19th century. During this same period Ignaz Semmelweiss postulated that the pathological-anatomical changes recorded in women who had died because of puerperal fever represented a pathological reality clinically suggested by a whole cohort of symptoms and signs, among them fever. Even if enormous progress has been made in the 20th century with regard to fever, which is currently considered a clinical sign of many different diseases, its etiologic assessment remains a challenge. In fact, in 1961 the clinical picture of 'Fever of Unknown Origin' was officially defined. Since such diagnostic labelling is in effect a cover for our inability to discover the real causes of fever, in this case, paradoxically, fever goes back to being the whole pathological picture, just as it was retained to be many centuries ago.

Plague, policy, saints and terrorists: a historical survey.

Plague is an infectious disease of humans and animals caused by the bacterium Yersinia pestis. During the Middle Ages millions of people in Europe died from plague, whose current mortality-if untreated-ranges from 50% to 90%. The plague has been a great protagonist in history because it has often been grimly present in the collective events of humans. Its plurisecular history, tied to the whole chain of ecological balance, has had a strong influence on the collective imagination on account of its sudden occurrence and unavoidable mortality. In the past, the passage from contagion to illness ended in death, as human remedies had no effect. The only way to conquer it was invoke the incorruptible spirit of a saint. Therefore, in the past, the major plague icons were saints to whom ordinary people attributed a fame for healing. More recently, many epidemic diseases have ceded place to biological weapons, and terrorists have become the modern icons of such a threatening reality. As a matter of fact, bioterrorism has become a great public health and infection control threat, and, among the number of potential biological agents, plague has assumed a key role.