A dual process model for paleopathological diagnosis

Chronic maxillary sinusitis in palaeopathology: A review of methods

OBJECTIVE

This study reviews the palaeopathological literature discussing maxillary sinusitis to examine current trends and issues within the study of this condition, and to make recommendations for future research in this area.

MATERIALS

Seventy-five studies were identified through a literature search of digital and physical sources.

METHODS

Information regarding study metadata, the populations investigated, sinusitis diagnostic criteria, and sinusitis prevalence was examined.

RESULTS

Populations from the UK and Europe were the most studied, reflecting both palaeopathology's systemic colonialism and academic legacies. Most studies used diagnostic criteria published in the mid-1990s, with some subsequent studies modifying these criteria.

CONCLUSIONS

The diagnostic criteria from 1995 are widely used but do not include all possible bone changes seen within sinusitis. There is also a need for researchers to engage in issues of data reductionism when using descriptive categories for archaeological sites and populations.

SIGNIFICANCE

This paper provides considerations as to how the 1995 diagnostic criteria may be revised by future researchers and synthesises much of the published sinusitis prevalence data to assist researchers interested in the palaeopathology of respiratory disease.

LIMITATIONS

More general osteological research, which includes palaeopathological information, was likely missed from this review due to the choice of key terms and languages used in the literature search.

SUGGESTIONS FOR FURTHER RESEARCH

Additional research into sinusitis in archaeological populations outside of Western Europe is required. Further work examining the ability to compare pathological data from macroscopic observation and medical imaging would be advantageous to palaeopathology as a whole.

Perspectives on anemia: Factors confounding understanding of past occurrence

OBJECTIVE

This paper reviews factors confounding the understanding of the past occurrence of anemia. Using the evidence gathered, a framework is presented of ways forward to enable greater confidence in diagnosing acquired anemia in paleopathology, facilitating insights into longer-term perspectives on this globally relevant condition.

RESULTS

To date, porotic lesions have been central to paleopathological investigations of anemia. The fact that porotic bone lesions are omnipresent and have multiple causes but are likely to have a relatively low, age-related frequency in individuals with anemia, a condition that will have been common in past communities, is confounding.

METHODS

Establishing frameworks that move away from porotic lesions is proposed to facilitate higher levels of more accurate anemia diagnoses in paleopathology.

SIGNIFICANCE

Acceptance of the fundamental principle that anemia may be better considered as a condition requiring metric evaluation of bone structures, supplemented by careful consideration of lesions, will advance understanding of acquired anemia in past communities. Such an approach would provide a clear basis for further consideration of congenital conditions causing anemia, such as sickle-cell disease and thalassemia.

LIMITATIONS

This paper simply opens the conversation on the better diagnosis of anemia in paleopathology; it starts the iterative process of achieving some consensus and progress on diagnosing anemia in paleopathology.

SUGGESTIONS FOR FURTHER RESEARCH

Engagement with ideas presented, sharing data and development of metric parameters will assist in identifying the effects of marrow hyperplasia on bone, enabling more robust work on the important topic of anemia.

The potential for over diagnosis of Paget's disease of bone using macroscopic analysis

OBJECTIVE

This study explores the validity of Paget's disease of bone (PDB) reported in unpublished skeletal reports, based on macroscopic analysis alone.

MATERIALS

The high prevalence of 'suspected' Paget's disease (10.7%) in an early modern sample from St John's the Evangelist Church in Redhill, Surrey is reassessed.

METHODS

Signs of PDB were examined in 53 well-preserved adults aged 35 + years using macroscopic, radiographic and histological techniques.

RESULTS

Macroscopic features of PDB were identified in 8 individuals (15%), with 5 individuals later rejected using radiography. Two individuals showed classic radiographic features of PDB, with a third presenting possible features in radiography (5.7%). These three cases were confirmed by histological analysis.

CONCLUSIONS

PDB should not be suggested as a single diagnosis in cases of bone hypertrophy without confirmation using radiography.

SIGNIFICANCE

The growing popularity of 'big data' projects and limited collections access means that unpublished cases of PDB are often included in large scale analyses, impacting our understanding of the evolution of this disease. Using macroscopic analysis alone leads to overdiagnosis. Histological analysis is unnecessary when radiographic features are present, but provides a useful diagnostic step in long bones in advanced cases of PBD.

LIMITATIONS

The radiographic sample in this study was limited to three individuals.

SUGGESTIONS FOR FURTHER RESEARCH

The conclusion that radiography alone can be used to identify PDB in archaeological cases merits further research on a larger number of cases.

The role of case studies in recent paleopathological literature: An argument for continuing relevance

OBJECTIVE

To critically examine the role that case studies play in recent paleopathological literature, by evaluating their frequency of publication, academic impact, and the public engagement they generate.

MATERIALS

Articles published in International Journal of Paleopathology between 2011 and 2018 (N = 377).

METHODS

Articles were coded as case studies, population studies, methodological studies, or reviews. Case studies were coded as cultural practices, differential diagnosis, historical, or methodological/theoretical. We utilized bibliometric analysis to assess academic impact and altmetric analysis to evaluate public engagement.

RESULTS

Case studies continue to be the most frequently published, but least frequently cited, article type. There are no significant differences in public engagement data between article types. Methodological/theoretical case studies have the most academic impact. Differential diagnosis case studies have the least academic impact and generate the least public engagement.

CONCLUSIONS

The case study genre includes a variety of approaches, some of which hold significant potential for contributing to the discipline of paleopathology and beyond.

SIGNIFICANCE

This study updates Mays' (2012b) citation analysis, pioneers the use of altmetric data to analyze public engagement with paleopathological publications, and identifies less productive approaches and areas of heightened relevance in the case study genre.

LIMITATIONS

Publications in only one journal were analyzed. Only one source was utilized for citation data (Google Scholar) and one source for altmetric data (PlumX).

SUGGESTIONS FOR FUTURE RESEARCH

Expanding the granular analysis of case studies piloted here to additional journals and/or citation indexes to enlarge the sample size and provide keener insights.

A content analysis by bibliometry of the first ten years of the International Journal of Paleopathology

OBJECTIVES

The aim is to provide an overview of the nature of the content of palaeopathology articles in the International Journal of Paleopathology during the first ten years of publication (2011-2020), and to compare these results with those from other similar journals.

METHODS

The method used is bibliometry of International Journal of Paleopathology plus nine other periodicals publishing in the field of osteoarchaeology / palaeopathology. In these ten journals, 2513 publications in human osteology are reviewed of which 1032 are devoted specifically or substantially to palaeopathology.

RESULTS

International Journal of Paleopathology has attracted a large number of palaeopathology publications, but this has not been at the expense of extant journals. Its appearance appears to have coincided with an expansion of the discipline, and it may also act as a focus for publication for articles that would not previously have found a venue. Its output is distinctive from other journals assessed, with greater emphasis on review articles (including those focusing on method and theory in palaeopathology) and, especially, on case reports.

SIGNIFICANCE

International Journal of Paleopathology acts as a focal point for publications from diverse areas of the field. The connection with the Paleopathology Association provides a conduit by which outcomes of debates within the profession concerning future priorities for the field (e.g. development of method and theory; the status of the case report within the discipline) can be reflected in journal policy.

LIMITATIONS

Palaeopathology and other osteoarchaeology articles are published in venues other than those analysed in the current work.

How rare is rare? A literature survey of the last 45 years of paleopathological research on ancient rare diseases

OBJECTIVE

This paper aims to provide a quantitative estimation of the representation of diseases defined as rare today in the bioarchaeological literature and to outline the reasons for this.

MATERIALS

A 45-year bibliometric study of publications in seven bioarchaeological journals, along with two journals and editorial groups of broader scientific focus.

METHODS

Analyses of distribution patterns of the search hits and diachronic trends for achondroplasia, autosomal-dominant osteopetrosis, osteogenesis imperfecta, and osteopoikilosis, compared to those for tuberculosis as control measure of coverage.

RESULTS

Studies of ancient rare diseases (ARD) are mostly published as case reports in specialized journals and their number did not benefit from the introduction of biomolecular studies. The higher frequency of cases of achondroplasia suggests that not all rare diseases are equally under-represented.

CONCLUSIONS

Rare diseases are still largely under-represented in bioarchaeological literature. Their marginality likely results from a combination of taphonomic, methodological and public visibility factors.

SIGNIFICANCE

This article is the first attempt to provide a quantitative assessment of the under-representation of ARD and to outline the factors behind it.

LIMITATIONS

Rare diseases are an etiologically heterogeneous group. The number of surveyed journals and articles, as well as targeted diseases might be limiting factors.

SUGGESTIONS FOR FURTHER RESEARCH

Increasing collection and dissemination of data on ARD; opening a wide-ranging debate on their definition; implementation of biomolecular studies.

Do computed tomography findings agree with traditional osteological examination? The case of porous cranial lesions

OBJECTIVE

The current study evaluates the feasibility of using clinical cranial computed tomography (CT) scans for assessing the presence and morphology of porous cranial lesions (cribra orbitalia, porotic hyperostosis).

METHODS

Observers (n = 4) conducted three independent evaluations of porous cranial lesions based on photographs, 2-D CT, and 3-D CT scans of archaeological crania. Evaluations of the crania from each viewing scenario were compared to findings from direct macroscopic observation.

MATERIALS

Twenty-two complete adult crania from the Peruvian sites of Pachacamac and Chicama.

RESULTS

We found that lesion visibility differed by location: vault lesions with porosity larger than the resolution of the CT scan were identifiable across all viewing scenarios, but orbital lesions were identifiable only when extensive porosity was accompanied by widening of the inter-trabecular spaces. Lesions in stages of advanced remodeling were not visible on CT.

CONCLUSIONS

Paleopathological criteria applied to head CTs from clinical cases of suspected cranial fracture can reliably identify moderate to severe porous cranial lesions in living individuals.

SIGNIFICANCE

This validation study opens the door to broader study of porous cranial lesions in living individuals that can address open questions about the causes and consequences of these commonly reported skeletal indicators of stress.

LIMITATIONS

Performance of all viewing scenarios was evaluated relative to assessment data from direct observation of skeletal remains, but direct observation is itself subject to error.

SUGGESTIONS FOR FURTHER RESEARCH

The increasing resolution of routine CTs makes it increasingly possible to explore skeletal lesions in clinical contexts.