02002nas a2200277   4500000000100000008004100001260001300042653001000055653002700065653001900092653002600111653001100137653001200148653001100160653001200171653000900183653001500192653002100207653003200228100001600260245007600276300001000352490000800362520134000370022001401710       2001                            d  c2001 Aug10aAdult10aAnthropology, Physical10aBone and Bones10aEpidemiologic Studies10aFemale10aFossils10aHumans10aleprosy10aMale10aPrevalence10aReference Values10aSensitivity and Specificity1 aBoldsen J L00aEpidemiological approach to the paleopathological diagnosis of leprosy.  a380-70 v1153 a<p>In paleopathology it is usually assumed that modern diagnostic criteria can be applied to infectious diseases in the past. However, as both the human species and populations of pathogenic microorganisms undergo evolutionary changes, this assumption is not always well-founded. To get valid estimates of the frequency (the point prevalence at death) of leprosy in skeletal samples, sensitivity, specificity, and sample frequency must be estimated simultaneously. It is shown that more than three symptoms must be evaluated in at least three samples in order to reach estimates with well-described properties. The method is applied to three skeletal samples from Medieval Denmark; the samples were scored for the presence of seven osteological conditions indicating leprosy. For the osteological conditions, sensitivity varied from 0.36-0.80, and specificity from 0.58-0.98. The frequency of leprosy in the three samples was: Odense (a lepers' institution), 0.98, 95% CI 0.64-1.00; Malmö (urban cemetery), 0.02, 95% CI 0.00-0.07; and Tirup (rural cemetery), 0.36, 95% CI 0.23-0.46. It is concluded that it is indeed possible to estimate disease frequencies without reference to modern standards, and that leprosy occurred with widely differing frequencies in different segments of the Medieval population in southern Scandinavia.</p>  a0002-9483