<b>Background/Objectives</b>: Aging is associated with a progressive decline in biological function due to a complex interplay of physical, psychological, and social factors. This randomized controlled trial aimed to evaluate the effects of a functional health education program on functional capacity in older adults. <b>Methods:</b> Twenty participants (mean age: 80.70 ± 5.992 years) were randomized to either an experimental group that received a 12-week exercise program or a control group. The exercise program included aerobic, flexibility, strength, and cognitive components. Outcomes were assessed using the Timed Up and Go (TUG) test, Falls Efficacy Scale (FES), and Visual Analog Scale (VAS) for pain. <b>Results</b>: In the population studied, 80% of the older adults indicated some type of back pain. The experimental group results showed a significant reduction in back pain (<i>p</i> = 0.032) and risk of falling (<i>p</i> = 0.013). Additionally, the experimental group demonstrated significant improvements in functional capacity (<i>p</i> = 0.016) and cognitive capacity (<i>p</i> = 0.023). <b>Conclusions</b>: This study demonstrated that a specific activity significantly improved participants’ perceived risk of falls, functionality, cognitive function, and reduced back pain complaints in the experimental group.
Objectives To explore possible factors related to the increased likelihood of retirement from practice and increased number of complaints and concerns received by osteopaths in practice 10 years or more.Design Online cross-sectional survey.Setting UK osteopathic healthcare.Participants UK-based osteopaths registered with the General Osteopathic Council.Results 570 questionnaires were eligible for analysis. Respondents were mostly women (57.5%), working in England (90.7%), white or white British (91.8%), 50–59 years of age (29.6%) and practicing for 0–5 years (16.9%). Osteopaths who had been in practice for 10 years or more were significantly (χ² tests, p<0.05) more likely to be a principal (81.1% vs 49.2%), aged 50–59 years (37% vs 14.3%) have a bachelor’s degree (64.3% vs 31.2%), work alone (23.9% vs 11.6%), in fewer than three clinics (84% vs 69.3%), use paper patient records (47.5% vs 28.3%), see fewer than five new patients a week (59.8% vs 40.2%) and use cranial osteopathy on a daily basis (37.3% vs 18.5%).Conclusions Osteopaths who have been in practice for 10 years or more have some significantly different demographics and aspects of clinical practice and patient management to those in practice less than 10 years. However, it is not clear whether these differences are influential in decisions for leaving practice or the increased number of concerns and issues received.
Ulloa-Clavijo C, Martín-Vírgala J, Gómez-Alonso C
et al.
Objetivo: En enfermos renales, la enfermedad ósea-metabólica, la inflamación sistémica y la malnutrición exacerban el riesgo de calcificación vascular (CV) y la morbimortalidad. Dada la fuerte asociación entre CV y fracturas por fragilidad, el objetivo de este estudio es evaluar la contribución de los mayores determinantes de CV al deterioro óseo en pacientes en diálisis peritoneal (DP).
Métodos: En 31 pacientes no diabéticos en DP (>6 meses), se estudiaron marcadores de alteraciones del metabolismo óseo, daño vascular, inflamación y desnutrición, y, su impacto en el deterioro óseo (osteopenia radiológica y/o antecedentes de fractura por fragilidad).
Resultados: En estos pacientes, (20 varones y 11 mujeres; edad=54±15 y 60±11 años respectivamente (p=0,24)), la prevalencia de fracturas por fragilidad fue de 5% en hombres y del 27% en mujeres. El deterioro óseo fue mayor en personas de edad avanzada, sexo femenino, índices de Charlson y Kauppila elevados, menor masa muscular y con expansión de una subpoblación altamente inflamatoria de granulocitos inmaduros de baja densidad (LDGi). Un análisis de regresión logística demostró que el riesgo de deterioro óseo está más influenciado por el sexo femenino que por la edad y que, de los múltiples factores asociados a mayor deterioro óseo estudiados, sólo la expansión de LDGi estima el riesgo de alteraciones óseas en estos pacientes independientemente de su edad y sexo.
Conclusión: La expansión de LDGi provee de un biomarcador certero para el diagnóstico de deterioro óseo y para monitorizar estrategias que atenúen su progresión en pacientes en DP de cualquier edad y sexo.
Los fundamentos fisiopatológicos que justifican la suplementación con calcio y vitamina D en la osteoporosis se sustancian en una amplia evidencia científica que se ha obtenido a través de varios ensayos clínicos aleatorizados y posteriores meta-análisis que han demostrado una reducción del riesgo de fracturas osteoporóticas estadísticamente significativa y clínicamente relevante. Esta evidencia ha conducido a su recomendación por parte de varias sociedades científicas interesadas en el manejo de la osteoporosis.
Con el fin de optimizar la eficacia y el balance beneficio/riesgo de estos, el calcio y la vitamina D deben administrarse conjuntamente con los fármacos que se prescriban para el tratamiento de la osteoporosis, pues en todos estos estudios de referencia se ha utilizado calcio y vitamina D tanto en la rama que recibe el fármaco como la del placebo. La sal de calcio mayormente utilizada es el carbonato y el metabolito de la vitamina D, el colecalciferol o vitamina D3.
No existe consenso ni evidencia científica concluyente sobre cuál es la dosis a emplear en la deficiencia de vitamina D asociada a osteoporosis. No obstante, la tendencia ha sido siempre a ir aumentando estas cantidades, desde las 400 UI que se recomendaban hace unos 30 años a las 2.000 UI diarias de la actualidad. Revisaremos en este artículo cuales son las recomendaciones que se realizan por medio de las guías clínicas, al recoger éstas la evidencia científica disponible.
INTRODUCTION Osteopathic care may support an individual's adaptive capacity, including allostatic regulation and tissue changes in both health and disease. The palpatory findings which osteopaths claim are related to tissue changes may be linked to allostatic load. However, this putative link has not been formally investigated. METHODS We conducted a scoping review to critically appraise the relevant literature on the relationship between allostatic processes and tissue alterations. This review evaluates the use and relevance of palpatory findings in osteopathic care. We searched on PubMed, EMBASE, Cochrane library for research exploring the links between tissue adaptation, allostasis and osteopathic palpatory findings (OPF). RESULTS Recent studies provide insights into the role of allostatic regulation on body systems' responses related to tissue alterations. These results provide new insights into the relevance of OPF to clinical practice. DISCUSSION We build upon the findings of our review to propose a putative model for OPF in clinical practice. CONCLUSION Although the clinical phenomena associated with OPF may be biologically plausible, it lacks the necessary underpinning research evidence. Arguably, the classical focus on the diagnosis of palpable tissue changes fails to integrate biological, social and neuropsychological aspects such as stress responses. Tissue alterations related to stress and allostatic load markers have been less studied. Tissue changes involved in the adaptive process may be useful to practitioners in the field of manual therapy, particularly in osteopathy. We propose that OPF are one of the multidimensional aspects that may inform osteopathic decision-making. However, they should be considered within a biopsychosocial perspective and taking into account concepts of allostatic load and regulation.
Objetivos: Conocer las acciones del oxígeno a alta concentración en cámara hiperbárica (CH) sobre la expresión de genes relacionados con el metabolismo óseo en líneas celulares osteoblásticas y hueso trabecular humano.
Material y métodos: Se analizó la expresión diferencial de varios genes relacionados con el metabolismo óseo (SOST, RUNX2, MMP14, OPG, HIF-1α y SIRT1) en dos líneas celulares osteoblásticas humanas (Saos y Super-Saos) y en fragmentos de hueso trabecular humano sometidos a una, tres o cinco sesiones de CH (90 minutos, oxígeno 100%; 2,3 atmósferas). En cada experimento se utilizó un control que no recibió CH.
Resultados: No encontramos diferencias significativas tras la CH en la expresión de los genes estudiados, ni en las células ni en hueso trabecular. Solo en la línea celular Super-Saos la expresión de OPG tras 5 sesiones de CH descendió 6 veces con respecto a la del grupo control (2-ΔCt de 72; p=0,01).
Conclusiones: El oxígeno a alta concentración en cámara hiperbárica no parece tener influencia en la expresión de genes relacionados con el metabolismo óseo.
Julie A. Swartzendruber Ryan W. Incrocci Samantha A. Wolf Ariee Jung Katherine L. Knight College of Graduate Studies, Midwestern University, Downers Grove, Illinois Department of Microbiology and Immunology, Midwestern University, Downers Grove, Illinois Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois College of Dental Medicine – Illinois, Midwestern University, Downers Grove, Illinois Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois
Objective Board examinations in undergraduate medical education are imperative for competency assessment and a standard licensure process. While the cost of attendance and mean indebtedness of medical students have been quantified, the financial burden experienced by medical students from board preparation and examination has never been quantified. Materials and methods A total of 290 fourth-year osteopathic medical students from 38 osteopathic medical schools completed an anonymous survey that asked them to select the resources they had purchased for board preparation. Along with demographic information, respondents were asked which board examinations they had taken during their medical school education. The price for each resource was located by going to the resource website and finding the “list price” of a brand-new copy/version of that resource. If a price was not found, a current Amazon.com “list price” was utilized. These prices best approximate the maximum a student would spend per resource. Response and statistical analysis such as analysis of variance, post hoc comparison (Scheffé and Bonferronis test), and chi-square tests were conducted using the Statistical Package for Social Sciences (SPSS) Statistics, version 25.0 (IBM SPSS Statistics, Armonk, NY). Results This study found that osteopathic medical students spent, on average, $7,499 (s.d.=$2,506) for board preparation and examination. This cost when isolated is $3,370 for the cost of taking board examinations and $4,129 for the cost of board preparation. Respondents from the West were found to spend most at $9,432, while students from the Northeast spent the least, $7.090. Additionally, non-traditional medical students, those who matriculated after the age of 30 were found to spend more than individuals who began when they were under the age of 25 or between the ages of 25-30. The two most commonly used resources for both Level 1/Step 1 and Level 2/Step 2 examinations were COMBANK and UWorld. Conclusions/relevance This study is the first of its kind to quantify the mean cost of board preparation and examination in undergraduate medical education at $7,499. When considering the mean indebtedness of the osteopathic graduating class of 2017-2018, 2.94% of medical education debt can be attributed to the cost of board preparation and assessments. As competitiveness for graduate medical education increases, individuals will spend more money to ensure a competitive board exam performance, a key selection factor. Stakeholders in undergraduate medical education are encouraged to further understand the interplay between medical student debt and the cost of board examinations and preparation.
Objetivo: En las últimas décadas se han identificado genes asociados a la masa ósea y al riesgo de fractura osteoporótica, varios de los cuales pertenecen a la vía de Wnt. En este proyecto se estudió la funcionalidad de 7 mutaciones de cambio de sentido del gen DKK1 –un inhibidor de la vía de Wnt– presentes en la población general.
Material y métodos: Se realizaron estudios in vitro del gen reportero luciferasa para medir la actividad de la vía de Wnt en presencia o ausencia de DKK1 silvestre o mutada, y estudios de western blot, para evaluar si las distintas mutaciones afectan a su síntesis y/o a su estabilidad.
Resultados: La proteína DKK1 con la variante p.Ala41Thr presenta menor actividad inhibidora de la vía en comparación con la proteína silvestre. También se observaron diferencias significativas entre los experimentos realizados en ausencia de DKK1 y los que incluyen DKK1 con la mutación p.Ala41Thr. Los western blots mostraron que la cantidad de proteína era similar para todas las variantes, tanto las mutadas como la silvestre, por lo que la pérdida de actividad de p.Ala41Thr no parecía deberse a falta de proteína. El resto de las mutaciones no presentaron un comportamiento diferente al de la proteína DKK1 silvestre.
Conclusiones: La variante de cambio de sentido p.Ala41Thr de la proteína DKK1, con una frecuencia poblacional de 0,013%, presenta una pérdida parcial de su función inhibidora, que no es debida a la falta de expresión de ésta. Esta variante génica podría conllevar un aumento de la densidad mineral ósea en las personas de la población general portadoras de esta mutación.
Marked changes have occurred in health care delivery in the United States with the implementation of the Affordable Care Act (ACA), including the advancement of integrated health systems, the introduction of patient centered medical homes and the creation of accountable care organizations. With millions of Americans newly insured, never has there been a more pressing need for accurate physician workforce information and planning. Opinions vary about the nature and degree of anticipated physician shortages, and health care workforce determinations are fraught with variables and uncertainties that are challenging to address definitively. Identifying accurate information about the nation's currently licensed physician workforce, however, is an important starting point. This article reviews data received in 2014 by the Federation of State Medical Boards from the nation's state medical and osteopathic boards about the current supply of actively licensed physicians in the United States and the District of Colum...
Alexander S. Lutsenko, Liudmila Y. Rozhinskaya, Natalia V. Toroptsova
et al.
This article considers the role of calcium and vitamin D in body functions, with focus on skeletal system. We reviewed the results of studies on calcium and vitamin D supplementation worldwide and in Russia. According to these studies, there is insufficient dietary intake of these nutrients, irrespective of geographical, ethnic features and physiological conditions. We also reviewed the data on safety of calcium supplementations for urinary and cardiovascular systems, regimens and doses for vitamin D deficiency treatment in various age groups. The article also contains data on calcium, vitamin D and combined medications, available in Russia, for prevention and treatment of osteoporosis, with highlight on combined ones for better compliance and more convenient dosage frequency.
The osteopathic treatment of the fascia involves several techniques, each aimed at allowing the various layers of the connective system to slide over each other, improving the responses of the afferents in case of dysfunction. However, before becoming acquainted with a method, one must be aware of the structure and function of the tissue that needs treating, in order to not only better understand the manual approach, but also make a more conscious choice of the therapeutic technique to employ, in order to adjust the treatment to the specific needs of the patient. This paper examines the current literature regarding the function and structure of the fascial system and its foundation, that is, the fibroblasts. These connective cells have many properties, including the ability to contract and to communicate with one another. They play a key role in the transmission of the tension produced by the muscles and in the management of the interstitial fluids. They are a source of nociceptive and proprioceptive information as well, which is useful for proper functioning of the body system. Therefore, the fibroblasts are an invaluable instrument, essential to the understanding of the therapeutic effects of osteopathic treatment. Scientific research should make greater efforts to better understand their functioning and relationships.
Abstract Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University–School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities. J Am Osteopath Assoc. 2015;115(4):202-211 doi:10.7556/jaoa.2015.042
F. Cerritelli, G. Pizzolorusso, C. Renzetti
et al.
Background Despite some preliminary evidence, it is still largely unknown whether osteopathic manipulative treatment improves preterm clinical outcomes. Materials and Methods The present multi-center randomized single blind parallel group clinical trial enrolled newborns who met the criteria for gestational age between 29 and 37 weeks, without any congenital complication from 3 different public neonatal intensive care units. Preterm infants were randomly assigned to usual prenatal care (control group) or osteopathic manipulative treatment (study group). The primary outcome was the mean difference in length of hospital stay between groups. Results A total of 695 newborns were randomly assigned to either the study group (n= 352) or the control group (n=343). A statistical significant difference was observed between the two groups for the primary outcome (13.8 and 17.5 days for the study and control group respectively, p<0.001, effect size: 0.31). Multivariate analysis showed a reduction of the length of stay of 3.9 days (95% CI -5.5 to -2.3, p<0.001). Furthermore, there were significant reductions with treatment as compared to usual care in cost (difference between study and control group: 1,586.01€; 95% CI 1,087.18 to 6,277.28; p<0.001) but not in daily weight gain. There were no complications associated to the intervention. Conclusions Osteopathic treatment reduced significantly the number of days of hospitalization and is cost-effective on a large cohort of preterm infants.