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Introduction: Migraines are the leading cause of disability in the United States, and the use of non-pharmaceutical treatments like osteopathic manipulative treatment (OMT) has shown promise. Despite its potential, the lack of mechanistic understanding has hindered widespread adoption. This study aims to investigate the efficacy of OMT in treating acute migraines and unravel its underlying mechanisms of action. Methods: Female rats were subjected to a "two-hit" approach to induce migraine-like pain. This involved bilateral injections of Complete Freund's Adjuvant (CFA) into the trapezius muscle (1st hit) followed by exposure to Umbellulone, a human migraine trigger, on Day 6 post-CFA (2nd hit). Soft tissue and articulatory techniques were applied to the cervical region for acute abortive or repeated prophylactic treatment. Cutaneous allodynia and trigeminal system activation were assessed through behavioral tests and immunohistochemical staining. Results: Following Umbellulone inhalation, CFA-primed rats exhibited periorbital and hind paw allodynia. Immediate application of OMT after Umbellulone inhalation as an abortive treatment partially alleviated cutaneous allodynia. With OMT applied thrice as a prophylactic measure, complete suppression of tactile hypersensitivity was observed. Prophylactic OMT also prevented the increase of c-fos signals in the trigeminal nucleus caudalis and the elevation of calcitonin gene-related peptide expression in trigeminal ganglia induced by CFA and Umbellulone exposure at 2â h post-inhalation. Discussion: These findings provide mechanistic insights into OMT's migraine-relief potential and underscore its viability as a non-pharmacological avenue for managing migraines.
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Objective: To analyze the consistency of study designs in osteopathic manipulative treatment (OMT) research, focusing on blinding protocols and the use of sham treatments. Data Source and Study Selection: PubMed and CINAHL were searched in January 2022. A total of 83 research studies between 2009 and 2021 were selected based on the presence of a double- or single-blind study design and/or sham treatment. Data Extraction and Analysis: Data regarding the primary outcome measures, blinding design, measures used to determine success of blinding, osteopathic technique used, and sham technique used for each eligible study were extracted and compared among different study designs. Results: A total of 5968 subjects participated in the 83 trials. The study population mainly consisted of asymptomatic individuals (25%) and chronic back pain patients (19%). Light touch was employed most commonly (49%) as the sham treatment, followed by unrelated sham (20%) and incomplete maneuvers (20%). Most studies blinded the subjects (80%) or the outcome evaluator/data analyzer (71%), while only 20% studies blinded the osteopathic physicians. Conclusions: Strict double-blinding is achievable for OMT clinical research by blinding the subjects and data collectors/analyzers rather than the osteopaths providing the actual treatment. The use of questionnaires to determine the success of blinding should be considered. Additionally, including OMT-naïve subjects is preferred to enhance blinding success. When designing a sham treatment, careful consideration should be given to blinding the data collector, accounting for the placebo effect, and incorporating an additional no-treatment control group to improve the rigor of the study design.
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CONTEXT: In the first half of the 20th century, nearly all osteopathic physicians used osteopathic manipulative medicine (OMM) in the care of hospitalized patients. Over the past few decades, however, inpatient OMM care has declined and is more commonly provided by OMM specialists. OBJECTIVE: To retrospectively evaluate the details of a specialty-level OMM inpatient consultation service. METHODS: Inpatient OMM consultations that took place at Northeast Regional Medical Center in Kirksville, Missouri, between July 1998 and March 2008 were identified from billing records. Consultations were reviewed for demographic information, admission location, postoperative status, intensive care unit and mechanical ventilation usage, admission and discharge diagnoses, consultation reasons and final diagnoses, areas of somatic dysfunction treated and types of osteopathic manipulative treatment (OMT) techniques used, and hospital length of stay (LOS). RESULTS: A total of 1509 OMM consultations were identified (580 for male patients [38%]; 929 for female patients [62%]; mean [SD] age, 54 [31] years [range, 0-99 years]), representing 11% of all inpatient consultations. Of these, 1372 consultations (91%) were initiated in the inpatient acute care facility, 87 (6%) in the inpatient acute rehabilitation facility, and 50 (3%) in the skilled nursing facility. Further, 265 consultations (18%) were for postoperative patients, 187 (12%) were for patients in the intensive care unit, and 54 (4%) were for patients receiving mechanical ventilation at the time of the consultation. The most common admission diagnoses were hypertension, routine newborn care, lower respiratory infection, chronic obstructive pulmonary disease, and gastrointestinal symptoms. The most common reasons for OMM consultation were chest/rib pain, spinal pain, lower respiratory infection (adjunctive treatment), cranial asymmetry, and infant feeding disorder. The most common types of OMT techniques used were myofascial release, balanced ligamentous tension, muscle energy, soft tissue, and inhibition. The mean (SD) LOS was 5.7 (3.3) days (range, 0-48 days), while the mean (SD) number of days the patient received OMT was 3.1 (2.2) days. CONCLUSION: Medical records reviewed in the current study revealed that OMM consultations were ordered primarily for musculoskeletal complaints, respiratory problems (adjunctive treatment), and newborn care. A variety of OMT techniques were used. Further retrospective study is warranted to determine if OMM had an effect on LOS.
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Registros de Hospitales , Pacientes Internos , Osteopatía/estadística & datos numéricos , Enfermedades Musculoesqueléticas/rehabilitación , Derivación y Consulta/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Missouri , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Despite growing interest in the molecular epidemiology of influenza virus, the pattern of viral spread within individual communities remains poorly understood. To determine the phylogeography of influenza virus in a single population, we examined the spatial diffusion of H1N1/09 influenza A virus within the student body of the University of California, San Diego (UCSD), sampling for a 1-month period between October and November 2009. Despite the highly focused nature of our study, an analysis of complete viral genome sequences revealed between 24 and 33 independent introductions of H1N1/09 into the UCSD community, comprising much of the global genetic diversity in this virus. These data were also characterized by a relatively low level of on-campus transmission as well as extensive spatial mixing, such that there was little geographical clustering by either student residence or city ZIP code. Most notably, students experiencing illness on the same day and residing in the same dorm possessed phylogenetically distinct lineages. H1N1/09 influenza A virus is therefore characterized by a remarkable spatial fluidity, which is likely to impede community-based methods for its control, including class cancellations, quarantine, and chemoprophylaxis.
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Geografía , Subtipo H1N1 del Virus de la Influenza A/clasificación , Estudiantes , Universidades , California/epidemiología , Humanos , Funciones de Verosimilitud , FilogeniaRESUMEN
BACKGROUND: Diabetes is the sixth leading cause of death and results in significant morbidity. The purpose of this study is to determine what demographic, health status, treatment, access/quality of care, and behavioral factors are associated with poor glycemic control in a Type 2 diabetic, low-income, minority, San Diego population. METHODS: Longitudinal observational data was collected on patients with Type 2 diabetes from Project Dulce, a program in San Diego County designed to care for an underserved diabetic population. The study sample included 573 patients with a racial/ethnic mix of 53% Hispanic, 7% black, 18% Asian, 20% white, and 2% other. We utilized mixed effects models to determine the factors associated with poor glycemic control using hemoglobin A1C (A1C) as the outcome of interest. A multi-step model building process was used resulting in a final parsimonious model with main effects and interaction terms. RESULTS: Patients had a mean age of 55 years, 69% were female, the mean duration of diabetes was 7.1 years, 31% were treated with insulin, and 57% were obese. American Diabetes Association (ADA) recommendations for blood pressure and total cholesterol were met by 71% and 68%, respectively. Results of the mixed effects model showed that patients who were uninsured, had diabetes for a longer period of time, used insulin or multiple oral agents, or had high cholesterol had higher A1C values over time indicating poorer glycemic control. The younger subjects also had poorer control. CONCLUSION: This study provides factors that predict glycemic control in a specific low-income, multiethnic, Type 2 diabetic population. With this information, subgroups with high risk of disease morbidity were identified. Barriers that prevent these patients from meeting their goals must be explored to improve health outcomes.
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Enfermería en Salud Comunitaria , Diabetes Mellitus Tipo 2/prevención & control , Manejo de la Enfermedad , Poblaciones Vulnerables , Factores de Edad , Anciano , California/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/etnología , Femenino , Hemoglobina Glucada/análisis , Índice Glucémico , Accesibilidad a los Servicios de Salud , Humanos , Estudios Longitudinales , Masculino , Pacientes no Asegurados , Persona de Mediana Edad , Análisis de Regresión , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: The objective of this study was to determine the demographic, treatment, clinical, and behavioral factors associated with dropping out of a nurse-based, low-income, multiethnic San Diego diabetes program. METHODS: Data were collected during a 17-month period in 2000 and 2002 on patients with type 2 diabetes from Project Dulce, a disease management program in San Diego County designed to care for an underserved diabetic population. The study sample included 69 cases and 504 controls representing a racial/ethnic mix of 53% Hispanic, 7% black, 16% Asian, 22% white, and 2% other. Logistic regression was used to determine factors associated with patient dropout. RESULTS: Patients who had high initial clinical indicators including blood pressure and hemoglobin A1c and those who smoked currently or smoked in the past were more likely to drop out of the diabetes program. CONCLUSION: This study provides markers of patient dropout in a low-income, multiethnic, type 2 diabetic population. Reasons for dropout in this program can be investigated to prevent further cohort loss.
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Relaciones Comunidad-Institución , Diabetes Mellitus Tipo 2 , Educación en Salud/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Academias e Institutos/organización & administración , California/epidemiología , Estudios de Casos y Controles , Planificación en Salud Comunitaria/organización & administración , Comorbilidad , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/enfermería , Etnicidad , Hemoglobina Glucada/análisis , Educación en Salud/economía , Educación en Salud/organización & administración , Humanos , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Seguro de Salud , Gobierno Local , Modelos Logísticos , Medicaid , Indigencia Médica , Medicare , Pacientes Desistentes del Tratamiento/psicología , Factores de Riesgo , Fumar/epidemiologíaRESUMEN
BACKGROUND: Strategies to prevent adult osteoporosis are best undertaken during childhood and adolescence, when the greatest amount of bone mineral density is acquired. This study examines pediatricians' knowledge and practices regarding osteoporosis prevention. METHODS: One hundred eighty-seven primary care pediatricians from San Diego and Imperial Counties responded to a 44-item mailed survey that measured physician knowledge, attitudes, and practices regarding osteoporosis prevention. RESULTS: Knowledge of U.S. RDA for calcium in children and adolescents was limited, with only 23.7 and 32.3% of pediatricians correctly identifying the recommended values for children and adolescents, respectively. Thirty-eight percent of respondents regarded osteoporosis prevention to be an important issue, and less than half reported that they counseled patients for osteoporosis prevention. Of those pediatricians who did perform osteoporosis counseling, the two most frequently cited motivators for counseling were that counseling is recommended by professional boards and having a personal or professional interest in osteoporosis prevention. The most commonly reported barriers to counseling were other issues taking greater priority and having insufficient time to undertake counseling for osteoporosis prevention. CONCLUSIONS: Osteoporosis prevention should begin in childhood and adolescence. This study suggests that many pediatricians do not counsel patients to reduce osteoporosis risk, nor do they consider this an important issue. Furthermore, they may not have full knowledge about how to prevent osteoporosis.