Impact of osteopathic manipulative medicine training during graduate medical education and its integration into clinical practice.

CONTEXT: Osteopathic manipulative medicine (OMM) is a unique skill set consisting of physical manipulations that treat the neuromusculoskeletal system. Although OMM can improve patient outcomes such as functionality and pain, as well as increase physician reimbursement, its use is declining. Barriers to its use include a lack of proficiency, support, reimbursement, and time. Knowledge gaps remain as to how OMM training during graduate medical education (GME) affects OMM use. OBJECTIVES: This study describes relationships between OMM exposure during GME and the use of OMM in practice. METHODS: An online survey of physicians in a variety of medical fields during late 2022 assessed the impact of OMM education during postgraduate training on its use in clinical practice. Survey data were analyzed to compare training characteristics and OMM use via chi-square tests and binary logistic regression. RESULTS: A total of 299 surveys were completed. Respondents who received formal OMM education during residency were more likely (59.8 %) to utilize OMM in medical practice than those who practiced OMM informally (37.8 %, p<0.001) and those who had no OMM exposure during residency (10.3 %, p<0.001). Respondents who trained with more osteopathic attendings (p<0.001) and co-residents (p=0.012) were also more likely to utilize OMM. Those who completed residencies that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) with an Osteopathic recognition track, by the American Osteopathic Association (AOA), and were dually-accredited (ACGME/AOA), were all more likely to utilize OMM (60 %, 56 %, and 53 %, respectively) than those who completed residencies with ACGME accreditation alone (22 %, p<0.01). CONCLUSIONS: Although OMM can improve patient outcomes, it is underutilized by Doctors of Osteopathic Medicine (DOs) in practice. Lack of training after medical school has been identified as a contributing factor to its disuse. The results of our study illustrate that there is a positive association between OMM education during postgraduate training and OMM use in clinical practice.

Influenza Virus Genomic Surveillance, Arizona, USA, 2023-2024.

Influenza viruses are constantly evolving and are therefore monitored worldwide in the hope to reduce the burden of disease by annual updates to vaccine recommendations. We conducted genomic sequencing of 110 influenza A and 30 influenza B viruses from specimens collected between October 2023 and February 2024 in Arizona, USA. We identified mutations in the hemagglutinin (HA) antigenic sites as well as the neuraminidase (NA) gene in our samples. We also found no unique HA and NA mutations in vaccinated yet influenza-infected individuals. Real-time genomic sequencing surveillance is important to ensure influenza vaccine effectiveness.

Acceptability and Feasibility of Saliva-delivered PCR Coronavirus 2019 Tests for Young Children.

OBJECTIVES: Access to readily available, reliable, and easy-to-use coronavirus disease 2019 (COVID-19) tests remains critical, despite great vaccination progress. Universal back-to-school testing offered at early care and education ([ECE]; ie, preschool) sites to screen for positive cases may help preschoolers safely return to, and stay in, ECE. We examined the acceptability and feasibility of using a quantitative polymerase chain reaction COVID-19 saliva test for young children (n = 227, 54.0% girls: mean age = 52.3 ± 8.1 months) and their caregivers (n = 70 teachers: mean = 36.6 ± 14.7 years; n = 227 parents: mean = 35.5 ± 9.1 years) to mitigate the spread of COVID-19 and reduce days of school and work missed for households with children who test positive. METHODS: Participants were recruited at ECE sites serving low-income communities as part of the Rapid Acceleration of Diagnostic Testing-Underserved Populations Back to Early Care and Education Safely with Sustainability via Active Garden Education project (NCT05178290). RESULTS: Surveys in English or Spanish administered at testing events to children and caregivers at ECE sites showed child and adult acceptability and feasibility ratings were generally high. More favorable child and parent ratings were positively associated with child age and whether the child was able to produce a saliva sample. Language preference was not associated with any outcomes. CONCLUSIONS: Saliva sampling for COVID-19 at ECE sites is an acceptable strategy as an additional layer of protection for 4- and 5-year-olds; however, alternate testing strategies may be needed for younger children.

Osteopathic interventions via telehealth in a pediatric population: a retrospective case series.

CONTEXT: Healthcare delivery was dramatically affected during the coronavirus disease 2019 (COVID-19) pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment (OMT), via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician's experience in delivering osteopathic interventions to pediatric patients via telehealth. To our knowledge, these techniques have not previously been described in the literature. OBJECTIVES: To detail the experience of one osteopathic pediatrician's experience in delivering osteopathic interventions via telehealth. METHODS: Patients were offered the option of converting their existing OMT appointment to a telehealth visit. Prior to the appointment, instructions were emailed to the patient's parent or guardian along with a voluntary survey to provide feedback. Thirty-minute telehealth visits were conducted during which the provider gave verbal and visual instructions to a parent or guardian over a video platform to guide them in providing treatment to the patient based on osteopathic principles. Patients aged 3 and older rated their pain before and after the appointment using the Wong-Baker FACES scale. Deidentified patient demographics, chief complaints, treatments, anatomic locations, and pain scores were recorded in a REDcap database. Descriptive statistics were analyzed and paired samples t-tests were used with a p-value of <0.05 used to determine significance. RESULTS: Eighteen patients ranging from 6 months to 19 years of age were treated utilizing osteopathic interventions via telehealth during 54 distinct visits. The most common chief complaints treated were back (n=31; 26.3%) and neck (n=28; 23.7%) pain. The most common osteopathic techniques upon which instruction was based were inhibition (n=131; 29.7%) soft tissue (n=127; 28.8%) and counterstrain (n=78; 17.7%). The average post-treatment pain score (2.57) was significantly lower than the average pre-treatment pain score (6.77) p<0.01. No serious complications were observed. CONCLUSIONS: In our small retrospective case series, osteopathic interventions via telehealth resulted in decreased average pain scores following treatment while minimizing risk of viral exposure and transmission. Further study is needed to determine if such treatment methods could be effective on a larger scale when distance or illness preclude an in-person OMT visit.

Mercury in tadpoles collected from remote alpine sites in the southern Sierra Nevada mountains, California, USA.

Amphibians in alpine wetlands of the Sierra Nevada mountains comprise key components of an aquatic-terrestrial food chain, and mercury contamination is a concern because concentrations in fish from this region exceed thresholds of risk to piscivorous wildlife. Total mercury concentrations were measured in whole tadpoles of the Sierra chorus frog, Pseudacris sierra, two times at 27 sites from high elevations (2786-3375 m) in the southern Sierra Nevada. Median mercury concentrations were 14 ng/g wet weight (154 ng/g dry weight), which were generally low in comparison to tadpoles of 15 other species/location combinations from studies that represented both highly contaminated and minimally contaminated sites. Mercury concentrations in P. sierra were below concentrations known to be harmful in premetamorphic tadpoles of another species and below threshold concentrations for risk to predaceous wildlife. Concentrations in tadpoles were also lower than those observed in predaceous fish in the study region presumably because tadpoles in the present study were much younger (1-2 months) than fish in the other study (3-10 years), and tadpoles represent a lower trophic level than these fish. Mercury concentrations were not related to distance from the adjacent San Joaquin Valley, a source of agricultural and industrial pollutants.

An evaluation of mercury concentrations in three brands of canned tuna.

There is widespread concern over the presence of Hg in fish consumed by humans. While studies have been focused on determining the Hg concentration in sport fish and some commercial fish, little attention has been directed to canned tuna; it is widely held that concentrations are low. In the present study, the amount of Hg present in canned tuna purchased in Las Vegas, Nevada, USA, was examined, and the brand, temporal variation, type, and packaging medium impacts on Hg concentrations in tuna were explored. A significant (p < 0.001) brand difference was noted: Brand 3 contained higher Hg concentrations ($\bar x$ standard deviation (SD) (0.777 +/- 0.320 ppm) than Brands 1 (0.541 +/- 0.114 ppm) and 2 (0.550 +/- 0.199 ppm). Chunk white tuna (0.619 +/- 0.212 ppm) and solid white tuna (0.576 +/- 0.178 ppm) were both significantly (p < 0.001) higher in mean Hg than chunk light tuna (0.137 +/- 0.063 ppm). No significant temporal variation was noted, and packaging had no significant effect on Hg concentration. In total, 55% of all tuna examined was above the U.S. Environmental Protection Agency's (U.S. EPA) safety level for human consumption (0.5 ppm), and 5% of the tuna exceeded the action level established by the U.S. Food and Drug Administration (U.S. FDA) (1.0 ppm). These results indicate that stricter regulation of the canned tuna industry is necessary to ensure the safety of sensitive populations such as pregnant women, infants, and children. According to the U.S. EPA reference dose of 0.1 microg/kg body weight per day and a mean Hg value of 0.619 ppm, a 25-kg child may consume a meal (75 g) of canned chunk white tuna only once every 18.6 d. Continued monitoring of the industry and efforts to reduce Hg concentrations in canned tuna are recommended. Environ.