Pro-inflammatory diet and depressive symptoms in the healthcare setting.

BACKGROUND: Depression is a highly prevalent disease affecting more than 350 million people and has recently been associated with low-grade chronic inflammation. The role of diet in the development of a pro-inflammatory state was demonstrated in a recent study that found a high Empirical Dietary Inflammatory Index (EDII) score was associated with increased concentrations of circulating plasma inflammatory markers. It is becoming increasingly clear that diet and depression are linked, but the relationship itself has not been determined with absolute certainty. Pharmacologic and device assisted therapies are considered our most advanced treatments for major depressive disorder, though numerous studies suggest that they are not sufficient. Exploring the relationship of a pro-inflammatory diet and depressive symptoms is crucial for a holistic, evidenced-based approach to treating depression. METHODS: Our study investigated this association using the EDII to evaluate the inflammatory potential of diet and Patient Health Questionnaire-9 (PHQ-9) to score depression among healthcare personnel. Results from 631 participants were collected for analysis using REDCap software. RESULTS: High PHQ-9 scores and high EDII scores were significantly correlated (F = 18.32, p < 0.0001) even when accounting for gender, psychiatric diagnosis, physical exercise, and spiritual exercise. CONCLUSIONS: Our findings suggest that anti-inflammatory diets can play a key role in the treatment of depression.

Nelson-Denny Reading Test Scores as a Predictor of Student Success in Osteopathic Medical Education.

BACKGROUND: Reading skills are crucial in medical school, where students are expected to absorb an onslaught of new and complex material. Studies on reading assessment in osteopathic medical education are lacking. OBJECTIVE: To address gaps in the literature related to reading assessment and to investigate the correlation of the Nelson-Denny Reading Test with various performance indicators in osteopathic medical education. METHODS: The West Virginia School of Osteopathic Medicine administered the Nelson-Denny Reading Test to first- and second-year students between 2015 and 2017. Raw scores were translated into the percentile rank, scale score, grade equivalent score, and stanine score based on guidelines supplied with the Nelson-Denny Reading Test. These translated scores were compared with Medical College Admission Test (MCAT) scores, first- and second-year performance on course examinations, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores, and scores provided in a 2002 study by Haught and Walls. RESULTS: A total of 623 students took the first-year Nelson-Denny Reading Test, and 408 took both the first- and second-year Nelson-Denny Reading Test. Findings showed a large correlation between the Nelson-Denny Reading Test and the verbal reasoning section (r=0.56 for the class of 2020 and 0.46 for the class of 2021) of the old MCAT (before 2015) and the reasoning skills section (r=0.42 for the class of 2020 and 0.49 for the class of 2021) of the new MCAT (released in 2015). There were no correlations with first- and second-year course examination scores or COMLEX-USA Level 1 scores. The Nelson-Denny Reading Test scores reported by Haught and Walls for medical students and health professional students were slightly higher than those found for osteopathic medical students in this study. CONCLUSION: The reasoning skills section of the new MCAT could serve as a good proxy for a reading test. There were no correlations between the Nelson-Denny Reading Test and performance in the first 2 years of medical school or COMLEX-USA Level 1 performance. Further research can strengthen the findings and determine whether correlations exist with clinical performance.

Osteopathic Medical Students Entering Family Medicine and Attitudes Regarding Osteopathic Manipulative Treatment: Preliminary Findings of Differences by Sex.

CONTEXT: Factors distinguishing osteopathic physicians from their allopathic counterparts include the use of osteopathic manipulative treatment (OMT), application of osteopathic principles and practice (OPP), and a greater likelihood of entering primary care, specifically family medicine (FM). In the United States, the percentage of entering osteopathic medical students who were female rose from 14.3% in fall 1977 to 44.3% in fall 2015. OBJECTIVES: To investigate the perspectives of female osteopathic medical students as they relate to osteopathic distinctiveness. METHODS: Students at the West Virginia School of Osteopathic Medicine who were eligible to participate in graduation exercises in 2014 or 2015 were asked to complete the school's standard Exit Survey. The research team chose 5 items from the survey to include in the current analysis. Sex had been self-identified at admission, and residency in first postgraduate year was categorized as FM or other specialty. Graduates entering a transitional year or traditional internship were removed from analysis. RESULTS: Analysis was conducted for 308 of the 375 students (82%) expected to graduate in 2014 or 2015. χ2 analysis found no difference by sex in the number of graduates entering FM residencies vs other specialties (P=.727). Statistically significant differences were found in 2 survey items: "Use of OMT will enhance my practice" (P=.005) and "What emphasis do you believe OMT will have in your practice?" (P<.001). Graduating female students responded more favorably to OMT on both items. For the latter item, 91.4% of female and 80.3% of male students indicated OMT would have at least some role in their practices. Sex differences remained after statistically controlling for entry into FM. CONCLUSION: Female graduating osteopathic medical students were more likely to report that OMT will have at least some role in their practices. Future studies of the attitudes and practice patterns of osteopathic physicians should analyze for differences by sex.

Self-Reported Minimalist Running Injury Incidence and Severity: A Pilot Study.

INTRODUCTION: Minimalist running entails using shoes with a flexible thin sole and is popular in the United States. Existing literature disagrees over whether minimalist running shoes (MRS) improve perceived severity of injuries associated with running in traditional running shoes (TRS). Additionally, the perceived injury patterns associated with MRS are relatively unknown. OBJECTIVES: To examine whether injury incidence and severity (ie, degree of pain) by body region change after switching to MRS, and to determine if transition times affect injury incidences or severity with MRS. METHODS: Runners who were either current or previous users of MRS were recruited to complete an Internet-based survey regarding self-reported injury before switching to MRS and whether self-reported pain from that injury decreased after switching. Questions regarding whether new injuries developed in respondents after switching to MRS were also included. Analyses were calculated using t tests, Wilcoxon signed rank tests, and Fischer exact tests. RESULTS: Forty-seven runners completed the survey, and 16 respondents reported injuries before switching to MRS. Among these respondents, pain resulting from injuries of the feet (P=.03) and knees (P=.01) decreased. Eighteen respondents (38.3%) indicated they sustained new injuries after switching to MRS, but the severity of these did not differ significantly from no injury. Neither time allowed for transition to MRS nor use or disuse of a stretching routine during this period was correlated with an increase in the incidence or severity of injuries. CONCLUSION: After switching to MRS, respondents perceived an improvement in foot and knee injuries. Additionally, respondents using MRS reported an injury rate of 38.3%, compared with the approximately 64% that the literature reports among TRS users. Future studies should be expanded to determine the full extent of the differences in injury patterns between MRS and TRS.

Lower extremity biomechanical relationships with different speeds in traditional, minimalist, and barefoot footwear.

Minimalist running footwear has grown increasingly popular. Prior studies that have compared lower extremity biomechanics in minimalist running to traditional running conditions are largely limited to a single running velocity. This study compares the effects of running at various speeds on foot strike pattern, stride length, knee angles and ankle angles in traditional, barefoot, and minimalist running conditions. Twenty-six recreational runners (19-46 years of age) ran on a treadmill at a range of speeds (2.5-4.0 m·sec(-1)). Subjects ran with four different footwear conditions: personal, standard, and minimalist shoes and barefoot. 3D coordinates from video data were collected. The relationships between speed, knee and ankle angles at foot strike and toe-off, relative step length, and footwear conditions were evaluated by ANCOVA, with speed as the co-variate. Distribution of non-rearfoot strike was compared across shod conditions with paired t-tests. Non-rearfoot strike distribution was not significantly affected by speed, but was different between shod conditions (p < 0.05). Footwear condition and speed significantly affected ankle angle at touchdown, independent of one another (F [3,71] = 10.28, p < 0.001), with barefoot and minimalist running exhibiting greater plantarflexion at foot strike. When controlling for foot strike style, barefoot and minimalist runners exhibited greater plantarflexion than other conditions (p < 0.05). Ankle angle at lift-off and relative step length exhibited a significant interaction between speed and shod condition. Knee angles had a significant relationship with speed, but not with footwear. There is a clear influence of footwear, but not speed, on foot strike pattern. Additionally, speed and footwear predict ankle angles (greater plantarflexion at foot strike) and may have implications for minimalist runners and their risk of injury. Long-term studies utilizing various speeds and habituation times are needed. Key pointsFoot strike style does not change with speed, but does change with shod condition, with minimalist shoes exhibiting an intermediate distribution of forefoot strikes between barefoot and traditional shoes.Plantarflexion at touchdown does change with speed and with shoe type, with barefoot and minimalist shoes exhibiting a greater plantarflexion angle than traditional running shoes.Knee angles change with speed in all shod conditions, but knee flexion at touchdown is not different between shod conditions.Relative step length changes with speed and shod condition, but there is an interaction between these variables such that step length increases more quickly in traditional shoes as speed increases.

Relationship of admissions variables and college of osteopathic medicine variables to performance on COMLEX-USA level 3.

CONTEXT: New accreditation standards require that all US colleges of osteopathic medicine (COMs) publically report the first-time pass rates of graduates on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 3. Little is known about the extent to which admissions variables or COM performance measures relate to Level 3 performance. OBJECTIVE: To examine the relationship of admissions variables and COM performance to scores on Level 3 and to assess whether a relationship existed between Level 3 scores and sex, curriculum track, year of graduation, and residency specialty in the first postgraduate year. METHODS: Data were analyzed from 4 graduating classes (2008-2011) of the West Virginia School of Osteopathic Medicine in Lewisburg. Relationships were examined between first-attempt scores on COMLEX-USA Level 3 and Medical College Admission Test (MCAT) scores; undergraduate grade point averages (GPAs); GPAs in COM year 1, year 2, and clinical rotation years (years 3 and 4); and first-attempt scores on COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation. RESULTS: Of the 556 graduates during this 4-year period, COMLEX-USA Level 3 scores were available for 552 graduates (99.3%). No statistically significant differences were found in Level 3 scores based on sex, curriculum track, graduating class, or residency specialty. The strongest relationship between Level 3 scores and any admissions variable was with total MCAT score, which accounted for 4.2% of the variation in Level 3 scores. The strongest relationship between Level 3 scores and COM year performance measures was with year 2 GPA, which accounted for 35.4% of the variation in Level 3 scores. Level 1 scores accounted for 38.5% of the variation in Level 3 scores, and Level 2-Cognitive Evaluation scores accounted for the greatest percentage of variation (45.7%). The correlation of Level 3 scores with passing the Level 2-Performance Evaluation on the first attempt was not statistically significant. CONCLUSION: A weak relationship was found between admissions variables and performance on COMLEX-USA Level 3, suggesting that graduates with lower MCAT scores and undergraduate GPAs may have overcome their early disadvantage. Strong relationships were found between Level 3 scores and year 2 GPAs, as well as scores on COMLEX-USA Level 1 and Level 2-Cognitive Evaluation.

Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study.

CONTEXT: Childhood acute otitis media (AOM) is highly prevalent. Its usual sequela of middle ear effusion (MEE) can lead to conductive hearing loss, for which surgery is commonly used. OBJECTIVE: To evaluate the efficacy of an osteopathic manipulative treatment (OMT) protocol on MEE resolution following an episode of AOM. The authors hypothesized that OMT provided adjunctively to standard care for young children with AOM would reduce the duration of MEE following the onset of AOM. METHODS: We compared standard care only (SCO) and standard care plus OMT (SC+OMT) for the duration of MEE following AOM. Patients were aged 6 months to 2 years. The SC+OMT group received OMT during 3 weekly visits. Weekly tympanometric and acoustic reflectometer (AR) readings were obtained from all patients. RESULTS: There were 52 patients enrolled, with 43 completing the study and 9 dropping out. No demographic differences were noted. Only ears from each patient with abnormal tympanograms at entry were included. There were 76 ears in the tympanogram analysis (38 from SCO; 38 from SC+OMT) and 61 ears in the AR data analysis (31 from SCO; 30 from SC+OMT). Dependence of bilateral ear disease noted in AR readings was accounted for in statistical analysis. Tympanogram data demonstrated a statistically significant improvement in MEE at visit 3 in patients in the SC+OMT group (odds ratio, 2.98; 95% confidence interval, 1.16, 7.62; χ(2) test for independence, P=.02). The AR data analysis showed statistically significant improvement at visit 3 for the SC+OMT group (z=2.05; P=.02). There was no statistically significant change in MEE before or immediately after the OMT protocol. CONCLUSION: A standardized OMT protocol administered adjunctively with standard care for patients with AOM may result in faster resolution of MEE following AOM than standard treatment alone. (ClinicalTrials.gov number NCT00520039.).

Tobacco dependence curricula in US osteopathic medical schools: a follow-up study.

CONTEXT: Tobacco use is the leading preventable cause of illness and death in the United States. A 1998 survey of US osteopathic medical schools identified deficiencies in tobacco dependence curricula. OBJECTIVE: To assess the current content and extent of tobacco dependence education and intervention skills in US osteopathic medical school curricula. DESIGN: An electronic survey. SETTING: Osteopathic medical schools with students enrolled for the 2009-2010 academic year. PARTICIPANTS: Twenty-seven osteopathic medical school deans or their designated administrators. MAIN OUTCOME MEASURES: Reported instruction in 7 basic science and 6 clinical science content areas (elective or required) and hours of tobacco dependence education were assessed and compared with the 1998 data. RESULTS: The mean (standard deviation) number of content areas reported as covered in 2010 was 10.6 (2.3) (6.1 [1.2] basic science areas, 4.6 [1.3] clinical science areas). Seventeen of 27 respondents (63%) reported that smokeless tobacco content was covered at their school, and 9 of 27 (33%) reported that the stages of change counseling technique was covered. Compared with 1998, a significant increase was noted in the percentage of schools covering tobacco dependence (92.6% in 2010 compared with 57.9% in 1998, P=.0002). Reported hours of tobacco dependence instruction were also significantly higher in 2010 compared with those in 1998 (Fisher exact test, P<.05). No statistically significant changes were found in the proportion of schools covering all 13 content areas (15.7% vs 22.2%), the proportion covering motivational interviewing in detail (26.3% vs 33.3%), or the proportion requiring curricula on smokeless tobacco (57.9% vs 59.3%). CONCLUSION: Osteopathic medical school respondents reported more instruction on tobacco dependence in 2010 compared with those in 1998. However, some important basic science and clinical science content areas are not being adequately taught in US osteopathic medical schools.

Salivary uric acid as a noninvasive biomarker of metabolic syndrome.

BACKGROUND: Elevated serum uric acid is associated with obesity, hypertension and metabolic syndrome. Because a linear relationship exists between serum and salivary uric acid (SUA) concentration, saliva testing may be a useful noninvasive approach for monitoring cardiometabolic risk. The goal of this pilot study was to determine if SUA is increased in patients with metabolic syndrome and to investigate correlations between SUA and individual cardiometabolic risk factors. FINDINGS: Volunteers between the ages of 18 and 65 without conditions known to affect serum uric acid levels were recruited. Height, weight, blood pressure and waist circumference were measured and a full lipid panel along with fasting blood glucose was obtained. Saliva samples were collected and uric acid levels were determined. 78 volunteers, 35% of whom had metabolic syndrome, completed the study. SUA was significantly elevated in patients with metabolic syndrome (p=.002). The incidence of metabolic syndrome in the 4th quartile for SUA was 67% compared to 25% in quartiles1-3 combined. Significant correlations were seen between SUA and systolic blood pressure (r=.440, p=.000), diastolic blood pressure ( r=.304, p=.007), waist circumference (r=.332, p=.003), BMI ( r=.269, p=.018), fasting blood glucose ( r=.341, p=.002), triglycerides (r=.410, p=.000), HDL ( r=.237, p=.036) and the number of cardiometabolic risk factors present (r=0.257, p=.023). CONCLUSIONS: These results suggest that SUA may be a useful biomarker for noninvasive monitoring of cardiometabolic risk. Larger studies are needed to validate this approach.

Which U.S. medical schools are providing the most physicians for the Appalachian region of the United States?

PURPOSE: To identify the U.S. medical schools with the most graduates practicing in rural, urban, and economically distressed areas of Appalachia. METHOD: Using June 2009 American Medical Association Physician Masterfile data, the authors identified physicians who graduated from medical school during 1991-2005 and were practicing in the 420 counties of the United States' Appalachian region. They then determined the U.S. medical schools with the most 2001-2005 graduates practicing in primary care (PC) or non-PC specialties in urban or rural areas and the most 1991-2005 graduates practicing in economically distressed/at-risk counties. RESULTS: Ten U.S. medical schools, led by the West Virginia School of Osteopathic Medicine, produced 50.5% (197/390) of 2001-2005 graduates practicing PC in rural areas of Appalachia; 10 schools, led by the University of Alabama School of Medicine, produced 44.1% (366/829) of graduates practicing PC in urban areas. During 2001-2005, 10 schools, led by the West Virginia University School of Medicine, graduated 42.1% (128/304) of non-PC physicians practicing in rural counties; 11 schools, led by the University of Alabama School of Medicine, graduated 38.5% (323/840) of non-PC physicians practicing in urban areas. All schools on the top 10 lists are located within states with Appalachian counties. University of Kentucky College of Medicine had the most 1991-2005 graduates practicing in economically distressed or at-risk counties. CONCLUSIONS: Physicians practicing in Appalachia are largely graduates of medical schools in or near the region. New schools being developed in the region may help reduce its continuing physician shortages.