Volume 119, Issue 11

Context In the aging brain, reduction in the pulsation of cerebral vasculature and fluid circulation causes impairment in the fluid exchange between different compartments and lays a foundation for the neuroinflammation that results in Alzheimer disease (AD). The knowledge that lymphatic vessels in the central nervous system play a role in the clearance of brain-derived metabolic waste products opens an unprecedented capability to increase the clearance of macromolecules such as amyloid β proteins. However, currently there is no pharmacologic mechanism available to increase fluid circulation in the aging brain. Objective To demonstrate the influence of an osteopathic cranial manipulative medicine (OCMM) technique, specifically, compression of the fourth ventricle, on spatial memory and changes in substrates associated with mechanisms of metabolic waste clearance in the central nervous system using the naturally aged rat model of AD. Results Significant improvement was found in spatial memory in 6 rats after 7 days of OCMM sessions. Live animal positron emission tomographic imaging and immunoassays revealed that OCMM reduced amyloid β levels, activated astrocytes, and improved neurotransmission in the aged rat brains. Conclusion These findings demonstrate the molecular mechanism of OCMM in aged rats. This study and further investigations will help physicians promote OCMM as an evidence-based adjunctive treatment for patients with AD.

Context Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement. Objective To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed. Methods We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests. Results A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs. Conclusion(s) Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.

Context Many studies have explored whether plant and animal-based food consumption is associated with prostate cancer (PCa) risk, but there is much discordance. Objective To perform an updated review of the literature that further investigates the association of plant- and animal-based food consumption with PCa risk. Methods This review was conducted by using 3 databases and produced a total of 550 references. The search was limited to a publication date range of 2006 to February 2017, English language, and humans. After case reports, comments, letters, editorials, and duplicate references were removed, 297 citations remained for review. Articles that did not investigate the association of dietary patterns or a major component of diet with PCa were excluded. Results Of the 297 references found, 47 were eligible for inclusion in this review. The authors identified 2 very large cohort studies (≥100,000 participants), 6 large cohort studies (≥40,000 participants), 11 medium cohort studies (≥10,000 participants), 10 small cohort studies (<10,000 participants), 13 case-control studies, 4 meta-analyses, and 1 population study investigating diet and PCa risk. Most studies showed that plant-based foods are associated with either decreased or unchanged risk of PCa, whereas animal-based foods, particularly dairy products, are associated with either increased or unchanged risk of PCa. Conclusion This review of the literature suggests that consumption of higher amounts of plant-based foods may be associated with decreased PCa risk, and consumption of higher amounts of dairy products may be associated with increased PCa risk.

Context Residents receive little parenting education despite its potential to improve parenting behavior and decrease child maltreatment despite the inclusion of parenting content on board certification examinations. Teaching residents how to discuss parenting and foster positive parent-child relationships is essential to treating the whole person in osteopathic pediatric medicine. Objective To improve pediatric and internal medicine–pediatric residents’ knowledge, confidence, and skills in providing parenting advice. Methods Four toddler parenting and discipline modules were developed. During continuity clinic, residents viewed and discussed modules with faculty. Residents completed a confidence and knowledge questionnaire before and after the curriculum, provided a self-report of use of skills learned, and completed a feasibility survey. Faculty also completed a feasibility survey. Results Forty-one of 61 residents (67%) participated in the study. Before participation, the median (interquartile range [IQR]) resident score for confidence in giving advice was 6.0 (4.0-7.0) (on a 10-point scale), increasing to 7.0 (6.0-8.0) for those completing 1 to 3 modules and 8.0 (8.0-9.0) for those completing 4 modules. Median (IQR) score on board-style questions was 8.0 (7.0-9.0) (on a 12-point scale) before participating in the modules and 8.5 (7.5-9.5) for those completing 1 to 3 modules and 9.0 (7.0-9.0) for those completing 4 modules after participation; the increase was not statistically significant. Nine faculty and 29 residents completed the modules and responded to the exit survey regarding feasibility and acceptability of the curriculum. On a 4-point scale (4 being excellent), sessions had an overall mean (SD) rating of 3.7 (0.5) by faculty and 3.5 (0.5) by residents. Most residents (27 [93.1%]) reported interest in more modules, and 28 residents (96.6%) reported using information learned from the modules during clinic visits. Conclusion Confidence delivering parenting advice increased among residents who completed the curriculum modules. Faculty and residents reported high feasibility ratings, and residents endorsed application of skills during clinic visits and interest in more modules.

Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.

Prostate-specific antigen (PSA) levels are routinely surveilled after oncologic intervention in patients with prostate cancer. Occasionally, PSA levels are elevated because of factors unrelated to disease recurrence, such as herbal supplement use. False-positive PSA elevations may confound the clinical picture and subsequent decision-making processes, potentially leading to unnecessary diagnostic and therapeutic interventions. In this case report, a patient with low-risk prostate cancer who was treated with low-dose-rate interstitial brachytherapy presented several years after treatment with an erroneously elevated PSA level after taking an herbal supplement. This case highlights the importance of a holistic approach to patient care, whereby tactful assessment of the psychosocial and spiritual aspects of health led to the identification of an uncommon but potentially morbid entity.

Pelvic malalignment is a somatic dysfunction that can lead to pelvic discomfort, despite normal genital examination findings. A 3-year-old girl presented with vulvar discomfort after a straddle injury sustained while riding a tricycle. The symptoms persisted despite standard medical treatment for vulvovaginitis and chronic vulvar irritation. An osteopathic structural examination revealed distortions of the bony pelvis, often associated with genitourinary complaints. After 5 osteopathic manipulative treatment sessions, the patient experienced significant relief. With persistent vulvar pain, somatic dysfunction should be considered in the differential diagnosis. A brief musculoskeletal examination of the pubic tubercles, iliac crest, and iliac spines can help to identify somatic dysfunction in a gynecologic patient with symptoms that are unresponsive to standard treatments.