Volume 124, Issue 11

Objectives This study aims to quantify the areas of most concern in medical students in relation to their residency application in the setting of the COVID-19 pandemic and to identify risk factors for all that cause concern and specific areas of concern in a population with well-established high rates of anxiety at baseline. The COVID-19 pandemic introduced sweeping changes to medical education that had wide-ranging effects on medical students and their applications for medical residencies. Methods In August 2020, we utilized a cross-sectional study to quantify student’s areas of concern related to residency application related to the COVID-19 pandemic. We asked participants to rate their levels of concern in 15 different aspects related to medical residency applications and the perceived impact that COVID-19 had on each. Results The survey was distributed to 984 osteopathic medical students, with 255 complete responses. The three areas of greatest impact were shadowing opportunities (4.15), volunteer opportunities (4.09), and conferencing opportunities (4.09). The most salient demographic variables were year in school, sex, and locale. Females reported higher levels of concern across all categories in the study compared to males, with statistical significance across all categories (all p<0.05, Range d=0.16 to 0.43), except for letters of recommendation and sub-internships. Conclusions The areas of most concern identified in our study were consistent with prior studies and may implicate the pressures that female medical students may feel compared to their male counterparts. The underlying cause(s) may be subject to future research.

Context A third of the population aged 65 and over experiences a fall during a given year, often with severe traumatic consequences, dependence, and consequently, a decline in quality of life. The fear of falling itself leads to avoidance behavior from daily activities leading to a downward spiral of dependence, loss of confidence, and therefore an increased risk of falling. Joint stiffness is often observed during clinical examination of elderly people. However, the association between lumbopelvic stiffness and fear of falling has not been studied. Objectives Osteopathic manipulative treatment/medicine (OMT/OMM), targeted to improve the stiffness of the pelvic girdle, may improve the prognosis of patients afraid of falling and slow down their loss of autonomy. Methods We performed a prospective cohort study enrolling hospitalized patients and nursing home residents over 75 years of age. Patients able to walk and without significant cognitive impairment completed the International Fall Efficacy Scale (FES-I) questionnaire to assess their intensity of fear of falling. The modified Schober test and hip goniometry (flexion and extension) were measured and compared to the FES-I score. Results A total of 100 patients were included. A high fear of falling (FES-I≥28) was associated with female sex (31 [79.5 %] vs. 29 [47.5 %]; p=0.002) and with a reduction in the amplitudes tested by the Schober test (2 [1.5–3] vs. 3 [2–4]; p=0.002), the hip extension goniometry (7 [4–10] vs. 10 [7–15]; p<0.001) and the hip flexion goniometry (70 [60–77] vs. 82 [71–90]; p<0.001). The association between FES-I score and each anthropometric variable was strongly linear (p<0.001 for all), especially with hip flexion goniometry (R 2 =30 %). Conclusions Lumbopelvic stiffness, especially in hip flexion, is strongly associated with a high fear of falling in patients over 75 years of age. When combined with other movement-based therapies, OMM targeted to improve the stiffness of the pelvic girdle may improve the prognosis of patients afraid of falling and slow down their loss of autonomy.

Context Anxiety disorders have a far-reaching impact on society, with profound implications on both mental and physical health. In response, there is growing interest in manual therapy modalities, with emerging research suggesting their potential to alleviate related symptoms. Objectives To establish a consensus regarding manual therapy modalities for addressing anxiety symptoms, a systematic review of current literature was conducted. Methods A literature search was conducted between May and August 2023, utilizing a systematic search on both PubMed and Google Scholar, adhering to the defined inclusion criteria. In addition, information was gathered utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both authors (KLW and TH) conducted the literature review. The inclusion criteria include articles written in English, peer-reviewed, anxiety conditions documented, and manual therapy delivered by a respectfully qualified professional. Manual therapy modalities include massage therapy, osteopathic manipulative treatment (OMT), foot reflexology, acupressure, manual therapy, healing touch, therapeutic touch, and gentle touch. After initial data collection, both researchers independently screened articles utilizing two metrics: a level of evidence (LOE) table and a screening criterion incorporating unique elements from the search process. The quality of the included articles was assessed utilizing Strength of Recommendation Taxonomy (SORT). When reviewer discrepancies arose, authors reread full-text studies and discussed the inclusion and exclusion criteria to achieve consensus. Results The data searches identified 8,979 articles, with 239 articles remaining after duplicates and nonapplicable articles were removed. A total of 42 articles met the inclusion criteria, with only 40 articles able to be obtained for full-article review. After full review and the exclusion of articles with invalid author conclusions, meta-analysis, or systematic reviews, 34 articles were included in the review. All articles received an LOE rating of 2 or better and aligned with our specific screening criteria. Based on SORT, each modality was assigned a “B” rating. Among the included articles, n=27 demonstrated statistical significance in favor of manual therapy modalities as an anxiety treatment. The positive results for the aforementioned manual therapies on anxiety symptom improvement are shown: 15/18 (83 %) massage therapy, 2/6 (33 %) OMT, 5/5 (100 %) foot reflexology, 1/1 (100 %) acupressure, 1/1 (100 %) manual therapy, 0/2 (0 %) healing touch, 1/1 (100 %) therapeutic touch, and 1/1 (100 %) gentle touch. Conclusions A pattern emerged, wherein individuals receiving manual therapy interventions displayed a statistically significant reduction in anxiety intensity. Considering the positive results, manual therapy should be considered an effective strategy for anxiety management.

Context Prenatal substance exposure (PSE) can lead to various harmful outcomes for the developing fetus and is linked to many emotional, behavioral, and cognitive difficulties later in life. Therefore, examination of the relationship between the development of associated brain structures and PSE is important for the development of more specific or new preventative methods. Objectives Our study’s primary objective was to examine the relationship between the physical development of the amygdala, hippocampus, and parahippocampus following prenatal alcohol, tobacco, and prescription opioid exposure. Methods We conducted a cross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) Study, a longitudinal neuroimaging study that measures brain morphometry from childhood throughout adolescence. Data were collected from approximately 12,000 children (ages 9 and 10) and parents across 22 sites within the United States. Prenatal opioid, tobacco, and alcohol use was determined through parent self-report of use during pregnancy. We extracted variables assessing the volumetric size (mm 3 ) of the amygdala, hippocampus, and parahippocampal gyrus as well as brain volume, poverty level, age, sex, and race/ethnicity for controls within our adjusted models. We reported sociodemographic characteristics of the sample overall and by children who had PSE. We calculated and reported the means of each of the specific brain regions by substance exposure. Finally, we constructed multivariable regression models to measure the associations between different PSE and the demographic characteristics, total brain volume, and volume of each brain structure. Results Among the total sample, 24.6% had prenatal alcohol exposure, 13.6% had prenatal tobacco exposure, and 1.2% had prenatal opioid exposure. On average, those with prenatal tobacco exposure were found to have a statistically significant smaller parahippocampus. Conclusions We found a significant association between prenatal tobacco exposure and smaller parahippocampal volume, which may have profound impacts on the livelihood of individuals including motor delays, poor cognitive and behavioral outcomes, and long-term health consequences. Given the cumulative neurodevelopmental effects associated with PSE, we recommend that healthcare providers increase screening rates, detection, and referrals for cessation. Additionally, we recommend that medical associations lobby policymakers to address upstream barriers to the effective identification of at-risk pregnant individuals, specifically, eliminating or significantly reducing punitive legal consequences stemming from state laws concerning prenatal substance use.

Context Opioid use disorder (OUD) has a considerable morbidity and mortality in the United States. Healthcare providers are key points of contact for those with OUD; however, some providers may hold stigma toward OUD. Stigma toward OUD can lead to lower quality of care and more negative health outcomes. Thus, new trainings designed to reduce stigma toward OUD while increasing empathy are critical. We created a web-based cinematic virtual reality (cine-VR) training program on OUD for osteopathic medical students. Objectives The aim of this pilot study was to assess changes in stigma toward OUD and empathy before and after the online cine-VR training program on OUD. Methods We employed a single-arm, pre- and posttest pilot study to assess changes in stigma toward OUD and empathy. Osteopathic medical students from one large medical school in the Midwest with three campuses were invited to participate in the online cine-VR training. Participants completed two surveys before and after the cine-VR training. We performed paired t tests to examine changes in stigma toward OUD and empathy scores before and after the cine-VR OUD training program. Results A total of 48 participants completed the training. We observed a decrease in stigma toward OUD posttraining ( t =4.402, p<0.001); this change had a Cohen’s d of 0.64, indicating a medium effect. We also observed an increase in participants’ empathy scores posttraining ( t =−2.376, p=0.023), with a Cohen’s d of 0.40 signifying a small effect. Conclusions Findings from this pilot study suggest that the online cine-VR training may reduce stigma toward OUD while increasing empathy. Future research employing a randomized controlled trial design with a larger, more diverse sample and a proper attention control condition is needed to confirm the effectiveness of the online cine-VR training. If confirmed, this cine-VR training may be an accessible approach to educating osteopathic medical students about OUD.