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1.
J Osteopath Med ; 124(7): 321-332, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38650438

RESUMO

CONTEXT: Interoceptive bodily awareness (IBA) is one's attentional focus on and relationship with comfortable and uncomfortable (e.g., pain) internal body sensations. Integrating IBA into research on osteopathic manipulative treatment (OMT) is growing, both as an outcome and predictor of treatment outcomes; however, it has yet to be studied in a clinical setting. OBJECTIVES: We aimed to conduct a pilot study to measure IBA, with the Multidimensional Assessment of Interoceptive Awareness (MAIA), in patients seeking OMT for pain, and to test if OMT exposure may be associated with higher IBA as measured by the MAIA. The primary outcome was the change in MAIA scores, and the secondary outcomes were reduction in pain intensity, reduction in pain interference, and increase in participants' perception of change post-OMT. METHODS: A convenience sample was recruited from individuals presenting for OMT appointments at a College of Osteopathic Medicine OMT teaching clinic. Participants were recruited into our single-arm observational cohort study (n=36), and categorized into one of two groups, OMT-naïve (n=19) or OMT-experienced (n=17), based on prior exposure to OMT. We measured MAIA scores and clinical pain-related outcomes prior to, immediately after, and at 1 and 3 weeks after a usual-care OMT session in the clinic. Covariates including experience with mind-body activities, non-OMT body work, and physical and emotional trauma were also collected to explore potential relationships. We utilized t tests to compare MAIA scores and pain outcomes between groups and across time points. Stepwise regression models were utilized to explore potential relationships with covariates. RESULTS: The OMT-experienced group scored higher on the MAIA scales "Not-worrying" (p=0.002) and "Trusting" (p=0.028) at baseline. There were no significant changes in the MAIA scores before and after the single OMT session. Analysis of secondary outcomes revealed that all pain outcomes significantly decreased post-OMT (p<0.05), with the largest relative improvements in the acute pain and OMT-naïve subgroups, with diminishing effects over time. CONCLUSIONS: Assessing IBA with MAIA in a clinical OMT setting is feasible. There were significant positive correlations between OMT exposure and two of the eight MAIA scales. Future studies are justified to further explore this relationship.


Assuntos
Interocepção , Osteopatia , Manejo da Dor , Humanos , Projetos Piloto , Feminino , Masculino , Osteopatia/métodos , Adulto , Interocepção/fisiologia , Manejo da Dor/métodos , Pessoa de Meia-Idade , Estudos de Coortes , Conscientização/fisiologia , Medição da Dor , Resultado do Tratamento , Adulto Jovem
2.
J Osteopath Med ; 123(8): 371-378, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37192547

RESUMO

CONTEXT: Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit. OBJECTIVES: The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians. METHODS: More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables. RESULTS: Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (ß=0.332, p=0.00, se=0.052) and Satisfaction with the visit (ß=0.209, p=0.01, se=0.081) only when the physician was a DO. CONCLUSIONS: Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.


Assuntos
Medicina Osteopática , Médicos Osteopáticos , Médicos , Adulto , Humanos , Gravidez , Feminino , Medicina Osteopática/educação , Relações Médico-Paciente , Avaliação de Resultados da Assistência ao Paciente
3.
J Am Osteopath Assoc ; 118(11): 719-729, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30398569

RESUMO

Obesity and climate change conspire to create an environment in which subclinical vascular inflammation leads to progressive atherosclerosis, which contributes to the number 1 cause of global mortality: cardiovascular disease. The syndemic model requires 2 or more diseases or contributors to disease (such as obesity and climate change) clustering within a specific population in addition to the associated societal and social factors, ultimately creating an environment supportive of a greater adverse interaction. This article explores the syndemic of obesity and climate change as a driver for cardiovascular disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Saúde Global , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Sindemia , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Mudança Climática , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/epidemiologia , Masculino , Síndrome Metabólica/diagnóstico , Avaliação das Necessidades , Obesidade/diagnóstico , Prevalência , Medição de Risco
5.
J Am Osteopath Assoc ; 117(8): 503-509, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28759092

RESUMO

CONTEXT: Physician empathy influences rapport with patients and improves outcomes, but it is not well understood as an outcome of osteopathic medical education. OBJECTIVE: To determine how clerkship preceptors at Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo define empathy and how they compare observed empathetic behavior of TUCOM students with that of other medical students. METHODS: Cross-sectional data were obtained from a survey of TUCOM clinical preceptors comparing TUCOM students with other medical students on 10 behaviors. Results were analyzed with a 2-tailed z test of proportional difference at the 95% confidence level. RESULTS: Of 650 preceptors contacted, 177 responded and were included in the final analysis (27%). Survey item reliability was high (Cronbach α=0.96). A majority of preceptors (59% to 71%) considered TUCOM students "similar" to other medical students for each behavior. A majority of preceptors (107 [60%]) shared a definition of empathy with one another and with the National Board of Osteopathic Medical Examiners and the American Association of Colleges of Osteopathic Medicine. Approximately 39% of preceptors rated TUCOM students "better" or "advanced" for "displays of empathy" compared with approximately 30% of preceptors who rated students as better or advanced across all 10 behaviors. Preceptors who shared a definition of empathy rated TUCOM students as better or advanced at a significantly higher rate for "displays of empathy" (z=1.982, P<.05) compared with preceptors who did not share a definition (n=70). Osteopathic preceptors (n=67) rated TUCOM students significantly higher on "displays of empathy" (z=2.82, P<.05) and "clear and effective communication to patients, families and co-workers" (z=2.83, P<.01) than did allopathic preceptors. No significant differences were found based on number of years as a preceptor or on the combination of types of students the preceptor taught. CONCLUSION: Most clinical preceptors shared a definition of empathy, and they were able to observe and rate displays of it in clerkship students. Preceptors rated TUCOM students more favorably than other students they taught for displays of empathy.


Assuntos
Atitude do Pessoal de Saúde , Educação Médica , Empatia , Medicina Osteopática/educação , Preceptoria , Estudos Transversais , Humanos , Relações Médico-Paciente , Inquéritos e Questionários
6.
J Am Osteopath Assoc ; 117(2): 114-123, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28134953

RESUMO

CONTEXT: With the coming single accreditation system for graduate medical education, medical educators may wonder whether knowledge in basic sciences is equivalent for osteopathic and allopathic medical students. OBJECTIVE: To examine whether medical students' basic science knowledge is the same among osteopathic and allopathic medical students. METHODS: A dataset of the Touro University College of Osteopathic Medicine-CA student records from the classes of 2013, 2014, and 2015 and the national cohort of National Board of Medical Examiners Comprehensive Basic Science Examination (NBME-CBSE) parameters for MD students were used. Models of the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores were fit using linear and logistic regression. The models included variables used in both osteopathic and allopathic medical professions to predict COMLEX-USA outcomes, such as Medical College Admission Test biology scores, preclinical grade point average, number of undergraduate science units, and scores on the NBME-CBSE. Regression statistics were studied to compare the effectiveness of models that included or excluded NBME-CBSE scores at predicting COMLEX-USA Level 1 scores. Variance inflation factor was used to investigate multicollinearity. Receiver operating characteristic curves were used to show the effectiveness of NBME-CBSE scores at predicting COMLEX-USA Level 1 pass/fail outcomes. A t test at 99% level was used to compare mean NBME-CBSE scores with the national cohort. RESULTS: A total of 390 student records were analyzed. Scores on the NBME-CBSE were found to be an effective predictor of COMLEX-USA Level 1 scores (P<.001). The pass/fail outcome on COMLEX-USA Level 1 was also well predicted by NBME-CBSE scores (P<.001). No significant difference was found in performance on the NBME-CBSE between osteopathic and allopathic medical students (P=.322). CONCLUSION: As an examination constructed to assess the basic science knowledge of allopathic medical students, the NBME-CBSE is effective at predicting performance on COMLEX-USA Level 1. In addition, osteopathic medical students performed the same as allopathic medical students on the NBME-CBSE. The results imply that the same basic science knowledge is expected for DO and MD students.


Assuntos
Medicina Clínica/educação , Educação de Graduação em Medicina/métodos , Medicina Osteopática/educação , Ciência/educação , Acreditação , Competência Clínica , Intervalos de Confiança , Currículo , Bases de Dados Factuais , Avaliação Educacional , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Médicos Osteopáticos/educação , Curva ROC , Estudantes de Medicina/estatística & dados numéricos , Estados Unidos
7.
Proc Natl Acad Sci U S A ; 106(32): 13511-6, 2009 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-19666578

RESUMO

Raman spectroscopy is a newly developed, noninvasive preclinical imaging technique that offers picomolar sensitivity and multiplexing capabilities to the field of molecular imaging. In this study, we demonstrate the ability of Raman spectroscopy to separate the spectral fingerprints of up to 10 different types of surface enhanced Raman scattering (SERS) nanoparticles in a living mouse after s.c. injection. Based on these spectral results, we simultaneously injected the five most intense and spectrally unique SERS nanoparticles i.v. to image their natural accumulation in the liver. All five types of SERS nanoparticles were successfully identified and spectrally separated using our optimized noninvasive Raman imaging system. In addition, we were able to linearly correlate Raman signal with SERS concentration after injecting four spectrally unique SERS nanoparticles either s.c. (R(2) = 0.998) or i.v. (R(2) = 0.992). These results show great potential for multiplexed imaging in living subjects in cases in which several targeted SERS probes could offer better detection of multiple biomarkers associated with a specific disease.


Assuntos
Imageamento Tridimensional/métodos , Nanopartículas/química , Análise Espectral Raman , Animais , Feminino , Injeções Intravenosas , Injeções Subcutâneas , Fígado/metabolismo , Camundongos , Camundongos Nus , Nanopartículas/administração & dosagem , Propriedades de Superfície
9.
Arch Gen Psychiatry ; 62(3): 328-34, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15753246

RESUMO

BACKGROUND: A link between cigarette smoking and suicidal behavior has been reported in clinical and epidemiological studies. OBJECTIVE: To examine the association between smoking and suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal behaviors is taken into account. DESIGN: A longitudinal study of young adults interviewed initially in 1989, with repeated assessments over a 10-year follow-up. SETTING AND PARTICIPANTS: The sample was selected from a large health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3, 5, and 10 years after baseline) exceeded 91%. MAIN OUTCOME MEASURES: Relative risk of occurrence of suicidal behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each reassessment. RESULTS: Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior depression and substance use disorders (adjusted odds ratio, 1.82; 95% confidence interval, 1.22-2.69). Additionally, current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, adjusting for suicidal predisposition, indicated by prior suicidality, and controlling for prior psychiatric disorders (adjusted odds ratio, 1.74; 95% confidence interval, 1.17-2.54). CONCLUSIONS: The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed cautiously.


Assuntos
Fumar/epidemiologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adulto , Comorbidade , Coleta de Dados , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Michigan/epidemiologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fumar/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
10.
Psychol Med ; 34(7): 1205-14, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15697047

RESUMO

BACKGROUND: Partial PTSD, employed initially in relation to Vietnam veterans, has been recently extended to civilian victims of trauma. We examined the extent to which partial PTSD is distinguishable from full DSM-PTSD with respect to level of impairment. METHOD: A representative sample of 2181 persons was interviewed by telephone to record lifetime traumatic events and to assess DSM-IV PTSD criteria. Partial PTSD was defined as > or = 1 symptom in each of three symptom groups (criteria B, C and D) and duration of > or = 1 month. Impairment in persons with PTSD and partial PTSD was measured by number of work-related and personal disability days during the 30-day period when the respondent was most upset by the trauma. RESULTS: Compared to exposed persons with neither PTSD nor partial PTSD, increment in work-loss days associated with PTSD was 11.4 (S.E. =0.6) days and with partial PTSD, 3.3 (S.E. =0.4) days (adjusted for sex, education and employment). Similar disparities were found across other impairment indicators. Persons who fell short of PTSD criteria by one symptom of avoidance and numbing reported an increment of 5.0 (S.E. =0.7) work-loss days, 6.0 fewer than full PTSD. PTSD was associated with excess impairment, controlling for number of symptoms. A significantly lower proportion of persons with partial PTSD than full PTSD experienced symptoms for more than 2 years. A lower proportion of persons with partial PTSD than full PTSD had an etiologic event of high magnitude. CONCLUSIONS: PTSD identifies the most severe trauma victims, who are markedly distinguishable from victims with subthreshold PTSD.


Assuntos
Acontecimentos que Mudam a Vida , Doenças Profissionais/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Absenteísmo , Adolescente , Adulto , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/classificação , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Determinação da Personalidade/estatística & dados numéricos , Psicometria , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
11.
Arch Gen Psychiatry ; 60(3): 289-94, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12622662

RESUMO

BACKGROUND: We examine whether exposure to traumatic events increases the risk for nicotine dependence or alcohol or other drug use disorders, independent of posttraumatic stress disorder (PTSD). METHODS: Data come from a longitudinal epidemiologic study of young adults in southeast Michigan. Prospective data covering a 10-year period and retrospective lifetime data gathered at baseline were used to estimate the risk for onset of substance use disorders in persons with PTSD and in persons exposed to trauma without PTSD, compared with persons who have not been exposed to trauma. The National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R was used. Logistic regression was used to analyze the prospective data, and Cox proportional hazards survival analysis with time-dependent variables was applied to the lifetime data. RESULTS: The prospective and retrospective data show an increased risk for the onset of nicotine dependence and drug abuse or dependence in persons with PTSD, but no increased risk or a significantly (P =.004) lower risk (for nicotine dependence, in the prospective data) in persons exposed to trauma in the absence of PTSD, compared with unexposed persons. Exposure to trauma in either the presence or the absence of PTSD did not predict alcohol abuse or dependence. CONCLUSIONS: The findings do not support the hypothesis that exposure to traumatic events per se increases the risk for substance use disorders. A modestly elevated risk for nicotine dependence might be an exception. Posttraumatic stress disorder might be a causal risk factor for nicotine and drug use disorders or, alternatively, the co-occurrence of PTSD and these disorders might be influenced by shared risk factors other than traumatic exposure.


Assuntos
Alcoolismo/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/epidemiologia , Adulto , Alcoolismo/diagnóstico , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Seguimentos , Humanos , Incidência , Acontecimentos que Mudam a Vida , Masculino , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tabagismo/diagnóstico
12.
Acad Psychiatry ; 26(3): 184-6, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12824137
13.
Pain ; 10(3): 357-366, 1981 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7279422

RESUMO

A new electric stimulation pain assessment technique using the Tursky electrode and a non-parametric analysis of subjects ratings was found sensitive to aspirin, morphine and opiate antagonists in a series of double-blind cross-over trials in normal adults. Stable individual differences in pain sensitivity (off medication) were maintained on two testing sessions 7 months apart. Older individuals were less pain sensitive than younger individuals. Men were more insensitive than women under age 30. Together, these results suggest the empiric usefulness of this pain measurement technique.


Assuntos
Aspirina/uso terapêutico , Morfina/uso terapêutico , Dor/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Método Duplo-Cego , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
14.
Pain ; 10(3): 367-377, 1981 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7279423

RESUMO

Somatosensory evoked potentials (EPs) to stimuli ranging from barely perceptible to painful were recorded in 153 normal adults. Reliability of amplitude and amplitude/intensity slopes were demonstrated in 29 individuals tested twice, two or more weeks apart. In randomized, double-blind placebo controlled trials, both aspirin and morphine significantly diminished N120 component at high stimulus intensities. Age, sex and pharmacological effects paralleled those found with psychophysical techniques in part I of this study.


Assuntos
Aspirina/uso terapêutico , Morfina/uso terapêutico , Dor/tratamento farmacológico , Córtex Somatossensorial/efeitos dos fármacos , Adolescente , Adulto , Fatores Etários , Idoso , Método Duplo-Cego , Estimulação Elétrica , Eletroencefalografia , Potenciais Evocados/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
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