Maura Adams, Meghan Beucher, Colleen Gerrity, Brock Libby, Ronald Masson, Michael McQuiggan, Johann Patlak, Laura Piper, Alan Rubin, and Judith Christensen
Background: Woodside Juvenile Rehabilitation Center provides a safe and secure environment to teenagers who have been remanded here by the court system for either short or long term care. We focused on nutrition at the center, particularly the evening snacks provided. The foods teens choose to eat are extremely important as total nutrient needs are higher in adolescence than during any other time in the life cycle. Little prior research on the nutritional beliefs or habits of institutionalized youth has been done. Our goal was to improve the provided snacks, as some staff members were concerned that these were not healthy. Nutritional value of food is not a priority for many teens, despite the fact that they are usually well informed about good nutrition. Rather than simply dictate a menu change, we also attempted to assess and possibly modify esident attitudes regarding healthy food. We hoped to both provide a more nutritionally healthy environment and to each knowledge and skills that would lead to long-term physical and emotional benefits in an at-risk population.
Laura Anderson, Kovi Bessoff, Brandon Chapman, Angela Dunn, Michael Larochelle, Tessa Scripps, Jessica Wood, Christine Frenette, Carol Dembeck, Jan Carney, and Mark K. Fung
Introduction: The process of double RBC donation by apheresis (DRBC), which facilitates the donation of two units of red blood cells (RBC) in a single donation session, was estimated to account for approximately 4% of blood donations in 2005, and is believed to be growing at a rate of 40% per year. Blood shortages in this country could be corrected by converting as few as 10% of current single unit whole blood donors to DRBC donors. Advantages of DRBC donation may include reduction in donor-related exposures in recipients, improved cost-effectiveness of the donation process, and improved convenience for donors. The safety profile of DRBC has been found to be equal to, and in some cases better than that of single unit whole blood donation, especially in young donors (/o). DRBC donors have been shown to restore 92% of RBC volume in 4 weeks without iron supplementation, and to have no significant differences in hemoglobin, serum iron, or ferritin when compared with single unit whole blood donors six months after donation. Our study seeks to quantify the number of current single unit whole blood donors who are both eligible for and interested in DRBC donation.
Aleksey Androsov, Jessica Chao, Kira Fiset, Erin Hickman, Amy Huckins-Noss, Daniel Kim, Amy Kravetz, Makeda Semma, and Scott Warhit
Introduction: The term intimate partner violence (or IPV) refers to a threat of abuse or actual psychological, physical, and/or sexual abuse perpetrated by a former or current intimate partner. IPV is an important public health issue that crosses socioeconomic lines. Approximately 4.8 million women experience physical or sexual assault perpetrated by their intimate partner each year in the US. There are no reliable statistics for how many women suffer psychological abuse, but the numbers are likely much higher. Physical, psychological, or sexual injuries can have wide ranging effects, including increased mortality. Although it has been firmly established that the prevalence of IPV is high, physician involvement in screening and diagnosing IPV has historically been very low. Previous studies have addressed IPV screening in other parts of the country. In one study, less than 15% of female patients reported being asked by a health professional about IPV, even though studies have shown that the majority of female patients would reveal their abuse if asked. Also, most physicians screened for IPV when the patient presented with physical trauma, but few screened all patients regularly. The more aware physicians were about IPV, the more likely they were to screen in all clinical settings. While both men and women are victims of IPV, and IPV can have a large effect on the children of the abused, only the screening and treatment of women was explored here. The purpose of this study was to examine the state of IPV screening in Vermont. The objectives were as follows: - ?Estimate the IPV screening, intervention, and policy practices of Vermont physicians ?- Examine the role of physicians in screening and intervention ?- Explore physicians’ knowledge of IPV resources
William Ares, Michael Hart, Derek Huang, Laurel Karian, Maria Michael, Auna Otts, Donna LaFromboise-Perretta, and Jill Jemison
Introduction: Adult Day Care programs provide cognitively or functionally impaired adults with medical, social, and therapeutic services as well as offer valuable respite and education to family caregivers. The Visiting Nurse Association’s Adult Day program manages three centers that offer these services and are located in Colchester, Williston, and South Burlington. We have explored the underutilization of these centers by comparing variables such as demographics, services provided, referrals, transportation constraints, and satisfaction surveys between centers and to national success guidelines for adult day services.
Identifying barriers to care in the Burmese and Bhutanese refugee populations of Burlington, Vermont
William Arscott, Brian Costello, Kathryn DiPalma, Alex Folkl, Megan Malgeri, Amanda Miller, Rebecca Purtell, Jon Bourgo, and Rodger Kessler
Introduction: Many refugees who escape persecution in their own country have trouble navigating and accessing the American health care system. Language barriers often impair effective communication, while financial challenges can be prohibitive after the eight-month government insurance subsidy for new refugees expires. In addition many refugees do not understand the concept of chronic disease, which is a concern considering the overall rise in hypertension (HTN) and type-two diabetes mellitus (T2DM) in the US population. Understanding how refugees access health care, and how well they understand chronic disease, is essential for organizations providing medical care for these populations. Little is known about how the Burmese and Bhutanese refugees experience the Vermont health care system, nor how well they understand chronic diseases such as HTN and T2DM. To address these limitations, we conducted focus groups with these two Vermont refugee populations at the Community Health Center of Burlington, Vermont (CHCB).
The What’s, Where’s, and Why’s of What Your Family Eats: The Burlington Children’s Space Farm To Table Program
Loren Babirak, Kelly Cunningham, James Dunlop, Jenny Nguyen, Cheddhi Thomas, Zea Schultz, Michael Visker, Nancy Drucker, and Barbara Frankowski
Introduction: Preventing childhood obesity is a national priority, and changing dietary behavior in both children and adults is challenging. Burlington Children’s Space, Inc. (BCS), a private, non-profit early education and childcare center providing services for families in the Burlington area, is trying to do just that. The Farm to Table Project was designed to positively influence the food choices of students and their families as well as to cultivate a relationship between families and local farmers. In an effort to secure expanded funding for the school’s food program, BCS requested that we assess the effectiveness of their Food Program
Assessing the Current State and Potential Needs of the Community for Autism Spectrum Awareness in the Classroom
Megan Berube, Adam David, Shannon DeGroff, Sharif Nankoe, Kaitlin Petros, Steven Schaub, Scott Wasilko, Deb W. Lyons, and Stephen Contompasis
Introduction: • Number of children with autism and related disorders has been growing in Vermont in the last ten years. • Puppets in Education, Inc (PiE) recently added a new program Friend 2 Friend Programs-Vermont (F2F), that will work with grades K?8 to educate students and teachers about autism spectrum disorders (ASD). • Goal is to promote understanding, acceptance, empathy and mutual friendships between children with ASD or other social communication disorders • Students from the University of Vermont College of Medicine partnered with PiE to evaluate the current needs of the community, determining what information would be most useful in the F2F program.
Marissa Bucci, Katie Casas, Emily Colgate, Holly Gunyan, Lincoln Heath, Matthew Hoffman, Ryan Smith, Bill Bress, Razelle Hoffman-Contois, Jan Carney, and Charles Hulse
Introduction: Bisphenol A (BPA) and phthalates are chemicals used in the production of many plastics, including food containers, water bottles, and medical intravenous tubing. These chemicals can leach from the plastic, especially when heated, and are found in varying concentrations in the human body. There is concern about the widespread exposure to BPA and phthalates since studies indicate they may cause adverse health effects, particularly related to endocrine development and regulation in young children.
Patrick O. Butsch, Laura C. DePouli, Nicholas A. Larochelle, Mckalyn G. Leclerc, Michael A. Maccini, Michael P. Morwood, Andrea M. Steely, Virginia Hood, George Phillips, William Wargo, Tom Delaney, and Jan Carney
Background: The Vermont legislature (bill H.435, Sec. 19) has tasked the Vermont Board of Medical Practice (VBMP) with making a formal recommendation on improving Vermont health professionals’ knowledge and practice of Palliative Care and Pain Management (PC/PM). In collaboration with the VBMP, our group set out to answer the following questions: • How confident/competent are VT physicians in the practice of PC/PM? • What are the barriers to achieving optimal patient care in PC/PM? • Do VT physicians believe mandatory CME would improve the overall quality of care in PC/PM? • What are the best methods of providing Continuing Medical Education (CME)?
Carl Cappelletti, Lindsay Corse, Aaron Kinney, Suleiman Lapalme, Nolan Sandygren, Danielle Scribner, Mariah Stump, Tom Delaney, Margaret Holmes, Molly Dugan, and Patricia Berry
Background: Older adults have unique nutritional needs due to physiologic changes that occur as part of the normal aging process. Maintaining adequate nutrition has the potential to reduce morbidity and mortality related to chronic disease, fall risk, dementia and Alzheimer’s disease. Aging also poses an increased risk of isolation and lack of social interaction, particularly noted at meal times. Unintentional weight loss is an independent risk factor for early mortality. Social eating is related to higher food intake, and meal programs can improve nutritional risk for vulnerable seniors. We partnered with the Cathedral Square Corporation (CSC) to assess nutrition and social eating in residents at Heineberg Senior Housing in Burlington, VT and conducted focus groups to determine general nutritional concerns and evaluate potential interventions.
Daniel Carballo, Anne Kamarchik, Lindsay Nadeau, Isaac Noyes, Marianne Reed, Louisa Salisbury, Nathaniel Ward, Rob Meehan, and Jan Carney
Introduction: Food insecurity is a household-level economic and social condition of limited access to nutritionally adequate and safe food. Food banks provide a major source of sustenance for individuals experiencing food insecurity, many of whom deal with obesity, diabetes and hypertension, however, the nutritional contents of many donations to these operations fail to meet the dietary recommendations set forth by the USDA for individuals with many chronic health conditions. In the present economy there is increasing demand for the services of local food shelves, however, often these organizations are unable to sufficiently meet the needs of their clients with regard to quantity ,and perhaps more importantly, the nutritional quality and variety of food available. One cause of the lack of nutritionally rich donations is poor public education about the needs of the food shelf and its clients. This study seeks to determine if consumer education at the point of purchase can influence donation decisions to increase the quantity and improve the nutritional quality of items donated to the Chittenden Emergency Food Shelf in a sustainable and reproducible manner.
Martha Choate, Francisco Corbalan, Mei Frankish, Semeret Munie, Jessie Kerr, Jonathan Nucum, Thomas Pace, Thomas Delaney, Wendy Carty, Colleen McLaughlin, and Robert Karp
Background: While alcohol misuse is largely a problem reported in younger populations, recent studies have shown that it may be a significant, under-reported and under-diagnosed problem in the senior population. Alcohol misuse in this population is further confounded by its association with serious co-morbidities including falls, confusion, and reactions with medications. These problems can be difficult to identify in the aging population, as they may be mistaken for dementia, depression, or other illnesses. Even less studied than alcohol use patterns in the general elderly population are the prevalence and patterns of alcohol use in senior care facilities. In Chittenden County, Vermont, these facilities appear to vary widely in how they identify and assist residents with alcohol misuse issues. Understanding their policies will be an important step towards developing effective strategies for reducing alcohol misuse among residents. The importance of understanding and identifying alcohol-related problems in the elderly is critical as the aging population in this country continues to grow. Proper intervention has the potential to have a real impact; studies have shown that older people have a greater ability to adhere to treatment plans than those in younger age groups, which may contribute to treatment success
Andrew Erb, Patrick Huffer, Tri Luu, Elizabeth Mebrate, Alyse Rymer, Eleonore Werner, Eric Worthing, Hal Colston, and Halle Sobel
Introduction: Maintaining a nutritious diet and physical activity is a challenge for many people,but especially for those with limited financial and social resources. Barriers to adequate exercise and healthy food include prohibitive costs of gym membership and high quality foods, lack of time during the day in which to exercise or prepare meals, and lack of access or transportation to exercise facilities or grocery stores. We assessed whether adoption of healthy exercise and eating habits could be established and sustained by educating participants on healthy diet guidelines and on non-traditional exercise forms. We encouraged family-centered activities such as walking, gardening, cleaning, dancing, and playing with children. We quantified changes in participants’ pre- and post-educational diets and exercise habits with 3-day dietary recall logs and pedometer-measured daily steps.
Piyush Gupta, Benjamin King, Katherine McBride, Damoon Rejaei, Jennifer Springer, Tyler Stewart, Diana Swett, William Pendlebury, and Linda Martinez
Background: As the population of elderly citizens in the U.S. continues to expand paralleled by an increase in the prevalence of dementia, the role of respite care within the healthcare system will increase in importance. Respite care is defined as providing the primary caregiver with relief, or a reprieve, from care commitments on a short-term or emergency basis. The need for caregiver respite is well-documented; has been shown to decrease emotional stress,burnout, anxiety and depression; and is considered vital to the overall well-being of the caregiver. While studies have shown that respite care is effective, there is an unmet need for more flexibility in existing programs to improve utilization rates and availability. We attempted to address this issue by adapting an existing model to increase respite care options available to caregivers in our region.
Referral Patterns Between Allopathic Physicians and Complementary and Alternative Medicine Practitioners: A Followup Study
Molly Hubbard, Hany Khattab, Matthew LeComte, Lindsay Peet, Meghan Small, Khine Win, Asha Zimmerman, Margaret Eppstein, Helene Langevin, and Phil Trabulsy
Introduction: • Despite the high prevalence of Complementary and Alternative Medicine (CAM) usage, several recent surveys suggest that the vast majority of patient visits to CAM practitioners are self-referred and that communication between conventional and CAM practitioners is limited. • There is a need for a better understandingof factors influencing referral patterns across these two groups of practitioners. • Network analysis provides a useful tool to quantify relationships between members of an interrelated social network. • The goal of this follow up study was to quantify the cross-class referral patterns between conventional and CAM classes of practitioners in Chittenden County Vermont as well as gather additional information on the basis of referrals for future studies. • This study was a preliminary examination of possible reasons for the referral patterns.
Assessing Health Concerns & Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators
Melissa Marotta, Renee Bratspis, Maria Furman, Brett Porter, Joseph Yared, William Timbers, Quillan Huang, Rebecca Ryan, Gerald S. Davis, and Jan Carney
Background and Objectives: Diesel vehicle idling reduction is an important national environmental and legislative issue. Exposure to diesel exhaust is associated with significant morbidity and mortality, including: • Lung & esophageal cancer • Asthma • Cardiovascular disease • Neurotoxicity • Decreased sperm count & testosterone deficiency Drivers of diesel vehicles have specifically been shown to have increased incidence and death from lung cancer. Diesel engines emit a number of known hazardous chemicals, including carbon monoxide, nitric oxide, sulfur dioxide, benzene, formaldehyde, and acrolein, into the air supply. While public health efforts to reduce diesel idling in Vermont and elsewhere have identified employers’ significant financial incentives in fuel conservation, perhaps there is also a role for appealing to drivers themselves: the people who are incurring the most direct exposure. It is unknown, however, whether Vermont diesel vehicle operators are aware of the health effects of diesel exhaust – or, more significantly, whether they are concerned about it. In order to identify potential targets for future interventions to reduce diesel idling in Vermont, this study aims to probe the following: • Have Vermont drivers been educated about exhaust exposure? • Are they concerned about potential health effects of diesel? • Are they satisfied with their understanding of the health impact of diesel fuel? • What are their health concerns, more generally? • What resources for health information do they respect? • What are their specific obstacles to idling reduction?