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  Barriers to Pediatric Blood Lead Screening

  Amanda Abramson, Catherine Avener, Jillian Brennan, Elizabeth Hill, Britton Keeshan, Jeffrey MacLean, Kelly Mebust, Sanchit Maruti, Wendy Davis, Austin Sumner, and Jan Carney

  Background: The pernicious effects of lead on the health of children are well-documented. The severity of many of these effects directly correlates with increasing blood lead levels (BLLs). The current recommendation from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) is that BLLs 10 g/dL are dangerous. However, new evidence demonstrates that there is no safe BLL and that children with BLLs /dL exhibit neurological and social deficits. The Vermont Department of Health (VDH) currently recommends universal blood lead screening for 12 and 24 month-old children. In 2006, 79% of 12 month-old children and 41% of 24 month-old children were screened in Vermont.

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  Health Literacy and Medication Practices in Senior Housing Residents

  M. Alavian, J. Cassavaugh, S. Haji, J. Hellmuth, M. Homes, S. Mulligan, A. Old, A. Whitehead, K. Fitzgerald, A. Kennedy, V. Hood, and J. Carney

  Objective: To conduct a descriptive analysis of health literacy, knowledge of prescribed medications, and methods of administering medications in a cohort of senior housing residents.

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  Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness Program

  Nicholas Antell, Michelle Cangiano, Jessica Deane, Chris Lin, Rebecca Martin, Sarah Schlein, Richard Zinke, Pam Farnham, and Kevin Hatin

  Introduction: Since 1999, the Burlington YMCA has offered a free aerobics class to members of the community with diabetes. Additionally, the class regularly monitors participants’ health status. These data support the well-established benefit of exercise in diabetes. Medical Monitoring •hemoglobin A1C •blood pressure •resting pulse rate (before and after each twelve week session) About the Program •Began in 1999 •Free •Physician’s referral required •2h aerobics, twice per week: 1h land + 1h water

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  Factors Affecting the Nutritional Status of Chittenden Emergency Food Shelf Clients

  Dilip Babu, Jessica Bordley, Luz Felix-Marquez, Kara Gaston, Jason Halperin, Elise Heath, Anna Liberatore, and Lynn Zanardi Blevins

  Objectives: Using a twenty-four hour food recall and the USDA MyPyramid guidelines, we considered how various factors affect the nutritional status of Chittenden Emergency Food Shelf clients. The factors we considered were housing stability, body mass index, sharing of food with dependants, skipping meals, and enrollment in the Food Stamp Program. The results of our study will inform the Food Shelf about their clients and the barriers they face in trying to maintain a healthy diet and potentially be used to improve programs.

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  Health Coverage History of Local Uninsured PatientsAssessing the Need for an Eligibility Specialist

  C J. Bailey, L P. Gerety, MH Guignon, A. S. Helminski, AA Merriam, J. Ravera, A Tang, W. G. Tharp, J Bourgo, and H Maltby

  Abstract: Uninsured Americans are a growing population as insurance premiums climb and fewer employers offer health coverage. Providing medical care to the uninsured often represents a significant financial loss to medical institutions. Our study sought to describe the insurance history and barriers to obtaining health coverage for uninsured patients at the Community Health Center of Burlington, Vermont (CHCB). The potential benefit of adding an insurance eligibility position to the staff at CHCB was also explored. Data were collected by random phone survey from 100 CHCB patients identified as uninsured at their last visit; patients were queried regarding insurance history and interest in enrollment assistance. At the time of survey 66% were currently uninsured, and the majority (87.9%) of these respondents previously held insurance. Loss of insurance was most often due to a change in job status, income or a change in eligibility. Cost was a major barrier to insurance noted by individuals; on average respondents indicated they would be willing to pay around $65 per month for overage. A majority (75.7%) of uninsured respondents also expressed interest in an onsite eligibility worker. These data suggest that the patient population at CHCB would be well served by implementing some form of eligibility staffing. There are a number of different health insurance options in Vermont that could benefit these patients, provided they have assistance with applying. Due to the small sample size of our survey, we recommend that the scope of the eligibility position be determined by closely examining the caseload encountered.

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  Smoking Profile of Woodside Juvenile Detention Center and Interventional Goal-Setting Workshop

  Stephanie Bakaysa, Daniel Goold, Meghan Gunn, Cortney Haynes, Jeffrey Kaye, Ryan Vealy, Yana Wirengard, Hijab Zubairi, Judith Christensen, and Jan Carney

  Abstract: We studied smoking status among teenage residents at the Woodside Juvenile Rehabilitation Center (Woodside) in Vermont. Using a modified CDC survey and focus groups, we found that short-term detention residents (S group) were significantly more likely to be “smokers” than the long-term treatment residents (L group). All residents reported that stress had an important impact on their lives. Based on our findings, we implemented a goal setting workshop for both L and S groups.

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  Barriers to Health Literacy and Competency Participatory Education in the Champlain Valley Head Start Program

  Alyssa Bennett, Kenneth Christian, Rosamund Davis, Vanessa Hui, Jessie Janowski, Elizabeth Lycett, Christopher Randall, Michael Salmela, Melissa Barrett, and Christa Zehle

  Background: Poor health literacy has impeded public health efforts for many years. Several barriers to achieving higher levels of health literacy have been identified and specific ethods to overcome these have been applied: • Role-playing has been shown to be an effective way to communicate ideas, creating audience participation and learner empowerment. • Pictographs, simple drawings depicting stories or principles, have also been used to make health information more comprehendible. • Non-written forms of communication have been especially useful in overcoming language barriers. • A recent Harvard study demonstrated the ability to increase health literacy in low-income populations. Over a three-year period, educational posters and pamphlets were placed in primary care offices throughout Massachusetts. Assessment surveys were mailed to participants before and after the trial. An increase in health competency was most significant in low-income populations. These studies formed the foundation for our current work, which sought to improve health literacy among parents of the Chittenden County Head Start Program. This is a nationally-funded program dedicated to providing free, comprehensive health, nutrition, and social services to families with pre-school children (ages three to five). Participants in the Head Start Program must have low-income to be eligible.

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  Access to Health Care Through Catamount Health; Do Providers Know Enough to Refer?

  Morgan Carlson, Lisa Chui, Walter DeNino, Neel Kapasi, Amy McGettrick, Adrienne Pahl, Trevor Pour, Heidi Schumacher, Serena Choudhry, and Burton Wilcke

  Background: On November 1, 2007, Vermont launched ‘Catamount Health,’ a state-sponsored private insurance plan. The goal: to close the gap between privately insured and Medicaid insured Vermonters. Previous programs such as Dr. Dynasaur and VHAP were already in place to care for children and low-income residents respectively. Now, under the umbrella title of “Green Mountain Care,” Catamount Health joins them. Catamount Health offers private coverage through either Blue Cross/Blue Shield of VT or MVP Health Care, the cost of which is offset by the state according to income level and household size. To qualify for Catamount, an individual must have an income of at least $1,277 (lower incomes qualify for VHAP), and meet a number of criteria: • Vermont residents 18 years or older • Not currently eligible for other state-sponsored health insurance programs • Have been living without health insurance for 12 months or more unless insurance was lost due to: - Loss of employment - Divorce from or death of a spouse/partner - Dis-enrollment from college or your parent’s plan - No longer eligible for Medicaid or VHAP - No longer have COBRA coverage • Do not have access to insurance through employer The estimate of uninsured Vermonters is 65,000, or 10% of the state population (National rate: 15.7%). 73% of all uninsured residents are between the ages of 18-49, which has been cited as the target population for Catamount. The State of Vermont has budgeted close to $1.6 million dollars to fund a large-scale advertising campaign on television, radio, newspaper, and on foot. Following this campaign, there is a high likelihood that Vermonters will bring questions and concerns about Catamount to their physician offices and community leaders, emphasizing the importance of a well-educated provider.

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  Defining a Paradigm for the Dissemination of Health Information to Immigrant Populations at the Fletcher Free Library

  Kristen Connolly, John DeWitt, Juli Gardner, Joseph Lopreiato, Leah Novinger, Timothy Plante, Uni Wong, Amber Gaster, Mark Pasanen, and Jill Jemison

  Abstract: In recent years, the surge of refugee families to the greater Burlington area has lead to a significant increase in the minority population of the city. The Fletcher Free Library (FFL) represents a potential health information resource for this population; it is, however, little utilized. Our project sought to target one of these minority populations, the Somali Bantu, and to diminish the barriers to the use of the FFL’s resources within the Somali population itself. To reduce barriers to access of health information by the Somali Bantu population, we educated the FFl’s reference librarians on Somali culture, developed a compendium of health information in both English and Somali for inclusion within the library’s collection, and staged a one-day intervention at the Community Health Center of Burlington to present the FFL as a potential source of health information for refugee populations. Somali Bantu use of the library, as well as reference librarian confidence in serving this minority population,was objectively assessed via pre- and post-interventional surveys.

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  Respiratory Management of Patients with ALS in Northern New England

  Katie Davisson, Ariel Gallant-Bernstien, Mai Hoang, David Longstroth, Bryan Mason, Colleen Moran, Omar Ozgur, Abigail Woodhead, Rup Tandan, and Christine Broderick

  Background: • Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease caused by the degeneration of brain and spinal cord motor neurons, leading to steady loss of voluntary muscle function and early death from respiratory failure. •The incidence of ALS is 1?2/100,000 population, the prevalence is 5?6/100,000 and approximately 30,000 people are living with ALS in the United States. • Currently there is no cure for ALS; treatment is focused on symptomatic care and improving the quality of life. • Most ALS patients in the United States are treated either at multidisciplinary ALS centers/clinics in academic institutions or by community?based physicians/ neurology practices. • It is unclear if outcomes in patients with ALS are different among those followed in multidisciplinary clinics(MDC) versus community based physicians/ neurology practices (CP). • The goal of this project was to compare the type of respiratory education and care received by patients with ALS from Northern New England at MDC’s (Fletcher Allen and Dartmouth Medical Center) versus CP.

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  Hypertension Education and the Burlington Housing Authority

  Rebecca Evans, Matt Greene, David Iberri, Casey Johnson, Benjamin Kunz, Annice Mason, Kanayo Tatsumi, Kelsey Walton, Sarah Russell, Alan Rubin, and Jan Carney

  Background: • 2/3 seniors are hypertensive (>140/90 mm Hg) • Hypertension is the most common risk factor for premature heart disease and stroke • Non-modifiable risk factors: race, age, sex, diabetes mellitus, and hypercholesterolemia • Modifiable risk factors: smoking, obesity, and excessive alcohol • Clinical trials show that lifestylemodification and medications can reduce the incidence of adverse outcomes associated with hypertension • Patient education is a high priority

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  Barriers to Completing Colonoscopy Screenings

  Adetola Fadeyibi, John Fialkovich, Mellory Gibberson, Joseph Kaserman, Peter Lloyd, Melinda Myzak, Joseph Pare, Greta Spottswood, Debbie Dameron, and James Vecchio

  Background: - Colon cancer is the second leading cause of cancer death in the United States and the third leading cause of cancer death in Vermont. - Colon cancer progression may be prevented by removing precancerous polyps found on colonoscopy screening. -Vermont ranks among the states with the best colon cancer screening rates, but there is room for improvement. In 2006, 55.5% of Vermonters over 50 years of age had undergone a sigmoidoscopy or colonoscopy within the last 5 years. Vermont’s public health goal is to raise this percentage of screened individuals to 65% by 2010. - Vermont medical institutions have the resources to perform screening colonoscopies on all Vermonters over 50 years of age. - Although primary care physician (PCP) recommendations increase the likelihood of a patient completing a colonoscopy screening, a substantial number of patients referred for screening colonoscopies do not complete their appointments.

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  Chittenden County Child Care Providers & Conflict Implementing Sick Child Guidelines

  Shahin Foroutan, Joanna Gell, Hui-Shan Hsu, Elena V. Simon, Justin Smith, Kirsten Threlkeld, Nicholas Weinberg, Meghan Flanders, and Jillian Sullivan

  Introduction: Nationwide, 61% of children under age five are enrolled in a form of non-parental care. Problems arise when a child becomes sick and is not able toattend daycare or has to be sent home. Parents must either miss work to care for their child or find someone else to care for them. Since there is stress surrounding taking time off, and because the criteria used to exclude children from child care can be ambiguous, parents may feel that their child doesn’t need to be sent home. Each child care provider has to set up exclusion criteria that meet state licensing requirements. The American Academy of Pediatrics (AAP) developed exclusion guidelines specifically for childcare settings in 2006, but most daycare providers and pediatricians are unaware of its existence. Conflicts occur when there are differences in opinion on the child’s health status between the child care provider and the parents or the child’s pediatrician.