Gabriel Crowl, Anees Daud, Vanessa Franz, Nicholas Phillips, Maia Pinsky, Jennifer Pons, Areg Zingiryan, Carol Dembeck, Chris Frenette, Jan Carney, and Mark K Fung
Introduction: Supplying adequate blood for transfusions is an ongoing challenge for blood collection agencies. One potential source of increased Whole Blood (WB) supply is among 16-17 year-olds, whose donation rates are still quite low. In 2010, donors aged 16-18 years-old provided 14% of all WB collected by the American Red Cross. Young donors may represent an opportunity to establish a committed, long-term blood donation base as they are more likely to return after first donation and donate at a higher yield rate than older donors. However, younger donors also have higher rates of adverse events during donation. Currently, 38 states allow 16 year-olds to donate blood with parental consent but Vermont is not among them. Our study examines the public’s comfort with 16 year-olds donating blood. As blood donation is a voluntary system, ascertaining the perspective of the general population regarding this issue could contribute to a policy debate surrounding the minimum age of donation.
Calvin Kagan, Alison Krywanczyk, Xingfu Liang, John Malcolm, Molly Rovin, Bianca Yoo, Bailey Zhao, Jan Carney, Razelle Hoffman-Contois, and Heidi Hales
Introduction: In Vermont, cremation has increasingly become an alternative to interment of an intact body. Many of the bodies being cremated contain dental amalgams, which are commonly used by dentists to repair dental erosion and caries (cavities). They are an economical option for caries repair, and remain popular. Roughly one third of all caries fillings done in 2002 in the U.S. utilized amalgam. Amalgam is a metal alloy containing as much as 50% mercury by volume, a metal that is a known toxicant. Dental amalgams, may constitute a source of low level, continual exposure for those with these dental devices in situ and may be released to the atmosphere upon cremation. The goal of this project was to investigate: 1. The status of the scientific opinion on potential health effects that may be associated with having dental amalgams. 2. To help refine State estimates of potential mercury emissions from Vermont crematoria.
Michael Lam, Anurag Shukla, Margaret Gordon-Fogelson, Heather Lutton, Griffin Biedron, Andrew Ng, Bethany Collins, Kate Nugent, Hendrika Maltby, and Jan Carney
Introduction: • The local food environment plays an important role in defining the health of the neighborhood and is an important determinant of resident’s dietary intakes. • Specifically, food availability, affordability, and accessibility have been linked to diet quality and various health outcomes. • Fresh fruits and vegetables are markers for nutritional diets. Grocery stores and super markets tend to have better quality fruits and vegetables, greater variety and better affordability than convenient stores that tend to have more prepared and higher calorie foods. • People who live in neighborhoods with better access to supermarkets tend to have a greater daily intake of fruits and vegetables. • Increased distance from supermarkets is negatively associated with healthy food intake in a study of pregnant women. • “Food deserts” are areas that are devoid of a local supermarket where residents have a limited ability to purchase affordable healthy foods. They have become an emergent problem in the United States. This paucity of supermarkets in these areas combined with lack of private or convenient transportation among poorer residents may contribute to health disparities across socioeconomic classes. • The town of Winooski, VT has a population of 7,267. Although there are local food markets and convenient stores within the town, Winooski lacks a larger grocery store. • Insufficient public transportation and inadequate pedestrian sidewalks make it more difficult for residents to access supermarkets located in other towns.
Bhanu Muniyappa, Nicholas Wilkie, Ashley Miller, Katherine Anderson, Mayu Toner, Francesca Boulos, Michelle Force, Christine Finley, and Burton Wilcke
Introduction/Background: • Child immunization is nearly universally accepted as an effective preventative measure against infectious diseases, yet adult immunization rates continue to lag behind recommended levels. • Epidemiological trends suggest a correlation between vaccine administration and decreased rates of significant morbidity and mortality, hospitalization and emergency department visits, work absenteeism, and illness associated expenses. • As of 2010, Vermont is failing to meet its adult immunization goals by 13-43%. • This study aims to understand and identify specific barriers to adult immunization in Vermont.
Assessing Barriers to Healthy Living in Economically Challenged Communities of the Greater Winooski Area
Idil Aktan, Catherine Naber, Shetal Patel, Phillip Perrinez, Joshua Pothen, Alexandra Swartz, Janice Gallant, and Hal Colston
Introduction: NeighborKeepers (Winooski, VT) is a non-profit, anti-poverty organization that focuses on building supportive friend networks that direct families and individuals toward the resources they need to improve their health, get training and education, find jobs, and discover a sense of purpose and belonging. Keeping with the NeighborKeepers philosophy of giving those in need the tools to help improve their own circumstances, our project goals were to: •Engage community members •Connect individuals with community resources geared toward healthy living and improved healthcare access •Identify health needs and potential areas for intervention or further inquiry
Mohammed Almzayyen, Mark Dammann, Javier De Luca-Westrate, William Jeffries, Jeffrey McLaren, Diana Mujalli, Stell Patadji, Melissa Romero, and Angela Smith-Dieng
Background: Hunger Free Vermont’s mission is to feed more Vermonters, teach the community about healthy food and nutrition and lead advocacy and education efforts to end hunger in Vermont. In Vermont 11.4% of all seniors are considered food insecure. To address this issue, Hunger Free Vermont has taken on the task of increasing enrollment in 3Squares Vermont, the state food stamps program. 68% of people in VT who are eligible for 3SqVT are enrolled. Surprisingly, only 29.2% of eligible seniors are enrolled. Our study focuses on the leaders of community organizations who impact seniors. Through focus groups we assessed their: - Knowledge of the 3SqV program - Knowledge of senior enrollment and food insecurity - Ideas about the barriers leading to low enrollment - Solutions
Jonathan Ameli, Emily Crook, Ashleigh Kennedy, Megan Gray, Jared Sutherland, Jonathan Thomas, Grace Chi, Pam Farnham, Liz Smith, and Annika Hawkins
Background: Committee on Temporary Shelter (COTS) houses homeless individuals and families from the Burlington area. COTS believes that a high proportion of their residents use the Fletcher Allen Health Care Emergency Department (FAHCED) for their health care more frequently compared to the general population. There are many other primary care services offered in the Burlington area, such as Safe Harbor Clinic, Community Health Center, and private offices, which are more appropriate for non-emergent health concerns and are readily accessible to the homeless population. By surveying the population of homeless families in Burlington and conducting a focus group with the COTS staff, we hoped to discover the reasons for ED usage, potential barriers to primary health care, and any possible changes that could ameliorate the health care of this population
Elisabeth Anson, Aaron Burley, Samantha Couture, Katherine Irving, Stephen Morris, Darryl Whitney, Pam Fenimore, and Jill Jemison
Introduction: Oral health is an often overlooked aspect of healthcare with many effects on an individual’s well-being. Dental caries is the most common chronic disease in children, and most dental problems are preventable. Barriers to accessing dental care for low income children include: oral health beliefs of parents, transportation issues, and difficulty locating providers who accept Medicaid. Investigation of the pediatrician’s role showed an increase in dental visits among children who were recommended for care by their primary care providers. Recent data indicates that 67.1% of Vermont Medicaid enrolled children received dental care within one calendar year. While indicating a gap in services, this is the highest rate in the U.S. A comprehensive national survey found that 85% of Vermont children received preventive care in the past year, while recent state data shows that 18% of Vermont children on Medicaid and 16% of children overall have untreated dental decay. In 2009, The Ronald McDonald House Charities, along with the Health Center of Plainfield, implemented the Vermont Ronald McDonald Care Mobile (RMCM), a traveling dental clinic providing dental care for Vermont’s underserved children. In one year, the RMCM visited 15 Vermont schools and treated 214 children, only 9% of the 2400 children projected. The RMCM currently serves sites in three Counties: Grand Isle, Orange, and Lamoille. The objective of our study was to investigate barriers to access to Dental care among Vermont children, with particular regard to the RMCM. The underutilization of the RMCM was assessed by researching current data on Vermont oral health and by surveying overall attitudes toward both the RMCM and Towns the RMCM visited in the past year pediatric dental care in Vermont.
Robert Areson, Vicash Dindwall, Christopher Duncan, Erin Hayes, Emily Keller, Tiffany Kuo, Susanna Thach, Susan Vargas, Tom Delaney, Molly Dugan, and Patricia Berry
Background: In 2009, the Cathedral Square Corporation partnered with community provider organizations* to design a model for in-home services and support known as Seniors Aging Safely at Home (SASH). This comprehensive program, implemented at Heineberg Senior Housing in the New North End of Burlington, VT., combines health support, education, and social activities to create a safe and fulfilling environment for participants. Cathedral Squareplans to extend their SASH program to New North End (NNE) seniors residing in their own homes. However, the current and future needs of the NNE senior population (defined here as individuals age 50 and older) are not well known. NORCs are communities in which the population has aged in place, resulting in a high proportion of seniors living in one area. Neighborhoods with this dynamic have begun to organize programs which provide a variety of services to their seniors, including yard-work, educational workshops, social opportunities, and access to health care services. Village models are similar, but tend to be designed more intentionally as senior-supporting neighborhoods rather than arising naturally as the local population ages. By looking into current community models and by investigating the needs of the NNE senior population, Cathedral Square will be further equipped to offer important services to those who are interested.
Identifying Feasible Interventions to Prevent Long-Term Health Consequences of Psychotropic Medications Prescribed to Children at the Baird School
Irina Arkhipova-Jenkins, Andrew Harris, Lindsay Kleeman, Anna Meyendorff, Jesse Victor, Jared Winikor, Katie Wright, and Rodger Kessler
Introduction: •Many children with behavioral needs struggle in traditional classroom settings. Children receive help through specialized educational institutions, pharmacotherapy, and psychiatric counseling. •While substantial information exists about drug indications and side effects, there is little literature documenting the barriers caregivers face in addressing side effects •Our group conducted a literature review to identify the side effects and associated comorbidities of the six most frequently prescribed psychotropic drugs at the Baird School. •We designed a survey to assess the caregivers’ resources and barriers to minimizing these side effects, and then offered a collection of feasible recommendations.
Charles Ashley, Matthew Davies, Shane Diamond, Lauren Gilligan, Alberto Gutierrez, Lindsay Karr, Christina Pedro, Brenda Perkins, Colleen Wise, and Jan Carney
Introduction: A concussion is a type of traumatic brain injury (TBI) typically caused by bio-mechanical forces inflicted on the head that change the way the brain works. Concussions can also result from a blow elsewhere in the body causing an impulsive force transmitted to the head. These types of injuries often involve a sudden onset of neurologic function impairment such as confusion, amnesia, or loss of consciousness that quickly dissipates and is generally not life-threatening. Unfortunately, these seemingly “mild” symptoms have led numerous primary care providers to undermine its potential risks, often leading to inadequate evaluation, premature return to play, and poor psychological management. Complications of severe or repeated concussions include migraines, depression & mood changes, sleep disorders, convulsions, coma, and in some instances even death. The goals of our study were to evaluate public awareness and knowledge of concussion, identify common misconceptions, assess barriers to proper management, and propose uniform guidelines for education, prevention, diagnosis, and treatment to be used in the Vermont school system.
Nkem Aziken, Michael Boggs, Leslie Bradbury, Christopher Cahill, Sara Higgins, Lynsey Rangel, and Sandra Steingard
Introduction: •The HowardCenter in Burlington, Vermont is designed to empower and improve the lives of individuals with mental illness throughout Chittenden County. •People living with chronic psychiatric disabilities have higher mortality rates and earlier onset of medical illness. It has been observed that many of the risk factors for chronic conditions revolve around nutrition, implying a chance to intervene. •Understanding the various ways people with psychiatric disabilities eat, buy, cook, and value a healthy diet is fundamental for the Howard Center to address increased mortality in this population. •Our goal is to identify barriers and develop a resource to improve nutrition in this population.
Feliecia Bahadue, Serena Chang, Bryan Clark, Victoria Lindstrom, Iwan Nyotowidjojo, Joseph Rosenberg, Allison Smith, Nancy Drucker, and Stuart Offer
Introduction/Background: In the United States, childhood obesity has become the leading pediatric chronic disease. Increased caloric intake and decreased energy expenditure is hypothesized as contributing to the upward trend of obesity. Independent of adult weight, obese children have increased morbidity and mortality from metabolic syndrome as adults. Individuals engaging in exercise programs as short as 6 months have shown improvement in risk factors including body fat mass, waist/hip ratio, ambulatory systolic blood pressure, fasting insulin, triglycerides, and low-density lipoprotein ratio. In our study, adolescents were taught a foundation of health and well-being that incorporated regular exercise. Nutrition was taught through an evidence-based systems approach, including lessons about the cardiovascular, musculoskeletal, and gastrointestinal systems. Our aim was to improve adolescent food choices and increase physical activity through interactive educational sessions.
Mena Bakhit, Jessica Clem, Mayo Fujii, Meghan Garcia-Webb, Taylor Lincoln, Ariana Nesbit, Amanda Schwartz, Peymaun Vakhshoorzadeh, Deb Lyons, and Steve Contompasis
Introduction: •Autism spectrum disorders (ASD) are a group of related brain-based disorders that affect a child's behavior, social and communication skills. •In 2009, approximately 1,000 Vermont students received special educational services for ASD. •Puppets in Education (PiE) is a non-profit group that teaches kids how to keep themselves safe and healthy and to appreciate each other’s differences. •PiE’sFriend 2 Friend Program (F2F) addresses ASD in fun and interactive puppet and workshop presentations, promoting empathy for individuals on the autism spectrum by modeling, labeling, explaining and normalizing differences, and teaching prosocial communication and friendship skills. •Last year, UVM COM students collaborated with PiE to determine how the use of puppets could best educate the community regarding ASD. •This year our goals were to elicit: --the perceived effectiveness of current ASD education in the classroom --the perceived effectiveness of including children with ASD in the classroom; and --the most important aspects of ASD to address in the Puppets in Education (PiE) curriculum
Naiara Barbosa, Griffin Boll, Chantell Hemsley, John Hoyt, Michael Lahey, Razelle Hoffman-Contois, William Bress, and Jan Carney
Introduction: Although 30-50% of Vermont citizens rely on private wells for drinking water, there is no state requirement for regular contaminant testing. As a consequence, it is possible that private well users may be exposed to a variety of potential health hazards, including bacteria, arsenic, fluoride, and radionuclides. Our group sought to better understand public awareness of testing recommendations, how often private well users have their wells tested, and what obstacles may be keeping them from doing so. With this information we hope to learn more about how Vermonters are using private wells, and how we can better serve public health in Vermont
Adam Bensimhon, Kuang-Ning Huang, Paul Jarvis, Jonathan Jolin, Catherine Kelley, Kurt Schaberg, Cristine Velazco, Marianne Burke, and Christine Finley
Introduction: Nationally, childhood immunizations have proven themselves invaluable in preventing contagious diseases and their associated morbidity and mortality. Nonetheless, vaccines have become increasingly controversial, with a growing number of parents refusing to vaccinate their children. Primary reasons given for vaccination refusal include fears of side effects and the belief that the target diseases are not harmful. Those parents who refuse to vaccinate their children generally have higher levels of education and income. An additional population of under-vaccinated children who have received limited recommended vaccinations has been identified and often comes from a lower socioeconomic level. Unimmunized children have been associated with recent disease outbreaks, placing other individuals at risk and increasing the controversy about childhood vaccinations. Nationally, Vermont has one of the highest rates of unvaccinated children with recent data showing these rates are continuing to increase.
Krista Buckley, Mohammed Jafferji, Matthieu Larochelle, Louisa Mook, Haddon Pantel, Laura Sturgill, Luke Vierthaler, Carol Dembeck, Christine Frenette, Jan Carney, and Mark K. Fung
Introduction: The Burlington Chapter of the American Red Cross estimates that 8,000 donors a year become "lapsed," or fail to return for further donation. To better target this population and retain current donors, it is essential to identify reasons for lapsed donation. Several studies have been conducted on the barriers to retaining blood donors, revealing these common factors: past physical reactions, convenience, previous deferrals, lack of awareness, medical reasons, time, satisfaction with the experience, too impersonal, and personal benefit. While many studies have identified reasons for lapsed donation, the majority have not used free text as their data source, have been conducted in a wide range of geographic locations not specific to Vermont residents, and have focused on reasons for discontinuing donations, rather than positive factors. Using free text limits the question bias and eliminates constraints that predefined answers enforce. In 2007, Balderama et alconducted a study identifying common motivations for donating blood, which included an unanalyzed free text portion. We used this free text to answer the question, “What factors identified by lapsed donors might influence donor return?”
Olivia Carpinello, Bridget Collins, Jennifer Covino, Daniel Fischer, Angelica Santos, Kyle Schoppel, Aleksey Tadevosyan, William Pendlebury, and Linda Martinez
Introduction: Respite care is defined as providing the primary caregiver with relief or a reprieve from care commitments on a short-term or emergency basis. Despite a demonstrated interest in and need for respite care programs, our research has shown that scarce resources exist via a statewide dementia respite program administered by Vermont’s five Area Agencies on Aging. Grants are small and many families do not fall within the eligibility requirements. In FY2010, only 290 families across the state met eligibility requirements (physicians’ diagnosis of dementia, income less than 300% of poverty line, unpaid caregiver, primary residence in VT) and were awarded limited funding for the provision of outside care (up to $750.00 each). For many of these families, this money is typically used to provide substitute care when the primary caregiver is not available. To date, there is no true emergency respite program in place for caregivers. This has placed a strain on families and day facilities, particularly when situations arise in which a caregiver is unable to pick up their family member due to an emergency situation. Our goal was to demonstrate the feasibility of a respite program to address this need.
Advance Directives and End-of-Life Care: Completion, Conversations, and Concerns of Burlington Housing Authority Residents
Katherine Clark, Gwendolyn Fitz-Gerald, Claire Frost, Benjamin Goldstein, Eric Kalivoda, Sarah Persing, Damian Ray, Sarah Russell, Claire Rutenbeck, and Gerald Davis
Introduction: •An Advance Directive is a document that allows patients to declare their wishes regarding medical care and decision making should they become unable to communicate their preferences due to an accident or illness. •The Patient Self Determination Act, passed in 1991, requires that health care institutions, such as hospitals and nursing homes, inform patients of their rights to make health care decisions, the hospitals policies regarding recognition of Advance Directives, and educate the staff and community about advance care planning. •Despite the passage of this legislation, completion of Advance Directives remains low. It is estimated that less than 25% of adults nationwide have completed an Advance Directive.
Delia French, Matthew Graf, Jeremy Korsh, Harry Kreider, Erica Pasciullo, Katie Shean, Emily Wood, Jon Bourgo, Hendrika Maltby, and Jan Carney
Objectives: • To determine if refugees completing a Medical Orientation Program for New Americans are better with several aspects of medicine in the US, such as making appointments; knowing more about diet and hygiene; and understanding the implications of mental and chronic illnesses. • To determine if Medical Passports provided to these individuals to improve continuity of care are useful and effective. • To make recommendations for improvements to the Medical Orientation Program for New Americans to the Community Health Center of Burlington (CHCB).
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).
All posters from the UVM College of Medicine Public Health Projects, 2008 to present.
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