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  Influenza: Protect Yourself and Others

  Sarah Fieber

  In clinic, I would recommend to each patient that he or she should consider having a flu shot as flu season is quickly approaching. I heard a plethora of reasons for not being vaccinated, and few of these reasons were fact based. Teenagers are inconsistent about flu vaccination, and I thought if I could present an argument in favor of flu vaccinations, this could make a difference for the coming generations.

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  Identifying and Treating Food Insecurity

  Nicholas Field

  13% of Vermont households are food insecure, an increase of 45% since 2000. 25,400 children and 7,800 seniors in Vermont live with food insecurity. Based on metrics including poor health, hospitalizations, and lower educational productivity, food insecurity cost the State of Vermont $340,000,000 in 2010 alone.

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  Promoting Public Water Fluoridation in Bennington VT

  Leah Fox

  The Centers for Disease Control and Prevention has recognized community water fluoridation as one of the ten greatest public health achievements of the 20th century. It reduces tooth decay over a person's lifetime by 25%. Over the past 40 years, there have been 6 failed attempts to fluoridate the drinking water in the town of Bennington. There is an overabundance of tooth decay affecting citizens of Bennington. The need for dental care in Bennington far outweighs the resources available.

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  Improving Patient Education and Access to Anxiety Treatment

  Heather Gardiner

  According to the World Health Organization, in developed countries, mental health accounts for more disability than any other group of illnesses. About 25% of adults in the United States are reported to have a mental illness. Anxiety disorders are the most prevalent class of mental disorders faced by individuals in the United States. Although anxiety disorders are treatable, only 34% of people diagnosed receive treatment.

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  Vermont Radon Exposure

  Gary Gilmond

  Radon is a natural, odorless and tasteless radioactive gas that is found in soil, rocks and water all over the US including Vermont. Long-term radon exposure is linked to over 21,000 lung cancer deaths a year in the US, second only to tobacco. Roughly 1 in 8 homes in Vermont are believed to have high radon levels. Vermont law does not require a radon test as part of a real estate transaction. Thus despite the danger of Radon exposure, the issue remains unrecognized by many Vermonters. Since 2000 only 15,488 state radon test kits have been ordered in Vermont.

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  HPV Vaccination in Vermont: Identifying Educational Resources for Adolescents

  Shane Greene

  HPV vaccine is unique in that (1) it's not a required vaccine to enter school and (2) it's given at an age where patients have more agency over their medical care, so an adolescent who doesn't want to get the shot is often able to avoid it. In Vermont, there's a lack of educational material aimed at young adults about the benefits of the HPV vaccine.

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  Increasing Access to Community Support Groups for Patients with Mental Health Needs: A Guide for Primary Care Physicians

  Daniel Haddad

  A large percentage of patients seen by primary care physicians suffer from mental health afflictions that are requiring increasingly more time and resources to treat. There is a lack of mental health providers to meet the needs of the community which result in 3-6 month waiting periods for patients to get an appointment with mental health providers. More mental health resources are needed to help family practitioners address this problem.

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  Improving Vascular Health of Patients with Diabetes Mellitus

  Pishoy Haroun

  Some diabetic patients are reluctant to take the extra step in their long-term health care, which is particularly problematic as it relates to cardiovascular disease. In addition to difficulty controlling blood glucose levels, patients struggle maintaining an appropriate blood pressure. This is often due to a reluctance to maintain a proper diet, exercise regularly, and take certain medications. Studies have shown that compliance with exercise regimens falls from 80% at 6 weeks to 20% at one year. Many patients are reluctant to start on a statin, and some physicians are even hesitant to adhere to the new recommendations proposed by the AHA.

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  Marijuana Use Among Pregnant Women in Buprenorphine Treatment for Opioid Dependence

  Tara Higgins

  New program, "Closer to Home," will allow pregnant women in buprenorphine treatment for opioid dependence to get treatment closer to home and deliver at Copley Hospital instead of being required to go to Burlington. This requires local physicians to prescribe buprenorphine to pregnant women. In creating the program, prescribing physicians have to decide policies around non-opioid substance use.

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  Low T? Late Onset Hypogonadism

  Cheng-Wei Huang

  Recently, there has been an increase in commercials and ads by pharmaceuticals pushing for testosterone supplementation by capitalizing on the sensitive subject of "low T" or decreased manhood and vague non-specific symptoms of low T. The idea that testosterone is something that occurs within our natural body and that we are only supplementing what’s originally there can be misleading. Many may interpret this as there is no harm but good, but the latest studies have shown otherwise. It is clear that there is a lack of proper understanding regarding testosterone treatment in the public, from when treatment would be suitable to what the risks and benefits are.

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  Dietary Supplement Education in a Primary Care Setting

  Suleiman Ismael and Mikaela Rodriguez

  More than 50% of American adults use at least one dietary supplement. Despite their popularity, patients and physicians are often unaware of the limited regulation of these products as well as their potential risks and benefits. During our rotation at the Center for Family Medicine in Bangor, Maine, we observed several patients asking about the efficacy and safety of various supplements. Also, many patients wanted to avoid taking pharmacological drugs and inquired about any "natural" treatments to their illnesses. The residents we worked with expressed a lack of confidence in their ability to discuss dietary supplements with their patients. In the overwhelming majority of cases, if a patient did not bring up supplement use on their own, the providers never inquired about it.

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  Caregiver Burden: Finding Resources, Offering Support

  Sarah Johnson

  - Definition: Informal caregivers are unpaid individuals (often a spouse, partner, family member, friend or neighbor) involved in supporting others in activities of daily living.
  - Caregiver burden is an emerging public health issue largely attributed to longer life expectancy that not only increases the number of elderly individuals, but also the level of dependency in these individuals.
  - Despite many formal support services, informal support continues to be the primary source of care for the elderly, dependent and disabled.
  - Unpaid family caregivers will likely continue to be the primary source of long-term care in the United States as the aging population will more than double between the years 2000 and 2030 from 35.1 million to 71.5 million.
  - In 2009, three in ten U.S. households reported at least one person providing unpaid care as a family caregiver.
  - Caregivers report performing housekeeping and personal tasks, running errands, managing medical needs and more.
  - Caregivers spend on average 20.4 hours per week providing care. Those who live with their care recipient spend 39.3 hours per week caring for that person.

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  Health and Community Resources For Older Adults in Chittenden County, Vermont

  Matthew Jordan

  The vast number of resources available to older adults are widely unknown to both health care providers and the older adult population itself.

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  HPV Infection Prevention in Males by Gardasil Vaccination

  Russell Landry

  About 1% of sexually active males in the U.S. have genital warts. Each year 400 males get HPV related cancer of the penis, and 1,500 get HPV related cancer of the anus. 2-3 cases of Genital warts have been reported at Harwood High School (Moretown and Waitsfield), where the school nurse reports 1-3 males students each year seeking information about STIs (including HPV).

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  Alternative Medicine Resources for Primary Care Physicians

  Laura Lazzarini and Angelina Palombo

  Despite the prevalence of patients that would benefit from Complimentary and Alternative Medicine (CAM) at EMMC Center for Family Medicine (CFM), practicing physicians lack sufficient education on CAM and knowledge of community resources to refer their patients to.

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  Concussion Management in Primary Care

  James Levins

  Concussion awareness is a hot topic in youth sports, resulting in increased health care visits. There has been much change in concussion management over the past decade. VT passed a law (Act 68) implementing a concussion management program in schools. Not all primary care physicians are aware of how this law may affect their practice, nor are they all aware of some of the recent changes in concussion management. Improper concussion management can lead to prolonged symptoms, recurrent injuries and long-term sequelae.

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  School Based Yoga Intervention for Childhood Stress Management

  Erica Marden

  Childhood stress can have immediate and long-term negative impacts on physical health, mental health, school performance, self-esteem, and relationships. For children in rural communities there are fewer resources available as recreational and therapeutic outlets for healthy stress reduction. Extracurricular activity involvement also puts significant financial and time burdens on families. There is a particular need to provide children in rural areas with tools to manage stress that can be incorporated into the school day and require few resources. Yoga is an excellent school-based activity that has proven benefits on physical and emotional health for both students and teachers. It has been shown to be effective at improving children's sense of wellbeing and reducing self-perceived levels of stress, and can practiced individually at home without requiring any special equipment.

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  Community Resources for Elevated BMI in Downeast, ME

  Nicolas Monte

  The US is currently mired in a decades-long battle against an epidemic of obesity. ­According to the CDC 69.2% of the US population over the age of 20 is either overweight or obese. As primary care clinics move towards becoming “Patient-Centered Medical Homes” the need exists to provide adequate and specific educational materials.­While a great wealth of educational resources exist to inform patients about the nature and pathogenesis of individual diseases, access to specific local treatment tools is lacking. Although nearly all clinicians screen patients for elevated BMI and provide general information about general healthy habits, this is often the limit of the discussion.Time restrictions on appointment length hinders the ability of the clinician to adequately provide recommendations about how/where patients may work to reduce their BMI.

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  Managing and Treating Allergic Rhinitis in the Primary Care Setting

  Leah Novinger

  Screening and appropriate treatment of allergic rhinitis in the primary care setting is a challenge for providers due to time constraints. Providers in the practice desired more information about where in the community to refer patients with persistent allergic rhinitis and what information or test results they should send those specialists.

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  Fluoride supplementation: recommendations in the primary care office

  Dwight Parker

  Physicians in a Vermont family practice setting tend not to be very familiar with CDC/AAP/AAD recommendations regarding fluoride, especially when it came to rural areas in Vermont not on town or public water. Questions include: What are the pros and cons of fluoride supplementation? What are the indications for supplementation? How does one go about testing their well water? Which towns have fluoridated water, and what are their levels? What doses are recommended, and what options are there for treatment?

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  Common Naturopathic Therapies for Chronic Conditions

  Jordan E. Perlman

  Complementary and Alternative Medicine has started to achieve greater public prominence – many patients report satisfaction and believe these therapies are cost effective. Allopathic physicians are largely unfamiliar with the supplements prescribed by naturopathic doctors, and have trouble integrating these therapies into traditional treatment plans. Patients are not trained to evaluate the safety or efficacy of their medication regimens, and rely on their primary care physicians to provide that service -– even if the majority of their "medications" are supplements recommended by an "alternative" provider.

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  Creating a Guide for Patient Self-Management of Weight Loss (For Management of Diabetes)

  Kelsey Preston

  In my first week working with Dr. Flynn, I saw more patients coming in with a diagnosis of diabetes than those without; this is likely untrue, but it certainly felt like that. I realized how big of an issue diabetes really is, and hoped to work on a project targeted towards diabetes. While I noticed medical and medicinal management of patients with diabetes was adequate, there was a large gap in patient self-management of their diabetes – they followed their prescriptions, but did not seem to have changed other aspects of their lives, most importantly, their diets.

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  Improving Vaccination Rates in Bangor, ME

  Noah Quinlan and Whitney Thomas

  Providers believe vaccination rates at EMMC Center for Family Medicine can be higher. A resurgence in some preventable diseases is likely due to decreased immunization rates. While other preventable diseases have not seen a resurgence, the potential for outbreak exists if immunization rates remain low. Factors contributing to low immunization rates are misinformation, lack of awareness, cost, inconvenience, and infrequent office visits by adolescents.

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  Addiction Burden and Resources for Patients in Connecticut

  Jacob Reynolds

  Nationally, the US has 60 million smokers, 14 million dependent on alcohol, and 14 million illicit drug users. One quarter of Americans over 15 have physiologic dependence on at least one addictive substance. A quarter of all deaths in the US are caused by addictive substances: alcohol, tobacco, drugs. There are an additional 40 million injuries and illnesses per year. Locally, one Connecticut therapist reports sending 30 of her patients under age 22 to in-patient treatment for opiate abuse.

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  Providers’ Views on Transition of Healthcare for Youth with Developmental Disabilities

  Cordelia Y. Ross

  Problem: Youth with DD have conditions that may limit their ability to function, with resulting social, emotional, or behavioral sequelae, and experience difficulty transitioning from child to adult health care. Also, adult providers may lack training and comfort level in working with patients with DD. For example, youth with ASD need an adult provider who understands autism but doesn’t see every health or behavior problem as a result of autism.

  National Need: 1 in 6 children in the U.S. has a DD. Each year, almost half a million of these children transition into adulthood. As for ASD, 1 in 68 children (1 in 42 boys) meets ASD diagnostic criteria.

  State Need: In Vermont in 2006, 540 children and adults with ASD (with 126 in Chittenden County alone) were being served by the Vermont Community Mental Health and Developmental Services programs. Since then, the number of children with ASD has grown approx. 20% per year.

  Community Need: Hinesburg Family Practice currently sees 11 patients with a Code 299 diagnosis (pervasive developmental disorders) per year. These patients accounted for 25 visits during FY 2014. The patients range in age from 5 to 53 years (median age: 17 years).