Medicine and Health Sciences Commons^™

Improving Breastfeeding Supports In Primary Care Settings, Anya S. Koutras M.D., F.A.A.F.P., I.B.C.L.C

Family Medicine Scholarly Works

Background:

Although 84% of Vermont mothers initiate breastfeeding, only 26% exclusively breastfeed at 6 months of age. Surveyed physicians agree with the benefits of breastfeeding but claim insufficient knowledge and lack confidence in evaluating and managing breastfeeding, despite the availability of evidence-based strategies that address these concerns.

Objectives:

To increase the percentage of infants receiving a documented breastfeeding assessment at each well-child visit in the first 6 months.

To increase documentation of follow up plan in well-child exams in which a breastfeeding problem is identified.

To increase duration and exclusivity of breastfeeding and increase confidence of providers in performing a …

Investigation Of Dna And Rna Markers By Novel Technologies Demonstrates Dna Content Intratumoral Heterogeneity And Long Non-Coding Rna Aberrations In Breast Tumors, Zhouwei Zhang

Graduate College Dissertations and Theses

BACKGROUND:

Breast cancer is the most commonly diagnosed cancer and second leading cancer death cause among females in the U.S.A. About 1 in 8 women in U.S will develop invasive breast cancer over the course of her lifetime. In 2013, 234,580 new invasive breast cancer cases are expected to occur in women within the US and approximately 64,640 non-invasive carcinomas in situ were diagnosed in 2013, most of which were ductal carcinoma in situ (DCIS). Along with technological advances, a wide variety of candidate biomarkers have been proposed for cancer diagnosis and prognosis, including DNA content and non-coding RNA. Current …

Provision Of Reproductive Health Care Services By Nurse Practitioners And Certified Nurse Midwives: Unintended Pregnancy Prevention And Management In Vermont, Erica Lyons

Graduate College Dissertations and Theses

Background: In the United States, currently about half (49%) of the 6.7 million pregnancies are reported as mistimed or unplanned, and this rate of unintended pregnancy is significantly higher than the rate in most other developed countries. Abortion services are critical to the prevention and management of unintended pregnancies. Abortion in the United States has been legal since the 1973; however this right has little meaning without access to safe abortion care and access is declining. Medication abortion, the use of medications to induce abortion and terminate an early pregnancy, has been legal in the United States since 2000, is …

Classical And Alternative Nuclear Factor-Kappab In Epithelium: Impacts In Allergic Airway Disease And Avenues For Redox Regulation, Jane Elizabeth Tully

Graduate College Dissertations and Theses

Nuclear Factor kappaB (NF-êB) is a transcription factor whose activation is increased in settings of allergic asthma. At least two parallel NF-êB pathways exist: the classical pathway, which plays a role in inflammation and cell survival, and the alternative pathway, which regulates lymphoid cell development and organogenesis. The classical NF-êB pathway regulates inflammatory responses derived from lung epithelial cells; however, the role of the alternative pathway in lung epithelial cells remains unclear. We demonstrate that both classical and alternative NF-êB are activated in lung epithelial cells in response to multiple pro-inflammatory agonists, and siRNA-mediated knockdown of alternative NF-êB proteins largely …

An Analysis Of The Effect Of Ss-Hydroxy-Ss-Methylbutyrate On The Flight Ability And Lifespan Of Drosophila Melanogaster, Alexandra Elizabeth Beattie

Graduate College Dissertations and Theses

As muscle function deteriorates with age, the discovery of new ways to enhance the quality of human life by stunting inevitable aging processes, such as sarcopenia, is a subject of great interest to aging populations, to health care professionals and to nutritional companies. β-hydroxy-β-methylbutyrate (HMB) enhances muscle strength in humans and attenuates disease-induced and disuse-dependent atrophy in rodents. We investigated the feasibility of utilizing Drosophila as a model organism to study the biological effects of HMB in aging muscle. Using flight ability as an index of muscle function and monitoring the lifespan of flies, we found that normal food supplemented …

An Investigation Of Epigenetic Contributions To Inter-Animal And Age Dependent Variation In The Bovine Innate Immune Response., Benjamin Green

Graduate College Dissertations and Theses

Mastitis represents a major issue within the dairy industry responsible for economic loss via decreased animal productivity and associated veterinary costs. Currently, there is a push to identify a phenotypic innate immune response that will yield dairy cows with an enhanced resistance to mastitis. Bovine dermal fibroblasts were used as a cell model to measure the response of individuals to Gram-negative bacterial stimuli through the TLR4 signaling pathway. Fibroblast cultures were isolated from 15 dairy heifers at 5, 11, and 16 months of age in order to determine the variability in responsiveness to LPS as well as to monitor the …

Concussion Management In Primary Care, James Levins

Family Medicine Clerkship Student Projects

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.

Improving Vascular Health Of Patients With Diabetes Mellitus, Pishoy Haroun

Family Medicine Clerkship Student Projects

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 …

Influenza: Protect Yourself And Others, Sarah Fieber

Family Medicine Clerkship Student Projects

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.

Awareness And Prevention Of Heroin Use In Springfield Vt And A Drug Recovery Resource Map Of Southern Vt, Yun-Yun Kathy Chen

Family Medicine Clerkship Student Projects

Since 2000, more than 770% increase in treatment of opiate addiction according to Governor Shumlin’s Vermont annual address. On July 11, 2014, there was a shooting incident in Springfield, Vt., that injured a convicted drug dealer and wounded two other people was triggered by a dispute over heroin. This project aimed to create an educational and interactive pamphlet that can be used in the Family Practice office at Springfield Health Center and beyond in order to encourage dialogue and de-stigmatize heroin use recovery.

Advocating Powerhouse Fruits & Vegetables, Christine Tran

Family Medicine Clerkship Student Projects

Fruits and vegetables are great, but they are not all created equally. In 2014, the Centers for Disease Control and Prevention published a study on which fruits and vegetables contain the most nutrients for preventing cancer, diabetes, and heart disease.

The top 41 have been named "Powerhouse Fruits and Vegetables."

Providers’ Views On Transition Of Healthcare For Youth With Developmental Disabilities, Cordelia Y. Ross

Family Medicine Clerkship Student Projects

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 …

Improving Vaccination Rates In Bangor, Me, Noah Quinlan, Whitney Thomas

Family Medicine Clerkship Student Projects

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.

Mindfulness Resources In Lewiston, Me, Sabrina Bedell

Family Medicine Clerkship Student Projects

Mindfulness can be defined as open-hearted, non-judgmental, present moment awareness.
Evidence-based Benefits include
Decreased:
- Blood pressure
- Anxiety, stress, & depression
- Chronic pain
- Medical care visits (inpatient and outpatient)
Increased:
- Immune function
- Ability to act effectively under stress
- Self-esteem
- Quality of life

Fluoride Supplementation: Recommendations In The Primary Care Office, Dwight Parker

Family Medicine Clerkship Student Projects

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?

Hpv Vaccination In Vermont: Identifying Educational Resources For Adolescents, Shane Greene

Family Medicine Clerkship Student Projects

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.

Identifying And Treating Food Insecurity, Nicholas Field

Family Medicine Clerkship Student Projects

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.

Managing And Treating Allergic Rhinitis In The Primary Care Setting, Leah Novinger

Family Medicine Clerkship Student Projects

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.

Creating Patient Instructions For Community Health Resources, Kevin Saiki

Family Medicine Clerkship Student Projects

In the US, more than a third of adults are obese as well as 17% of children. A recent report estimates the annual cost of obesity in Maine amounts to approximately 452 million dollars. Additional reports estimate the cost of obesity to the entire country lies somewhere between 10-30 billion annually.

Encouraging patients to have healthy diet rich with whole grains, fruits, and vegetables, and to maintain regular exercise (150 minutes a week) are effective ways to combat higher BMIs and to stave off associated hypertension, coronary artery disease, type II diabetes, and dyslipidemia.

Marijuana Use Among Pregnant Women In Buprenorphine Treatment For Opioid Dependence, Tara Higgins

Family Medicine Clerkship Student Projects

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.

Increasing Awareness Of Adverse Childhood Experience (Ace) And The Benefits Of Inquiring About Ace, Maya Son

Family Medicine Clerkship Student Projects

Adverse Childhood Experiences (ACE), including childhood abuse/neglect, household dysfunction, and exposure to other traumatic stressors, have a large impact on health costs as well as social services, education, juvenile justice. Impact of ACE crosses socioeconomic boundaries. In 2011, the Vermont Department of Health reported that 58% of VT adults had experienced at least 1 ACE, and 17% of VT women had four or more ACEs.

Alternative Medicine Resources For Primary Care Physicians, Laura Lazzarini, Angelina Palombo

Family Medicine Clerkship Student Projects

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.

Hpv Infection Prevention In Males By Gardasil Vaccination, Russell Landry

Family Medicine Clerkship Student Projects

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).

Dietary Supplement Education In A Primary Care Setting, Suleiman Ismael, Mikaela Rodriguez

Family Medicine Clerkship Student Projects

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 …

Addiction Burden And Resources For Patients In Connecticut, Jacob Reynolds

Family Medicine Clerkship Student Projects

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.

Vermont Radon Exposure, Gary Gilmond

Family Medicine Clerkship Student Projects

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.

Creating A Guide For Patient Self-Management Of Weight Loss (For Management Of Diabetes), Kelsey Preston

Family Medicine Clerkship Student Projects

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.

Food For Thought: Nutrition Education And Nutrient Delivery At Two Local Elementary Schools, Jenna Bodmer

Family Medicine Clerkship Student Projects

I designed a 20 minute powerpoint presentation and delivered it to healthcare providers in the area.
- Discussed the growing problem of obesity, and new federal regulations designed to curb it - Summarized data gathered in interviews at both schools
- Compared schools to each other
- Suggested changes that each school could make in the future
- Offered suggestions for changes in office practices and office collaboration with schools, for PCP's in the area

Cyberbullying And Internet Safety, Waterbury Ct, Gia Colman

Family Medicine Clerkship Student Projects

Cyberbullying has become a growing public health concern with the rising interest and use of social media applications. This occurs mostly in the adolescent population but can continue through to college and adulthood.
Some important differences between cyberbullying and traditional bullying include:
- Students experiences cyberbullying can also be cyberbullies themselves
- Girls are more likely to be involved with cyberbullying.
- Cyberbullying doesn’t just reach students at school but at home as well.
- Students experiencing cyberbullying are 2x more likely to develop depression and anxiety disorders than those experiencing traditional bullying.

Improving Patient Education And Access To Anxiety Treatment, Heather Gardiner

Family Medicine Clerkship Student Projects

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.