Digital Commons Network^™

Cost Of Eating Well, Jake Ermolovich

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

No abstract provided.

The Lhome Initiative: A Pilot Study Assessing Food And Resource Insecurity Among Medical Students During The Covid-19 Pandemic At The University Of Vermont’S Larner College Of Medicine, Dana I. Allison, Eileen M. Cichoskikelly

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Background: Resource insecurity among medical students is a significant barrier to academic success and well-being. The LHOMe initiative at the Robert Larner College of Medicine, University of Vermont, was established in response to this challenge. It aims to support medical students by providing emergency shelter, resources, and mental health services, thereby allowing them to focus on their academic and professional responsibilities. This study assesses the prevalence of resource insecurity among medical students during the COVID-19 pandemic and evaluates their awareness of available institutional resources.

Methods: A survey was conducted from May 27, 2020, to May 31, 2023, targeting 480 medical …

Towards The Elimination Of Viral Hepatitis In Clinton County, New York, Michael H. Le

Family Medicine Clerkship Student Projects

Chronic viral hepatitis is a major public health issue, affecting approximately 300 million persons globally. In Clinton County, New York, chronic viral hepatitis remains a major concern, with incidence rates for hepatitis C virus infection (HCV) in the top quartile and hepatitis B virus infection (HBV) in the 3rd quartile for the state in 2022. This current study aimed to identify the trends in incidence and prevalence of chronic viral hepatitis in Clinton County, rates of HBV birth dose vaccination, and to reflect on the experiences in treatment and prevention of chronic viral hepatitis at a community health clinic in …

Examining The Feasibility Of Integrating An Alcohol Detoxification Protocol Within Primary Care, Emily A. Miller, Dnpc, Bsn, Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Medically supervised, in-home alcohol detoxification is safe, efficacious, cost-effective, and satisfying for patients. However, it remains underutilized within primary care practices. This feasibility study aimed to examine clinician perceptions of adopting a standardized outpatient alcohol detoxification protocol at a rural primary care clinic where no internal protocol exists.

Methods: An ambulatory alcohol detoxification protocol was created using the American Society of Addiction Medicine guideline on alcohol withdrawal management and presented to 38 providers and 11 nurses. Twelve participants (six providers and six nurses) completed a modified version of the Implementation Process Assessment Tool. The instrument measured stakeholder perceptions of …

Bayesian Experimental Design For Control And Surveillance In Epidemiology, Bren Case

Graduate College Dissertations and Theses

Effective public health interventions must balance an array of interconnected challenges, and decisions must be made based on scientific evidence from existing information. Building evidence requires extrapolating from limited data using models. But when data are insufficient, it is important to recognize the limitations of model predictions and diagnose how they can be improved. This dissertation shows how principles from Bayesian experimental design can be applied to surveillance and control efforts to allow researchers to get more out of their data and direct limited resources to best effect. We argue a Bayesian perspective on data gathering, where design decisions are …

A Delphi Consensus To Identify Perioperative Antibiotic Prescribing Best Practices In Mohs Surgery, Cari Carpenter Bs, Ba, Glenn Goldman Md, Katelyn Shea Md

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Abstract: Surgical site infections (SSI) make a significant global contribution to morbidity, mortality, and cost while remaining one of the most preventable causes of healthcare-associated infection. Perioperative antibiotics are a mainstay of prevention, but antibiotics are also associated with cost, risk, and increasing resistance. Dermatology is responsible for more oral antibiotic prescriptions than any other discipline. Despite a trend toward conservative prescribing practices and antibiotic stewardship in dermatology overall, antibiotic prescriptions in dermatologic surgery continue to increase, with a notable rise in short-term perioperative prescribing. There is currently a lack of evidence-based perioperative antibiotic prescribing guidelines within the dermatology literature. …

Community Resilience In Vermont After The 2023 Flooding Event, Alex Poniz

Family Medicine Clerkship Student Projects

Between July 10th-11th 2023 Vermont experienced catastrophic flooding after receiving prolonged heavy rainfall of up to 9” over 48 hrs. Damage from the 2023 event rivals the historic destruction of Hurricane Irene in 2011 and is exceeded only by the Great Vermont Flood of 1927, an event predating modern flood controls. We collected oral histories from Vermonters to better understand their lived experience of the flood and its impacts, and identifed common themes related to community and individual resilience.

Diabetic Foot Wound Care, Richard Q. Vuong

Family Medicine Clerkship Student Projects

Diabetic foot wound care educational pamphlet developed during the family medicine rotation for 3rd-year medical students. This project was developed in Brookfield, CT.

Nonlinear Relationships Between The Environment And Health, Levi N. Bonnell

Graduate College Dissertations and Theses

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) …

Screening For Ptsd In Veterans And Expanding Awareness Of Ptsd Resources, Audree S. Baroni, Bradford Clark

Family Medicine Clerkship Student Projects

PTSD is a prevalent mental health disorder that is especially prominent in the veteran population. Often veterans go without diagnosis and subsequently without treatment due to lack of awareness, screening, and a stigma they will loose benefits from the VA. This project aimed to identify the number of veterans with PTSD and provide alternative treatment methods for symptom management.

How To Analyze Parental Conversation Online: A Computational Stack For Studying Vaccine Hesitancy., Carter Willets Ward

Graduate College Dissertations and Theses

Despite national and international organizations such as the CDC and WHO recognizing the value of vaccines and their importance in addressing public health concerns, there has been a decline in coverage for even the most established vaccines over the past three years. The global COVID-19 pandemic has contributed to this decline via decreases in medical resource accessibility and an increase in vaccine hesitancy. Even before the COVID-19 pandemic, WHO had recognized vaccine hesitancy as one of the top ten threats to public health. In the present work, we introduce a background account of (1) vaccine hesitancy and (2) anti-vax activism, …

Low Birth Weight Status Combined With Socioeconomic Factors Influences Future Diagnosis Of Learning Disability, Sinead Donnelly, Nisagini Logendran, Anel Peco, Maris Sagamang, Elizabeth Sparks

Master of Public Health Culminating Projects

Objective: To determine if there is correlation between low birth weight and the development of learning disabilities in later stages of life.

Methods: Data from the National Child Health Survey from 2018-2020 was used with data from

59,963 U.S. households looking at children aged six to eleven years. A multiple linear regression model was used to assess the relationship between low birth weight (<2500g) and learning disabilities and developmental delays when controlling for ethnicity, family structure, and household income.

Results: The results indicate 7.2% of those surveyed reported a child with a diagnosed learning disability. In response to the low birth weight category, 8.2% of the children involved were in the category …

The Role Of Food Insecurity With Hunger And Physical Activity Level On Binge Drinking Among Vermont High School Students, Joe Stacy, Codi Williams, Zyakkiriah Rhoden, Han Naung Tun

Master of Public Health Culminating Projects

Objective: To determine the association of hunger, physical activity, Black Indigenous People Of Color (BIPOC) status , and BMI percentile on binge drinking among Vermont high schoolers.

Methods: A cross-sectional study was conducted on Vermont high school students aged between 12 to 18 years (n=18,540) using data obtained from the 2019 Youth Risk Behavior Survey of the Vermont Department of Health. Multiple logistic regression models were utilized to investigate the correlation between binge drinking status and hunger status, physically active status, BIPOC status, and Body Mass Index percentile.

Results: Binge drinkers had significantly higher levels of hunger …

Cardiovascular Disease Deaths Of Vermonters Aged 65+ Years By Rurality Status Of Residency, Francene Zavala, Katherine Rampone, Kailene Cruden, Tyler Flores, Mark Gauthier

Master of Public Health Culminating Projects

Objective: To analyze cardiovascular disease (CVD) mortality amongst individuals 65 years and older living in different areas of Vermont.

Methods: Using the state of Vermont's Electronic Death Registration System, the cross-sectional analysis compared the rate of CVD death for older Vermonters in urban and rural areas between 2015 and 2019.

Results: The binomial logistic regression model demonstrated statistically significant findings among the predictor variables: rurality (p

Conclusions: These findings suggest a need for increased research and awareness of the impact CVD mortality has among Vermonters 65 years and older in rural areas as this population continues to increase.

Over-The-Counter Approval Of Progestin-Only Pills, Hannah Grace Donovan

Family Medicine Clerkship Student Projects

Most women in the United States use contraception at some point in their life. While there are many types of short- and long-acting reversible birth control options available via prescription, the oral contraceptive pill (OCP) remains the most used reversible contraceptive agent. The proportion of those using an OCP is inversely proportional with age; more specifically, people who can get pregnant between the ages of 15 and 29 use OCPs most frequently. However, people in this age range may face increased barriers to obtaining contraception, such as cost, insurance, social and familial factors, policy, transportation, and access to healthcare. In …

Increasing Patient Education On Proper Antibiotic Stewardship, Arif S. Ahsan

Family Medicine Clerkship Student Projects

Antibiotic resistance is a growing public health issue in the United States. Coinciding with this, patients often inappropriately self-treat infections using antibiotics. Locally, this causes complications in treating patients in an outpatient setting, and nationally, this causes an increased economic burden on the United States healthcare system. A handout was developed for distribution at pharmacies in order to better educate patients on proper antibiotic stewardship, based on information that providers believed to be most important for patients to know.

Screening For Areca (Betel) Nut & Quid Use, Gabriela Sarriera Valentin Ms

Family Medicine Clerkship Student Projects

Standardized screening tools for patients who use betel quit and areca nut products do not currently exist. Given the increased risk of oral and oropharynx cancer development in this patient population, increasing awareness of this practice could result in decreased morbidity and mortality. The purpose of this project is to (1) increase provider awareness of this cultural practice and its associated health consequences, (2) to develop a screening tool, and (3) to propose suggested follow-up when concerning lesions are identified.

Improving Knowledge Of Contraceptive Options In Teenage Male Populations, Anthony Quach

Family Medicine Clerkship Student Projects

Despite a plethora of contraception available on the market, nearly 50% of pregnancies in Vermont are unintended. Currently, most educational initiatives aimed at improving contraceptive usage are targeted towards individuals with uteruses, and not their partners with penises. Both qualitative and quantitative data suggest that there are significant gaps in this latter population’s knowledge about contraception for various reasons like limited contraceptive education within formal sexual education in schools, lack of parental and/or physician discussions about contraception, and various complex social and cultural factors. This intervention aims to bridge the knowledge gap in this population by using an educational pamphlet. …

A 2022 Assessment Of Food Security And Health Outcomes During The Covid-19 Pandemic, Ashley C. Mccarthy, Farryl Bertmann, Emily H. Belarmino, Sam Bliss, Jennifer Laurent, Jonathan Malacarne, Scott Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Agriculture and Life Sciences Faculty Publications

We conducted a Northern New England survey to understand the impacts of the COVID-19 pandemic on food security, food access, home food production, health behaviors, and health outcomes. The surveys were conducted in the spring of 2022 (April-May) with a total of 1,013 adults (598 in Maine and 415 in Vermont) responding to the survey. Key findings include:1. The prevalence of food insecurity remains similarly high to early points in the pandemic, likely driven by inflation and food prices, and long-term impacts from the pandemic. 2. The majority (62%) indicated the recent rise in food prices affected their food purchasing, …

Persistent Diaper Need Identified During The Covid-19 Pandemic, Emily H. Belarmino, Rachel M. Zack, Lauren A. Clay, Nick W. Birk

College of Agriculture and Life Sciences Faculty Publications

Diaper need refers to the lack of a sufficient supply of diapers to keep an infant or child clean, dry, and healthy. More than 1 in 3 households (36%) experienced diaper need in the first year of the COVID-19 pandemic.

Creation Of A Parent-Directed Toolkit To Prevent Youth Vaping, Corinne Webb

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Vaping rates among adolescents are at an all-time high. Misperceptions about the harms of vaping may limit parents’ ability to impact youth vape use. This project developed and tested an evidence-based toolkit to educate parents of adolescents about the risks of vaping.

Methods: The toolkit’s creation was informed by published evidence and multimedia content delineating the scope of the vaping crisis. The toolkit was reviewed and revised by content experts. Pre- and post-implementation assessments were created and tested with faculty members, public health professionals, teachers, and parents. Assessments were utilized to evaluate parental vaping knowledge before and after implementation …

Evaluating The Indirect Effects Of A Community-Based Child Obesity Prevention Program On Adult Health Behaviors, Emily K. Rocheleau

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Community-based intervention (CBI) programs aim to change individuals’ behaviors to reduce the risk of chronic disease, often by addressing factors that contribute to obesity. To provide information for improving interventions, program evaluation is needed. In Franklin and Grand Isle Counties, childhood extreme obesity decreased where a child-targeted, obesity prevention focused CBI was implemented. It has been shown that these programs can have an indirect effect on parent health/body mass index (BMI), but it is unclear if indirect effects of such programs have an impact on adult BMI and related health behaviors. The purpose of this project was to determine …

Characterizing The Relationship Between Binge Drinking And Condom Use Among Vermont High School Students, Danielle G. Allen, Michael Schwartz, Steph Tack, Robert O'Conner, Madaline Schmidt, Kelsey Gleason

Master of Public Health Culminating Projects

Objectives. To determine if there is a relationship between binge drinking and risky sexual behavior in Vermont high schoolers.

Methods. We used data from the 2019 Vermont Youth Risk Behavior Survey, a survey administered every other year in high schools across Vermont asking students questions about various habits and behaviors. We used binary logistic regression to determine the association between binge drinking in the past 30 days and condom usage at last sexual intercourse.

Results. Binge drinking within the past 30 days was found to have increased odds of students not using a condom during intercourse (OR=0.782) when adjusting …

Change In Food Security And Health Outcomes Since The Covid-19 Pandemic In Northern New England, Jennifer Laurent, Farryl Bertmann, Mattie Alpaugh, Emily H. Belarmino, Sam Bliss, Jonathan Malacarne, Ashley C. Mccarthy, Scott C. Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Nursing and Health Sciences Faculty Publications

We conducted a Northern New England survey in March-June of 2021 to understand the initial and continued impacts of the COVID-19 pandemic on food security, health behaviors, and health outcomes. A total of 988 adults (562 in Maine and 426 in Vermont) responded regarding food access and availability, health behaviors such as diet composition and exercise, and use of habit-forming substances (e.g. alcohol, tobacco, etc.) before and in the year following the onset of the COVID-19 pandemic. Key findings include: 1. 39.1% of Maine and 43.2% of Vermont respondents indicated weight gain since the start of the COVID-19 pandemic. 2. …

Experiences Participating In Federal Nutrition Assistance Programs During The Early Months Of The Covid-19 Pandemic: A Mixed Methods Study In Vermont, Emma Haven Spence

Graduate College Dissertations and Theses

For many Americans, the impacts of the COVID-19 pandemic have extended far beyond its overt health risks, spanning from economic shocks to new social realities. Elevated rates of both novel and continued food insecurity during the pandemic have been well-documented, and this burden has not been equally shared. Examination of food insecurity at the present moment offers a unique opportunity to give voice to those affected during this unprecedented time and understand the ability of existing social services to meet increased needs. This research aims to delve into the experiences of individuals at risk for food insecurity. Specifically, (1) to …

Return To Play Following Covid-19, Tyler Landman

Family Medicine Clerkship Student Projects

Covid-19 infections among adolescents have led to significant decreases in physical activity and fitness. Many adolescents have been subject to return to play clearance before being able to get back to their sport. Protocols are not only a moving target but are also different from school to school, and county to county. Many patients are not involved in the decision making process of when they get to play again, and furthermore end up being out of sport longer than they need to due to the ordering of unnecessary tests, and long wait times for them. The aim of this study …

Opioid Overdose Deaths In Vermont: Comparing Rates Of Mortality In Urban Versus Rural Settings, Jamie Bernier, Jonna Thomas, Sindhu Donepudi, Sierra Serino, Mia Crisafulli, Joseph Zamboni

Master of Public Health Culminating Projects

Objective: To investigate differences in opioid-related overdose death in Vermont based on urban versus rural setting.

Methods: A retrospective cohort study was conducted using Vermont’s Electronic Death Registration System from 2015-2019. After applying exclusion criteria, 570 subjects were included in bivariate logistic regression analyses.

Results: Individuals who died in urban areas had 45.8% lower odds of death due to opioid use than those in rural areas. For every one-year increase in age, odds of overdose death decreased by 4.6%. For females, odds of death due to opioid use was 19.4% lower than the odds for males.

Conclusions: Vermont residents who …

The File Of Life: A Lifeline For First Responders In Fairfield County, Ct, Brittany Gilmore

Family Medicine Clerkship Student Projects

During a medical emergency, it can be difficult for first responders to obtain crucial medical information about their patients for a variety of reasons. The patient may be unconscious, have an altered mental status, or simply not know their medical history. This project aimed to increase awareness of the File of Life program, which many local Fire and EMS departments are implementing to improve their ability to deliver life-saving care.

Listen To Her Heart: Bridging The Gap In Recognizing, Preventing, & Treating Ascvd In Women, Stephen J. Foley

Family Medicine Clerkship Student Projects

Atherosclerotic cardiovascular disease (ASCVD) is traditionally considered a male disease, yet it is the leading cause of death in women. This may be associated with the significant lack of research of ASCVD in women, leading to poor recognition, diagnosis, prevention, and treatment. The American Heart Association reports that a majority of women experience prodromal symptoms more than one month before a heart attack or stroke, and these symptoms are often underestimated. This project intends to help address the question: How can earlier detection of ASCVD risk in women reduce missed signs of acute myocardial infarction/stroke and thereby reduce preventable ASCVD …

Modeling The Heterogeneous Temporal Dynamics Of Epidemics On Networks, Andrea Joan Allen

Graduate College Dissertations and Theses

Mathematical models of infectious disease are important tools for understanding large-scale patterns of how a disease spreads through a population. Predictions of trends from disease models help guide public health prevention and mitigation measures. Most simple disease models assume that the population is randomly mixed, but real-world populations exhibit heterogeneous patterns in the way people interact. These differences in population structure can be represented by networks. Networks can then be incorporated into disease models by using various interdisciplinary concepts and tools. Yet even network disease models often overlook that populations change over time. In this thesis, two models of infectious …