Medicine and Health Sciences Commons^™

Development Of A Sustainable Volunteer Model To Address Food Insecurity, Abigail Belser, Adrian Berg, Leah Miller, Kaitlyn Peper, Allison Tzeng, Carolyn Gould, Linda Howe, Jan Carney

Public Health Projects, 2008-present

Food insecurity is a predictor of poor health outcomes and a critical social determinant of health. Food shelves are critical community resources aimed to counter food insecurity by providing nutrition and other resources to those in need. Food insecurity in Winooski, Vermont is substantial and increasing, with 10% of residents utilizing the Winooski Food Shelf (WFS) in 2018. To aid in the increasing demand of the WFS, we determined the greatest need(s) to implement a sustainable intervention to ensure capacity to meet demands.

Vermont Legislature’S Views On The Reliability And Accessibility Of Available Resources Regarding Public Health Concerns Of Youth Marijuana Use, Aram Garewal, Luke Higgins, Jeannie Lin, Kathleen O'Hara, Michelle Oberding, Anna Quinlan, Joseph Teague, Lori Augustyniak, Karen Lounsbury

Public Health Projects, 2008-present

Vermont previously legalized possession and limited cultivation of marijuana. Proposed legislation for 2020 would legalize commercial sale of marijuana. Current knowledge surrounding public health impacts of the legal commercial sale of marijuana on youth is inconsistent, insufficient, and poorly understood by the public. This study investigated legislator utilization and perception of sources contributing to growing knowledge surrounding youth marijuana use.

Housing Initiatives Implementation In Vermont To Improve Health Outcomes, Jose Calderon, Marlijne Cook, Benjamin Kagan, Sylvia Lane, Maha Saleem, Kayla Sturtevant, Angela Troia, Heidi Klein, Jan Carney

Public Health Projects, 2008-present

Vermont Department of Health goals include improving population health outcomes, including social determinants of health. There is compelling evidence between housing and health; research demonstrates housing insecurities increase rates of negative health outcomes. Research further demonstrates improve-ments in housing reduce hospital stays, thus reducing financial burdens on hospitals. This project sought to understand what housing initiatives Accountable Communities for Health (ACH) in Vermont are implementing to alleviate the burdens of housing insecurity.

Assessing Prenatal Care Providers’ Promotion Of Immunization In Pregnancy, Emily Eakin, Francesca Garofalo, William Holden, Sunny Hutson, Ambrose Orr, Melanie Parziale, Anya Srikureja, Emily Straley, Christine Finley, Jill Jemison, Raj Chawla

Public Health Projects, 2008-present

Accurate information regarding prenatal immunization is critical for first-time mothers. Many vaccine-hesitant mothers decide whether to vaccinate their children during pregnancy. The Centers for Disease Control and Prevention (CDC) guidelines urge providers to recommend the Tdap and influenza vaccines to pregnant patients to reduce the risk of complications from pertussis and influenza, respectively, in both expectant mothers and infants. In 2018, about half of pregnant women in the US received an influenza vaccine and Tdap vaccine; however, uptake varies state to state. This study demonstrates the first survey of providers regarding prenatal immunization practices in Vermont.

A Comprehensive Needs Assessment Of Rural Syringe Services, Deena Chanowitz, Julia Clemens, Alim Esemenli, Matthew Hill, Erick Maclean, Adessa Morano, Adam Ross

Public Health Projects, 2008-present

The current opioid epidemic has resulted in a significant increase in opioid-related overdoses, and a corresponding rise in HIV and HCV transmission. Syringe Service Programs (SSPs) provide resources for people who inject drugs. There are fewer SSPs in rural U.S. and little research has been conducted to determine unique needs of SSP participants in rural areas.

Attitudes & Roles Regarding Firearm Access And Suicide Prevention In Vermont Middle & High Schools, Cari Carpenter, Kelly Chan, Jeremy Greenberg, Alyssa Heiser, Ashleigh Peterson, Peter Twining, Emerson Wheeler, Kristin Fontaine, Wendy Davis

Public Health Projects, 2008-present

Adolescent suicide is a serious public health concern in Vermont, and the presence of firearms in the home is a known risk factor. Suicide attempts with firearms are more likely to be completed than attempts with other means, with an 85% mortality rate of suicide with firearms compared to 5% with other means. This project aimed to assess attitudes, comfort, and perceived roles among school personnel in addressing gun safety and access to firearms with Vermont students and parents.

Physician Attitudes Toward Screening For Social Determinants Of Health, Michael Barnum, Rosie Friedman, Tierra Lynch, Collin Montgomery, Irene Sue, Jenna Wells, Hakeem Yousef, Elizabeth Cote, Charles Maclean

Public Health Projects, 2008-present

Social determinants of health (SDH) have a significant impact on health outcomes. Screening for SDH in the clinical setting can identify at-risk patients, but follow-up and management remain challenging. Currently, there is no single preferred screening tool recommended for SDH and the screening process varies widely. The goal of this study was to determine family medicine physician attitudes and practices regarding screening and follow-up for SDH in Chittenden County, VT.

E-Cigarette And Tobacco Use On A Tobacco-Free Uvm Campus, Sameer Alidina, Lauren Gernon, Kalin Gregory-Davis, Alexa Pius, Olivia Quatela, Samuel Raszka, Zeynep Tek

Public Health Projects, 2008-present

The prevalence of e-cigarette use has significantly increased in recent years. In the US, e-cigarettes are now the most common nicotine products used by adolescents. The CDC reported 1,299 cases of lung injury correlating to the use of e-cigarette and vaping products; the current recommendation is to refrain from using e-cigarette products that contain THC and/or nicotine.

Measuring The Impact Of Rise Vt: Evaluating Community-Based Obesity Prevention Initiatives With A Standardized Intensity Score, Brianna K. Johnson Bsn, Rn, Ocn, Dnpc

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

Background. Obesity is a leading cause of morbidity and mortality in the US. Rise VT is a multilevel community-based initiative to reduce obesity. The Community Programs and Policies Intensity Score (CPPI) is a standardized metric to evaluate multisector efforts over time, which has correlated with reductions in childhood obesity.

Purpose. The purpose of this project was to quantify the impact of Rise VT using the CPPI score. A secondary aim was to assess the feasibility of using the CPPI score for ongoing program planning and evaluation statewide.

Methods. Interviews with program managers were conducted to gather data related to …

Evaluation Of Clinician Prescribing Practices For Contraceptive Care: A Quality Improvement Collaboration, Julie Desrochers

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

Purpose: Primary care providers (PCPs) have the training and opportunity to provide contraceptive care. Unplanned pregnancy is a major public health issue for which up to 50% of the population is at overall lifetime risk. Reproductive life planning during healthcare visits can reduce rates of unintended pregnancy, prompting contraception or preconception planning. Studies suggest contraceptive counseling protocols and reproductive intent screening are effective tools. This project compares clinician behaviors with best practices. The purpose is to evaluate preventive reproductive healthcare practices in primary care, identifying opportunities to meet the contraceptive healthcare needs for people of reproductive age.

Methods: PCPs and …

Development Of Hospital-Wide Policy For Pediatric Needle Procedures At An Academic Medical Center, Katherine J. Rose

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

Purpose: Needle procedures are traumatic experiences for pediatric patients, and have been linked to formation of phobias and lifelong decreased healthcare utilization.^1,2 Pain management during needle procedures and hospital wide standardization of needle procedures are known to increase patient satisfaction, while decreasing long-term adverse outcomes related to seeking health care.^3,4 The purpose of this project was to develop a hospital-wide standardized policy for pediatric needle procedures at an academic medical center.

Methods: Those performing pediatric needle procedures were electronically surveyed to identify full spectrum issues regarding adoption of a pediatric needle policy. Based on survey findings …

Screening For Palliative Care Services In An Assisted Living Facility, Maria Delia Crosby

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

Background: Palliative care services remain under-utilized, even as evidence suggests that early palliative care leads to positive health outcomes, reduced ED visits, and substantial cost savings. Barriers include a lack of knowledge of palliative care services in the community, and under-utilization of validated assessment tools, including a symptom checklist. Aims of this project: 1. To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation.

Methods: A screening tool developed …

From Evidence To Practice: Promoting Continued And Exclusive Breastfeeding In Rural Eastern Uganda, Katherine Judge

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

Purpose: Malnutrition is responsible for about one third of deaths globally among children under age five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as uniquely effective in providing infants with nutrients for healthy growth and development. Ugandan demographic surveys (2016) indicate less than 43% of infants age 4-5 months are breastfed.

Methods: The objective was to equip Community Health Educators (CHEs) with evidence-based practice guidelines for promoting continued exclusive breastfeeding to postpartum women. This project was …

Easily Digestible: Addressing Food Literacy With Short Educational Videos, Kalle J. Fjeld

Family Medicine Clerkship Student Projects

Food literacy is the knowledge and skills needed to select and prepare food as well as determine food intake. These skills are necessary for a healthy diet, which is a major contributing factor to chronic disease prevention and management. People with diseases such as diabetes and cardiovascular disease can have great benefit from improving diet quality through increasing at-home food preparation and consumption of fruits and vegetables. In partnership with a Food Farmacy pilot program at Hudson Headwaters Health Network in Glens Falls, NY this project sought to use web-based food literacy education for a population of 40 patients with …

Promoting Physical Activity In School-Aged Children During The Covid-19 Pandemic, Abigail H. Belser

Family Medicine Clerkship Student Projects

Due to the COVID-19 pandemic, children and adolescents are engaging in less physical activity and are increasing their sedentary behavior. These changes can lead to long-lasting negative lifestyle behaviors, which increases risk of health complications.

To ensure safety during the pandemic, guidelines have created restrictions on physical education and sports, which are both primary physical activity outlets for children and adolescents. Children and adolescents have to find alternate ways and resources to meet the recommended 60 minutes of physical activity daily.

An informational pamphlet was created to educate parents and children of current physical activity recommendations, with resources and ideas …

Blood Pressure Management Education, Lauren G. Gernon, Cara Rathmell

Family Medicine Clerkship Student Projects

The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.

Addressing Barriers To Physical Activity In Vermont's Geriatric Population, Stephanie Udawatta

Family Medicine Clerkship Student Projects

A wide array of barriers exist which prevent many geriatric patients from engaging in regular physical activity. This project addresses the barriers unique to Vermont's population of geriatric patients and explores potential solutions.

Harm Reduction In The Emergency Department, Alexa J. Golden

Family Medicine Clerkship Student Projects

The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as …

Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer

Family Medicine Clerkship Student Projects

This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.

A Motivational Interviewing Approach Toward Mask Wearing In Franklin County, Vermont, Ashleigh N. Peterson

Family Medicine Clerkship Student Projects

COVID-19 has caused significant morbidity and mortality in Vermont and worldwide since the start of the pandemic. Wearing cloth face masks has been proven to limit viral spread, but few studies have quantified how many people are wearing masks or what their reasons are for doing so. This study aimed to assess and encourage mask use in Franklin County, Vermont by piloting an in-office motivational interviewing intervention at a primary care office.

Telemedicine Quality Improvement, Isidora R. Beach

Family Medicine Clerkship Student Projects

Telemedicine use has increased dramatically since the advent of the COVID-19 pandemic in the spring of 2020. However, not all patients and physicians were prepared for this rapid change, and little evaluation of these new mechanisms for delivery of healthcare has occurred thus far. This community project explores patient and physician perspectives on the use of telemedicine in place of in-person visits and makes recommendations for future improvements. Ultimately, telemedicine use will not likely diminish any time soon, making it increasingly important to triage patient visits to determine which would lend themselves well to the telemedicine format. As this project …

Onecare Vermont Aco Quality Metric Evaluation, Alexander Braun

Family Medicine Clerkship Student Projects

This project explores OneCare Vermont ACO quality metrics and how they can be used to improve patient care and reimbursement in a Vermont family medicine practice. Perspectives of physicians within the practice and others familiar with OneCare Vermont operations are shared. Several metrics were identified as areas for improvement within the practice by comparing ACO metrics with patient data.

Opportunities And Barriers To Implementing Tobacco 21 In Vermont, Audrea Bose, Cameron Burke, Jack Chen, Jenna Dafgek, Kathryn Kurchena, Alexander Miller, Catherine Pratt, Rebecca Ryan, David Kaminsky

Public Health Projects, 2008-present

Introduction

• Tobacco is the leading cause of preventable disease and death in the U.S. Demographics

• Approximately 90% of current smokers starting smoking before age 182

• Earlier age of tobacco use initiation associated with lower rates of smoking cessation

• The proposed Tobacco 21 bill (T21) would raise the minimum legal age of sales to 21, creating the opportunity to reduce tobacco use initiation

• Within five years of implementing the nation’s first T21 bill in 2005, the 30-day smoking rate in Needham, MA dropped from 13% to 7%

• Recently in Vermont, the age of gun sales …

Training: Key In Recognizing Potential Trafficking Victims In A Healthcare Setting, Alexis Dela Cruz, Jennifer Holland, Ibrahim Hussein, Dylan Koundakjian, David Viscido, Candice Wolf, Hannah Woodruff, Edith Kilmoski, Mariah Mcnamara

Public Health Projects, 2008-present

Background

• Human Trafficking (HT) is a crime that involves exploiting a person for labor, services, or commercial sex.

• HT can happen in any industry, to persons of any gender, age, economic status, religion, and nationality.

• In FY 2018, service agencies in the State of Vermont submitted over 180 reports of HT.

• HT has a profound negative impact on survivors’ physical and mental health.

• 25-88% of HT victims interact with a healthcare professional while they are being exploited.

• Providers have cited a lack of confidence and knowledge on HT as a major barrier to proper …

Impact Of Interactions Between First Responders And Opioid Drug Users, Rio Beardsley, Pirapon Chaidarun, Kalle Fjeld, Benjamin Grebber, Brian Muchmore, Ellen Seyller, Lauren Struck, Heng Tan, Peter Jacobsen, Jerry Larrabee

Public Health Projects, 2008-present

INTRODUCTION

In 2017, First Responders (EMS, Police, and Fire Department) in Vermont administered 848 doses of naloxone (Narcan®), an opioid antagonist that can block the effects of opioids in overdose. However, the rate of opioid-related fatalities has continued to rise from 74 in 2015 to 101 in 2017. Vermont CARES, a nonprofit organization, helps address this issue by working “for and with Vermonters affected by HIV/AIDS to promote well-being through a continuum of prevention, support, and advocacy services.” Their syringe service programs throughout the state provide access to clean needles, overdose prevention education, and naloxone.

AIMS

1. To better understand …

Assessing Food Insecurity Screening Among Healthcare Providers In Vermont, Menna Awadalla, Juan Conde Fabela, Annabelle Davey, Jack Dubuque, Jhaimy Fernandez, Ian Mcclain, Haewon Park, Connor Scagnelli, John Gorton, Shaden Eldakar-Hein

Public Health Projects, 2008-present

What influences primary care providers’ screening for food insecurity and recommending food resources?

This study examined the barriers primary care providers have to screening for food insecurity and recommending resources to their patients. By analyzing the factors that drive or prevent providers from making recommendations, we can help address food insecurity within the healthcare setting

• Food security is defined as having access to enough food in order to maintain an active and healthy life

• An estimated 1 in 8 Americans suffer from food insecurity, which is associated with adverse health outcomes and an increase of $77.5 billion in …

Converting Whole Blood Donors To Apheresis Donors, Collin Anderson, Racquel Decastro, Alexa Golden, Sidney Hilker, Flora Liu, Vincent Nocera, Seth Wolf, Jenny Lamping, Mark Fung

Public Health Projects, 2008-present

Donating blood is a noble act with real potential to save lives. Although millions of Americans donate blood each year, supplies of one blood component—platelets—is in chronically short supply. This is in part due to its significantly shorter shelf life (5-7d) vs. red blood cells (28-42d) or plasma cells (1yr). Platelet apheresis donation offers the opportunity to donate platelets more frequently and in higher quantities but accounts for only a small percentage of all donations. Our study aimed to better characterize perceived barriers in conversion to platelet apheresis donation.

Attitudes & Behaviors Surrounding Active Commuting In Chittenden County, Vt, Daniel Bak, Elizabeth Congdon, Doré Grier, Naira Goukasian, Max Silverstein, Georges Tahhan, Katrina Thornburgh, Rebecca Jones, Chester Areson, Dan Quinlan, Meredith Graves

Public Health Projects, 2008-present

Climate Change, Active Commuting, and Health

• Climate change contributes to 7 million deaths/year globally

• Negative health outcomes from increased carbon emissions include heat-related illness, mental health issues, and respiratory and allergic disease

• Active commuting reduces carbon emissions, promotes physical activity, and reduces chronic diseases such as hypertension, diabetes, and obesity

Active Commuting in Chittenden County

• Only 8.5% of Vermonters commute actively

• Burlington has been intensely promoting active commuting through developments in infrastructure and safety

• Most Burlington residents still commute by car

Project Goal

• Compare how active commuters and non-active commuters in Chittenden County …

Safe Driving Attitudes And Behaviors Among Vermont Student Drivers, Samantha Bissonette, Megan Garrido, Nicholas Haslett, Ashton Pike, William Prince, Davina Tolbert, Catherine Westbom, James Lockridge, Wendy Davis

Public Health Projects, 2008-present

Distracted driving contributes to approximately 10% of all driver fatalities and 17% of injuries in the US. Vehicle crashes are the leading cause of death for teens in the US. Drivers aged 16-19 are 3 times more likely to be involved in fatal crashes than those > 20 years. Increased teen risk is related to attachment to technology, limited driving experience, and an illusion of invincibility. Previous National Highway Traffic Safety Administration assessment of distracted driving attitudes and behaviors does not include significant data on teenage drivers. The goal of this project is to assess safe driving attitudes and behaviors among …

Effects Of Nostalgia Directed Music Therapy On Residents With Dementia In Nursing Home, Garrett Chan, Jack Fitzsimons, Sidika Kajtezovic, Kristen Keene, Marc Kostrubiak, Jessica Sikka, John Vandenberge, Shaden Eldakar-Hein, Cameron Segal

Public Health Projects, 2008-present

Background

• Studies support a beneficial relationship between music therapy and the management of dementia.

• Music therapy intended to activate memory may improve apathy and decrease cognitive decline in patients with mild to moderate dementia.

• Individuals are typically most influenced by music encountered during early adulthood.

Objective

To analyze the effect of nostalgia directed music therapy on the quality of life of nursing home residents with moderate to severe dementia.