Medicine and Health Sciences Commons^™

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 …

Food Security And Assistance Programs In Vermont Before And During Covid-19, Madeleine Burke, Ashley C. Mccarthy, Emily H. Belarmino, Farryl Bertmann, Meredith T. Niles

College of Agriculture and Life Sciences Faculty Publications

Here we surveyed a cohort of Vermonters at three time points over the first year of the pandemic. The surveys were conducted in March/ April 2020, June 2020, and March/April 2021. The demographics of the 441 Vermonters who responded to all three surveys are comparable to average Vermont demographics on income, but the respondents were more likely to have a college degree and to identify as female. This brief explores how the use of food assistance programs varied within this population and changed over the course of the pandemic. Key findings include: 1. The number of Vermonters using food assistance …

Opioid Overdose Deaths In Vermont: Effectiveness Of Buprenorphine Provider Density On Mortality Rates, Noah Chirico, Naw Ruth Doe, Alexandra Mesick, Amy Dubuque, Rachel Cruise, Jan K. Carney

Master of Public Health Culminating Projects

Background

Since 2017, there has been an increase in the frequency of mortality related to opioids in Vermont. Buprenorphine is a great alternative to traditional opioids because of its efficacy in treating opioid use disorder (OUD), however, it is underutilized by providers due to needing a specific waiver to prescribe it. This project looks at two different angles: is the number of Buprenorphine providers associated with the number opioid related deaths per county?; and does a rural setting in Vermont affect mortality rates due to a possible lack of Buprenorphine providers?

Methods

The incidence of overdose deaths per county to …

Food Insecurity In Vermont Households: An Analysis Of The Association With Tobacco Use, Alcohol Consumption And Physical Inactivity, Hannah R. Kaufman, Kyleigh Savoie, Emily Belanger, Kijonna Bowman, Darren Childs, Hendrika Maltby

Master of Public Health Culminating Projects

Objectives: To assess the relationship between chronic disease risk behaviors: tobacco usage, alcohol consumption, sedentary lifestyle, and food insecurity (FI) among Vermonters. Methods: This cross-sectional study uses a sample (n= 1,378) from Vermont’s 2018 Behavioral Risk Factor Surveillance System (BRFSS). The examined outcome is FI. The predictor measures were defined as at-risk tobacco use, alcohol consumption, and sedentary lifestyles.The following were established as covariates on the association between the dependent and independent variables: income, sex, age, race/ethnicity, and activity limitations. Results: In the unadjusted binomial logistic regression (Table 2), tobacco users were 3.32 times more likely to be food …

Age Well: Home Health Care Shortages In Northwestern Vt During The Covid-19 Pandemic, Jeremy Altman, Matthew Breseman, Edom Alemayehu Girma, Alexander M. Kubacki, Louisa Moore, Amanda Nattress, Noah Sorkow, Kristen Wright

Public Health Projects, 2008-present

As of February 2021, there have been over 26.6 million cases and over 450,000 deaths in the United States due to COVID-19. Since the outbreak, a critical focus in the healthcare system has shifted towards protection of healthcare providers as well as vulnerable patients such as the elderly. The growing shortages of providers has resulted in a growing need for home health care (HHC). Beyond HHC addressing this workforce gap, evidence has shown a reduction in emergency department (ED) visits, hospital admissions and a 14- million-dollar savings in healthcare cost. While the role of HHC has been crucial for the …

Assessment Of Snap Utilization And Accessibility In Vermont, Amanda Galenkamp, Mohamad K. Hamze, Elie Kaadi, Elise A. Prehoda, W. Evan Shaw, Nicole A. Walch, Shari J. Zaslow, Paula Tracy

Public Health Projects, 2008-present

Food insecurity exemplifies one of the many public health crises that the COVID19 pandemic both exposed and amplified. In 2019 an estimated 10.5% of households (13.7 million households) were food insecure as determined by the US Department of Agriculture (USDA) including 5.3 million children. In 2020 this number increased to 15.6% of households, including 17.0 million children as projected by Feeding America. Food insecurity in children, especially in infancy, is associated with the development of obesity and hyperlipidemia, highlighting the necessity of federal and state food assistance programs.

We believe that increased funding for SNAP incentive programs and wireless EBT …

Perceptions Of Mask Use During The Covid-19 Pandemic, David Bachoy, Clara Berard, Nicholas D. Brunette, Sadie M. Casale, Tonya Conley, Krystal Gopaul, Tyler Landman, Rhys Niedecker

Public Health Projects, 2008-present

The CDC recommends covering of the face and nose during the COVID-19 pandemic as a primary mitigation strategy for viral transmission. Masks minimize the number of viral particles emitted by the wearer; mask use serves to reduce the effects on population transmission.

Mask wearing behaviors have been shown to vary across different groups like gender identity, however, differences between people with and without lung disease have yet to be explored.

Goal: Examine perceptions, attitudes, and behaviors related to mask use during the COVID-19 pandemic of those with and without lung disease nationally.

Motivators For Convalescent Plasma Donors During The Covid-19 Pandemic, Betsy Assoumou, Natalie J. Bales, Amy K. Chang, Hannah K. Cook, Kiana Heredia, Colby J. Fischer

Public Health Projects, 2008-present

This study will seek to explore the motivators for convalescent plasma donors during the COVID-19 pandemic.

In 2020, the global pandemic caused by SARS-CoV-2 increased donations of transfusion products, particularly convalescent plasma from COVID-19 survivors that is used to provide passive antibody immunity to those infected. Convalescent plasma therapy has been identified as one of the only therapies for COVID-19 beyond supportive care.

Much of the current research focuses on the current motivators of whole blood and plasma donations, commonly citing altruistic motivations, knowing someone who has previously donated, and social media influence as common motivators for donations.

It is …

Health Benefits Are Associated With Employment Status For People With Intellectual Disabilities, Rachel Bombardier, Mialovena C. Exume, Jeremy Frank, Timothy W. Greenfield, Kaela Mohardt, Nathan Schweitzer, Devan Spence

Public Health Projects, 2008-present

Recent studies demonstrate that people with developmental disabilities are at increased risk for preventable illnesses. In our study, we examined several variables suspected to be major contributing factors, with emphasis on job security and employment. The development of sheltered workshops was initially an attempt to promote employment opportunities for people with intellectual and developmental disabilities (IDD), though at subminimum wages.

We explored whether these workshops allow for adequate community and healthcare engagement that is necessary for overall health and wellbeing. We designed a study that allowed us to statistically compare health-related data among states that eliminated sheltered workshops with those …

Assessing Cancer Prevention Knowledge During Covid-19 Pandemic, Robert Anthony Adamian, Lily Deng, Nicholas W. Krant, Trevor Ar Mcdonald, Natalie Qin, Ally Sarkis, Althea Jem Darbin Tapales

Public Health Projects, 2008-present

In response to the COVID-19 pandemic, adjustments in the provision of health care resources have caused a significant decrease in cancer screenings. These missed screenings may have considerable impacts on patients, health care practitioners and health systems.

In addition to the importance of resuming timely screening, studies have shown that a large portion of cancer deaths stemming from breast, skin, and colorectal cancer are preventable by risk factor modification at the patient level.

Many people remain uncertain of how best to prevent cancers, despite general awareness of concerns.

Raising awareness can empower patients to reduce their risk factors for developing …

No Fall Too Small: Assessing Barriers To Fall Prevention Programs, Christina Cobb, Arley Donovan, Heather G. Giguere, Arjune Singh Nibber, Brian L. Shaw Ii, Aathman Swaminathan, Ryan Warner

Public Health Projects, 2008-present

In Vermont, 1/3 of adults 45 years or older fell in the year 2018, statistically above the national average, which has not changed since 2012. Of those who fell, 34% experienced an injury after their fall.

Evidence-based interventions and fall prevention programs effectively reduce falls, and these programs aimed at reducing falls appear to reduce fractures. In fact, it has been shown that exercise intervention reduces fall risk by 30%.

Our review of the literature highlighted that there are numerous barriers to accessing fall prevention programs, including loss of independence, transportation, cost, and lack of interest. With this in mind, …

Initial Assessment Of A Suicide Prevention Resource For Vermont Primary Care, Sam Afshari, Eliot Binkerd-Dale, Zain Chaudry, Varun Gupta, Morgan Howlett, Colleen Mccarthy, Benjamin N. Price, Rebecca B. Rawlings

Public Health Projects, 2008-present

Suicide is the second leading cause of death for Vermonters ages 10-44. Studies have shown that of those who die from suicide 45% have seen their primary care provider in the month prior to their death and only 20% saw a mental health provider.

To help strengthen suicide risk screening in primary care, a group of Larner College of Medicine students partnered with Chittenden Accountable Community for Health to curate a suicide prevention informational resource to be used in Vermont's primary care practices to promote universal suicide screening.

We then surveyed users of the tool to assess its utility and …

Vermont School Districts Meal Service Response To Covid-19, Stephen Brand, Will D. Buick, John E. Fernan, Gina Jin, Rebecca Lapides, Jennifer Lor, Paul Mccleary, Timothy L. Long

Public Health Projects, 2008-present

The COVID-19 pandemic has posed many challenges worldwide, including lack of food access and security. Food insecurity in Vermont has increased from 18% to 24% since the outbreak of the pandemic.

Food insecurity among families with school-aged children puts children at risk for developmental delays, poor social functioning, and poor academic performance.

The goal of this project is to identify the challenges that the COVID-19 pandemic has posed for meal distribution services in school districts across Vermont, recognize the adaptations that were made by schools to address these challenges, and determine which adaptations had positive effects to encourage widespread implementation …

Bridging The Gap: Improving The Relationship Between Social Service Organizations And Healthcare Providers, Gabriela Bosmenier Cruz, Linda L. Cui, Liberty J. Dupuis, Ian Guertin, S. Halsey, Ying K. Loo, Finlay Pilcher, Joaquin Reategui

Public Health Projects, 2008-present

In Vermont, a significant social determinant of health is rurality. Barriers to healthcare services include distance to providers, lack of integration with social services, and failure to recognize community needs.

Integration and robust collaboration between healthcare and social services can likely improve outcomes for individuals who have high utilization of both categories of services.

Understanding relationships between healthcare and social services may provide an important framework for translating interventional research to rural communities to improve health equity.

Project Goal: To understand barriers affecting collaboration between social service providers and community health providers in order to promote research-based improvements in health …

Addressing The Needs Of Sara Holbrook Community Center Caregivers, Stephen J. Foley, Shubhankar Joshi, Ankrish Milne, Izabella Ostrowski, William Robinson, John A. Steinharter Ms, Rachel A. Wayne, Alayna M. Westcom

Public Health Projects, 2008-present

Previous research: parental stress can negatively impact behavioral and cognitive development of children.

Each year, over 4,000 people use SHCC resources: preschool, after school care, teen programs, food shelf, ESL services, etc.

SHCC supports families at the center itself, but many families still experience difficulties at home that contribute to caregiver stress.

The purpose of this study: understand the needs of the caregivers of students who attend SHCC and propose actionable solutions to address the top identified needs.

Attitudes Toward Informational Health Videos Among People With Intellectual Disabilities, Sydney M. Cardozo, Julie P. Connor, Jake Ermolovich, Tyler A. Harkness Bs, Anneliese Lapides, Jack F. Mangan, Nicole Obongo, Maxwell T. Tulimieri

Public Health Projects, 2008-present

An intellectual disability (ID) can be defined as a limit to a person's ability to learn and function in daily life when compared to an expected level. Due to these differences, a person with ID can face more challenges in daily life, including those that impact their health.

Special Olympics Vermont (SOVT) is an organization that hosts athletic events and competitions for people with an ID. We worked with them to formulate a plan for providing educational resources for people with an ID.

We created educational videos with corresponding one-page pamphlets containing material and imagery that was relatable to the …

Naturopathic Medicine In Vermont's Healthcare System: A Thematic Analysis, Trevor D. Coles, Tayler Drake, Rose Eiduson, Daniel J. Fried, Max C. Hoddwells, Simran Kalsi M.S., Mahima R. Poreddy, Clifford A. Reilly

Public Health Projects, 2008-present

Naturopathic Medicine is a system of health care that utilizes education, natural medicines, and natural therapies to support and stimulate a patient's intrinsic self-healing processes and prevents, diagnoses, and treats human health conditions, injuries, and pain.

There are 5 accredited schools of naturopathic medicine in the US and 2 in Canada. Naturopathic physicians were recognized as primary care providers (PCP) in 2009. There are 355 NDs licensed in VT, and 88 NDs with a VT address. 81% participate in Medicaid.

OBJECTIVE: To explore the role of naturopathic physicians in Vermont's healthcare system

Analyzing The Outcomes Of A Comprehensive Pain Management Program, Alia Johnson, Joshua Kohan, Cole Lutz, Patrick Mcclurg, Grace Merritt, Warrick Sahene, Katie Tang

Public Health Projects, 2008-present

An integrative and comprehensive approach to pain management seeks to advance patient outcomes with respect to quality of life, pain management, mindfulness, and physical function. This biopsychosocial approach is an evidence-based medicine modality that has been executed to be cost-effective and targeted to meet individual patient values. Participants can enroll in integrative pain intervention modalities to treat their chronic ailments; examples include Acceptance and Commitment Therapy, PT, OT, nutrition, reiki, hypnosis and yoga. In a systematic evaluation of integrative health projects, Turk et al. concluded interdisciplinary programs yielded better outcomes than traditional pain treatments.

This project tested the hypothesis that …

Improving The Accessibility And Efficacy Of The Uvmmc Chna To Populations Experiencing Homelessness, Rachel Carpenter, Jamie A. Cyr, William Kim, Megala Loganathan, Weida Ma, Dinukie-Chantal Perera, Sean Taylor, William J. Yakubik Iii

Public Health Projects, 2008-present

Under provisions in the Affordable Care Act, tax-exempt hospitals are required to conduct a triennial Community Health Needs Assessment (CHNA) to identify and prioritize the health needs of the community served. UVMMC is preparing to conduct the 2022 CHNA and is exploring best outreach approaches to marginalized or historically underrepresented populations within Chittenden and Grand Isle counties.

Research Question: What actions can be taken to effectively understand the diversity of needs in the homeless population of Chittenden County?

Hypothesis: The current CHNA incompletely captures how health barriers are disproportionately experienced by the homeless population in Chittenden County.

Goals: Identify best …

Addressing Food Insecurity Within New American Communities In Vermont, Lorena Ayoub, Carl W. Brasch, Aria Elahi, Justin L. Esteban, Juwairiyyah Fatima, Brianna J. Spano, Sean Wang, Erik J. Zhang

Public Health Projects, 2008-present

Food insecurity is defined as not having safe, nutritious, or culturally appropriate foods available, or having limited ability to acquire these foods/uncertainty as to when one can acquire these foods.

Reasons for food insecurity can be multifactorial such as language barriers, unfamiliar foods, and limited information about food environments.As a result, many turn to processed and energy- dense foods, contributing to the development of chronic diseases.

Food banks and local food shelves provide supplemental food assistance to residents and communities in need. However, with diverse New American populations living within the same community, it is challenging to determine which foods …

Emergency Medicine Super Utilizers And The Role Of Targeted Community Paramedicine, Nathan E. Dow

Family Medicine Clerkship Student Projects

Frequent emergency department (ED) users, colloquially known as “frequent fliers,” are a small population that account for a disproportionately large number of ED visits. Depending on the criteria used, ED super users may constitute as little as 1% of the individuals seen through the department, while accounting for up to 60% of the visit volume. There is an associated stress on the 911 system and a public health concern with burdening of already busy emergency departments. Unsurprisingly, ED super users have an associated financial cost. A 2015 Milwaukee area pilot program provided community outreach to only 39 of their well-known …

Food Security In The Covid-19 Era, Dana I. Allison, Alex Cohen, Elena Dansky, Willie Dong, Helen Gandler, Luke Hallgarth, Sarah Kendrick, A Carmola, M Bridges, Tv Delaney Phd, Jk Carney Md

Public Health Projects, 2008-present

Food insecurity is a national issue, one that affected 10.5% of households during some point of the year 2019. Those affected by food insecurity can have their access to food jeopardized due to financial hardship, eating patterns altered to prolong the food available, or various other adjustments including reliance on low-cost food, skipping meals, etc.

The state of Vermont is not immune to food insecurity, with a rate of 11.3% of households in 2018.

The Covid-19 pandemic created an unprecedented shift in daily life, with households having to rapidly adapt to meet newly imposed governmental regulations, including stay at home …

A National Dementia Care Pathway Explored, Mary Val Palumbo, Betty Rambur, Lori P. Mckenna

College of Nursing and Health Sciences Faculty Publications

Background: A national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). The 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to understand this systematic, primary care-led, home- and community-focused dementia management approach from the perspective of those delivering care. Providers in one US state were similarly studied.

Method: Maximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, …

What’S Going On With E-Cigarette Use In Vermont High Schools?, Fay Abdullah, Elizabeth Baumgartner, Delaney Curran, Noorin Damji, Madeline Fritz, Catherine Gereg, Ray Mak, Shayan Mcgee, Alex Crimmin, David Kaminsky

Public Health Projects, 2008-present

The use of electronic cigarettes (e cigarettes) has become popular practice among teenagers in the United States. E cigarettes have been marketed as a “healthier” alternative to traditional cigarettes and include several flavor options to make them more appealing to teenagers. However, studies have shown that e cigarettes are still harmful, leading to addiction, nausea, vomiting, headache, and upper airway irritation. Most recently, the outbreak of severe lung illnesses is believed to be related to e cigarette use; the CDC and FDA are investigating the cause of this outbreak.

Social Determinants Of Health Among Blood Donors, Amelia Anderson, Lauren Bougioukas, Alexander Braun, Adam Morehead, Collins Oguejiofor, Christina Sanchez-Grew, Rachel Tobin, Jenny Lamping, Mark Fung

Public Health Projects, 2008-present

Understanding the influences of social determinants of health (SDOH) on blood donation may help define the relationship between health in a community and rates of blood donation. While much is known about the demographics of blood donors in the United States, their SDOH have not yet been studied. Research examining SDOH outside the United States has found that many factors influence the likelihood of blood donations. These factors include education, income, health insurance, health status, and marital status. The aim of this study is to examine U.S. blood donors’ SDOH such as emotional support, stress levels, physical safety and access …

Primary Care Perceptions: Health Services For Vermonters With Intellectual Disabilities, Magalie Carey, Gia Eapen, Adam Fakhri, Taylor Marquis, Cara Rathmell, Claudia Russell, Nicole Wershoven, Elizabeth Cote, Mike Reilly, Stephen Everse

Public Health Projects, 2008-present

Champlain Community Services (CCS) provides developmental services and health care to Vermonters with intellectual disabilities (100 individuals in 2019), offering coordinated one-to-one support at work, home, school, and in the community. The goals of this study were to learn which services local primary care practitioners believe to be most beneficial to patients with intellectual disabilities (ID), to identify barriers to developmental services, and to gauge practitioners’ familiarity with CCS.

Addressing Vermont Childhood Obesity Through Public Policy: Scoring Vermont Supervisory Union Wellness Policies Using The Wellsat Assessment Tool, Olivia Cooper, Rachel Harrison, Jugerta Istrefi, Colby Mcginn, Micheal Mikheal, John O'Keefe, Pj Tran, Tina Zuk, Paula Tracy

Public Health Projects, 2008-present

As of 2016 the state of Vermont has required all public school supervisory unions to have a wellness policy guiding nutritional and physical education, nutritional quality of food served and sold, and the implementation and modification of the policy in the future. We hypothesize that differences between these policies throughout the state of Vermont will lead to changes in health outcomes for the students that they impact.

Trends In Buprenorphine Use And Barriers To Medication-Assisted Recovery, Isi Beach, Richard Brach, Carolyn Geraci, Kyle Leonard, Rose Martin, Nikkole Turgeon, Faith Wilson, Kayla Donohue, Mariah Mcnamara

Public Health Projects, 2008-present

Since the initiation of the "Hub and Spoke Model" in 2014, VT has been able to eliminate the waitlist for receiving Medication-Assisted Recovery (MAR) and has increased the number of MAR providers. However, many people still report using non-prescribed “street” MAR prior to entering treatment to avoid withdrawal from opiates. Our study aims to assess current trends and barriers to access in buprenorphine use.

Assessing Burnout In Early Childhood Educators, Megan Boyer, Sarah Clark, Emma Hall, Malla Keefe, Elena Martel, Michael Tabet, Mohammad Wali, Sarah Adams-Kollitz, Molly Moore

Public Health Projects, 2008-present

The stress of working as an early childhood educator can manifest as increased job turnover and burnout, leading to reduced teaching efficacy. Resilience training can increase wellbeing and decrease stress. This study assessed burnout, resilience, and organizational constraints at Burlington Children’s Space (BCS), a childcare education non-profit.

Assessing The Feasibility Of A Peer Developed Risk Reduction Plan In A Rural Middle School, Sara Brennan, Christian Brooks, Patrick Clarke, Isaac De La Bruere, Nicole Delgado, Alexandra Kuzma, Emma Levine, Joanna Jerose, Leigh Ann Holterman

Public Health Projects, 2008-present

Sheldon Middle School (SMS) reported above-average suicidal ideation and risky behavior (e.g., sexual activity, alcohol use) on the 2017 Youth Risk Behavior Survey, compared to state levels. Current literature highlights programs designed to reduce risky youth behavior. Little research exists on the feasibility of designing and implementing peer-created, peer-driven intervention programs. There is a gap around parent and faculty opinions surrounding the feasibility of these programs. We investigated the feasibility of partnering with students to design an empirically-based program that addresses some root causes of risky behaviors, then measured parent and faculty attitudes.