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University of Southern Maine

2019

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Full-Text Articles in Medicine and Health Sciences

Downeast Maine Mat Expansion Project: Year 1 Data Summary, Mary Lindsey Smith Phd, Olivia Dooley Mpa, Evelyn Ali Bs Dec 2019

Downeast Maine Mat Expansion Project: Year 1 Data Summary, Mary Lindsey Smith Phd, Olivia Dooley Mpa, Evelyn Ali Bs

Substance Use Research & Evaluation

This report summarizes the Year 1 activities of the Healthy Acadia Downeast Maine MAT Expansion Project. Through a collaborative effort of Healthy Acadia, its providers, the Downeast Substance Treatment Network and Downeast Substance Use Response Coalition, the project utilized multiple evidence-based strategies to combat opioid use disorder (OUD) in Downeast Maine.

Key findings focused on:

  • capacity building,
  • stakeholder engagement,
  • organizational and peer support,
  • payment and reimbursement issues,
  • the creation of low-barrier access to MAT,
  • barriers, including stigma, to MAT
  • patient-centered approaches
  • auxiliary recovery supports

For more information, please contact M. LIndsey Smith, PhD at m.lindsey.smith@maine.edu


Rural Health Clinic Costs And Medicare Reimbursement, John A. Gale Ms, Zachariah T. Croll Mph, Andrew F. Coburn Phd Nov 2019

Rural Health Clinic Costs And Medicare Reimbursement, John A. Gale Ms, Zachariah T. Croll Mph, Andrew F. Coburn Phd

Rural Health Clinics

The Rural Health Clinic (RHC) Program is one of the nation’s oldest rural primary care programs. A key feature of the RHC Program is Medicare and Medicaid volume-appropriate, cost-based reimbursement, which is designed to sustain these vulnerable rural primary care providers. Medicare currently pays RHCs for the lesser of reasonable costs (expressed as an adjusted cost per visit) for a defined package of RHC services or a per-visit reimbursement cap, from which provider-based RHCs owned by hospitals with fewer than 50 beds are exempt. Although the per-visit cap is updated periodically, RHC administrators, policymakers, and stakeholders question whether the updates …


Sociodemographic And Health Status Characteristics Of Maine's Newly Eligible Medicaid Beneficiaries [Data Brief], Zachariah T. Croll Mph, Erika C. Ziller Phd, Barbara Leonard Mph Sep 2019

Sociodemographic And Health Status Characteristics Of Maine's Newly Eligible Medicaid Beneficiaries [Data Brief], Zachariah T. Croll Mph, Erika C. Ziller Phd, Barbara Leonard Mph

Medicaid

This data brief identifies key characteristics of groups who will gain access through MaineCare expansion. Researchers Croll and Ziller at the University of Southern Maine, along with Leonardson of the Maine Health Access Foundation present a statistical analysis of uninsured non-elderly adults age 18 – 64 with no children and lower incomes, the population newly eligible for MaineCare through expansion. Drawing from five years of data from Maine’s Behavioral Risk Factor Surveillance System, the report addresses sociodemographic characteristics, health status, and access to care. The survey indicates that those who are likely eligible for expanded MaineCare coverage are twice as …


The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd May 2019

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.


Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn Apr 2019

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

Access / Insurance

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …


Substance Use Prevention: Communication And Strategies To Reduce Alcohol, Marijuana, And E-Cigarette Use Among College Students, Emily Bauer Apr 2019

Substance Use Prevention: Communication And Strategies To Reduce Alcohol, Marijuana, And E-Cigarette Use Among College Students, Emily Bauer

Muskie School Capstones and Dissertations

Substance use among college students impacts universities, communities and student outcomes across the United States. Based on the Monitoring the Future study (MTF), college students have a higher prevalence of past 30-day alcohol use at 63% than their non-college peers (59%) (2016). Nearly one-third of college students (32%) have had five or more drinks in a row in the past two weeks (2016). Monthly marijuana use for college students has remained steady at 22% (2016). Electronic cigarette (e-cigarette) use is 6.9%, which is gaining in popularity but still lower than traditional cigarettes (8.9%) (2016). There are many prevention communication strategies …


For Our Health: Partnerships In Maine, Joanna Morrissey Apr 2019

For Our Health: Partnerships In Maine, Joanna Morrissey

Muskie School Capstones and Dissertations

The Maine Shared Community Health Needs Assessment (Maine Shared CHNA) has created a mature network of local collaborations that come together every three years to conduct a statewide needs assessment. This capstone looks into whether there have been successful partnerships that continue collaborating on health improvement planning and implementation post CHNA. Key questions included, “Where there were successful collaborations, what was it that made them successful? What are the challenges to forming and maintaining a collaboration and how have groups overcome those challenges?” A comparative case study approach was used in order to compare and contrast two sites, each demonstrating …


Recommendations For Creating A Certification System For Community Health Workers In Maine, Lyvia Gaewsky Apr 2019

Recommendations For Creating A Certification System For Community Health Workers In Maine, Lyvia Gaewsky

Muskie School Capstones and Dissertations

Executive Summary

The following report was developed to inform the Maine Community Health Worker Initiative (MECHWI) on the processes used by five other states to create a Community Health Worker (CHW) certification system. An assessment of the current situation in Maine as it pertains to certification development was also conducted and a set of recommendations to guide the MECWHI in furthering CHW certification efforts is provided. In summary, the processes used to develop a CHW certification system in Massachusetts, Oregon, Texas, Rhode Island and Indiana tended to involve the following activities: outreach to CHWs and CHW employers, engagement of key …


A Comparative Analysis Of Primary Care Practice Payment Models: Practice And System Level Implications, Travis Masood Apr 2019

A Comparative Analysis Of Primary Care Practice Payment Models: Practice And System Level Implications, Travis Masood

Muskie School Capstones and Dissertations

EXECUTIVE SUMMARY

The purpose of this capstone was to (1) assess the likely effects of various primary care practice reimbursement models on quality of care and costs, (2) assess each reimbursement model’s applicability relative to practice size, and (3) analyze each model’s practice and system level implications. This was done through the conduction of a comparative analysis of current practice reimbursement models. The questions addressed in this analysis include:

  • What are the primary, practice reimbursement models currently being used?
  • What are the implications of these models on quality and costs?
  • Are these reimbursement models applicable in all practice types (e.g. …


Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka Apr 2019

Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka

Muskie School Capstones and Dissertations

The Centers for Disease and Control (CDC) describes opioid use disorder (OUD) also known as opioid addiction as the problematic pattern of opioid use leading to clinically significant impairment or distress. In 2016, about 2.1 million people were diagnosed of OUD in the US. In Maine, York County has the third highest drug overdose response and had 166 deaths occurring between 2012-2016. York County is a designated medically underserved area and has a shortage of provider workforce and limited treatment infrastructure. To further understand the challenges providers in York County encounter in managing patients with OUD, 6 focus groups was …


Measuring Birth Trauma Rates In Maine Using Public Data, Mike Lapika Apr 2019

Measuring Birth Trauma Rates In Maine Using Public Data, Mike Lapika

Thinking Matters Symposium Archive

An increasing number of states are creating databases that collect and organize health insurance claims from public and private health care payers. Since December 2016, at least 18 states have these “all-payer claims databases” (APCDs), including Maine. APCDs are intended to inform cost containment and quality improvement by increasing transparency and informing consumer choice. For this project, we assessed how Maine’s APCD data might be used to produce standardized quality measures across facilities in the state. Specifically, we tested a birth outcome quality measure developed by the Agency for Healthcare Research and Quality (AHRQ), Birth Trauma – Injury to Neonate …


Improving Safety On The Road Through Occupational Therapy Intervention, Katherine Uschmann, Zachary Childs Apr 2019

Improving Safety On The Road Through Occupational Therapy Intervention, Katherine Uschmann, Zachary Childs

Thinking Matters Symposium Archive

As the U.S. population ages, increasing the likelihood of impaired fitness-to-drive, the topic of road safety holds strong interest among numerous professionals. The field of occupational therapy (OT) affirms the importance of community mobility in supporting overall health and well-being. OT practitioners who encounter clients with questionable driving ability should refer them to driving specialists. However, the question remains what kind of interventions may help clients with cognitive decline who have the potential to return to safe driving. This project’s evidence search revealed a wide range of interventions that show promise including: classroom education (especially when augmented by on-road training), …


Interrupted Progress: Water And Sanitation In Haiti, Emily Bauer Apr 2019

Interrupted Progress: Water And Sanitation In Haiti, Emily Bauer

Thinking Matters Symposium Archive

Haiti has faced damaging environmental and social impacts, which have interrupted progress towards clean drinking water and adequate sanitation facilities for its over 10 million people. Natural disasters, disease outbreak, political corruption and economic instability have contributed to poor health and social outcomes for the small, island nation. This study used the most recent data from the World Health Organization and United Nations Children’s Fund Joint Monitoring Programme (WHO/UNICEF JMP) to assess national trends in water source and sanitation facility improvements from 1990-2015. WHO/UNICEF JMP defines water improvements as piped or non-piped protected water, and sanitation improvements as networked, flushed …


What Gun Safety And Access Policies Did Participants Think Would Be Effective In Preventing Accidental Gun Deaths?, Bridget O’Keefe, Stephen White Apr 2019

What Gun Safety And Access Policies Did Participants Think Would Be Effective In Preventing Accidental Gun Deaths?, Bridget O’Keefe, Stephen White

Thinking Matters Symposium Archive

Firearm-related incidents are often highly publicized tragedies that fuel unproductive political debates on gun policies at the local, state, and national levels. Current best practices in safe gun storage suggest that caregivers can protect their children from injury or death from an accidental gun discharge by keeping guns unloaded, locked up, and stored separately from their ammunition (Crifasi, Doucette, McGinty, Webster, & Barry, 2018). Child access prevention mechanisms including trigger locks, lock boxes, gun safes, and safe storage legislation are encouraged by the American Academy of Pediatrics (Dowd & Sege, 2012). This study gathers quantitative responses from 1,021 participants using …


Expanding International Health Curriculum For The Internal Medicine Residency At Mmc, Brian King, Hassan Mahmoud, Anthony Pastore Apr 2019

Expanding International Health Curriculum For The Internal Medicine Residency At Mmc, Brian King, Hassan Mahmoud, Anthony Pastore

Thinking Matters Symposium Archive

While internal medicine residents at Maine Medical Center provide care for many refugees and immigrants, there is not a formal international health curriculum to equip residents to care for this vulnerable population. Since 2002, 3,793 refugees have arrived in Maine for resettlement. Our aim was to survey residents about their interest in added international health instruction and design an educational curriculum for these physicians.


The Role Of Motivation And Cognition In Adults With Schizophrenia, Jaime Willard, Evangeline Abraham Apr 2019

The Role Of Motivation And Cognition In Adults With Schizophrenia, Jaime Willard, Evangeline Abraham

Thinking Matters Symposium Archive

Our work is based around the holistic nature of the field of occupational therapy. This evidence-based project initially began, at the request of our community partner, with the intention of finding one or more assessments that may help identify the cause of a lack of motivation among group home residents at Tri County Mental Health in Lewiston, ME who suffer from schizophrenia. Schizophrenia is a chronic and severe mental illness that is now diagnosed as a spectrum disorder. It is characterized by distortions in the perception of reality and impairments in cognition and motivation. Schizophrenia can be categorized into three …


Opioid Use Disorder At Delivery Hospitalization In Maine: Prevalence And Characteristics (2009-2017), Sarah Gabrielson Apr 2019

Opioid Use Disorder At Delivery Hospitalization In Maine: Prevalence And Characteristics (2009-2017), Sarah Gabrielson

Thinking Matters Symposium Archive

A recent multi-state analysis found Maine had the second highest average annual increase in opioid use disorder (OUD) at delivery hospitalization, with 34.1 OUD per 1,000 delivery hospitalizations in 2012. The objective of this analysis is to describe the prevalence and characteristics of OUD deliveries in Maine using recent data. We used International Statistical Classification of Diseases and Related Health Problems diagnosis and procedure codes (9th & 10th revisions) to identify deliveries among all hospital discharges in Maine, 2009-2017 (n=109,004), and to categorize deliveries according to prevalence of OUD and selected medical conditions. We ran log-binomial regression to assess trends …


Male Determining Gene Nix May Bring An End To Transmission Of Diseases Through Mosquitoes, Mohammed Mahdi Apr 2019

Male Determining Gene Nix May Bring An End To Transmission Of Diseases Through Mosquitoes, Mohammed Mahdi

Thinking Matters Symposium Archive

Female mosquitoes take blood from humans to gain protein needed to produce eggs, and in the process they can transmit viruses, such as Zika, Dengue, and chikungunya, or parasites, such as malaria. Male mosquitoes do not transmit diseases. This literature review will examine what is known about how sex is determined in mosquitoes and how this can be used to manipulate the females that spread diseases to humans. Using CRISPR Cas9, the lab of Zhijian Tu removed the Nix gene from mosquito embryos; all of these were feminized. Ectopic overexpression of Nix gene product in mosquito embryos caused even genetically …


Opioid Use Treatment Via Telemedicine: Treatment Options For Rural Maine, Benjamin Knapp Apr 2019

Opioid Use Treatment Via Telemedicine: Treatment Options For Rural Maine, Benjamin Knapp

Thinking Matters Symposium Archive

The ongoing opioid crisis has overwhelmed the traditional opioid use disorder (OUD) treatment resources across America. The treatment resources in rural communities have been especially hard hit as geographic and financial barriers limit service capacity. Telemedicine, or medicine delivered via remote means, has been proposed as a potential solution to the lack of conventional opioid treatment resources in rural Maine. Current legalities in the US prohibit telemedicine being used to prescribe opioid agonist drugs, and insurance reimbursement for telemedicine remains a major barrier. This qualitative content analysis looks at the existing research on telemedicine's treatment efficacy for use with OUD …


Evidence And Interventions For Children With Handwriting Deficits, Josephine Hatch Apr 2019

Evidence And Interventions For Children With Handwriting Deficits, Josephine Hatch

Thinking Matters Symposium Archive

The purpose of this project was to determine effective interventions shown to increase fine motor skills in children who experience handwriting deficits related to ADD/ADHD or other attention deficits. The project was prepared for a pediatric outpatient OT at Hasbro Children’s Hospital. The information was found via the USM databases through specific search terms and parameters.
This work is significant because many OTs and teachers are working with children who have deficits in handwriting and fine motor abilities. There needs to be additional research conducted specifically with children who have ADD/ADHD and exhibit fine motor and handwriting deficits.
The research …


The Experience Of Social Workers Who Utilize Therapy Dogs In Practice, Kathryn Jochems Apr 2019

The Experience Of Social Workers Who Utilize Therapy Dogs In Practice, Kathryn Jochems

Thinking Matters Symposium Archive

Animal assisted therapy, which incorporates animals into structured therapeutic interventions, and its use within social work has been shown to increase social interactions, communication, and the overall health and safety of clients (Nimer & Lundahl, 2007). However, there is a gap in the literature regarding the professional and personal experiences of individual social workers with incorporating certified therapy dogs into their practice. This study examined the approval process, perceived effects on practice, perceived effects outside of practice, and future implications of using therapy dogs in social work through the analysis of qualitative data from seven in-depth interviews with licensed social …


Professional Impressions And Experiences Of The Complex Needs Of Human Trafficking Survivors, Jackie Klock, Kelsey Haynes Apr 2019

Professional Impressions And Experiences Of The Complex Needs Of Human Trafficking Survivors, Jackie Klock, Kelsey Haynes

Thinking Matters Symposium Archive

Abstract Human trafficking is a monumental and pervasive human rights issue, and one that carries immense physical, psychological, and psychosocial repercussions to its survivors. This project explores the complex needs and service gaps that exist for survivors of human trafficking. Through a qualitative study, with six in-person interviews of professional providers in Maine, we gain access to important information regarding complex needs of human trafficking survivors. Using thematic analysis we analyze common themes throughout the interviews in relation to previous literature. Recommendations for practice are also presented.


Experiences Of Veterans With Ptsd And Sud In An Outpatient Setting, Andrew Breault, Hannah Shifflett-Kohler Apr 2019

Experiences Of Veterans With Ptsd And Sud In An Outpatient Setting, Andrew Breault, Hannah Shifflett-Kohler

Thinking Matters Symposium Archive

In 2014, there were approximately 7.9 million adults in the United States with co-occurring Post Traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUD) (SAMHSA, 2014). Of the veterans who served in the conflicts in Iraq and Afghanistan alone, 30% of those in SUD treatment also meet the criteria for PTSD (Seal et al, 2008, pp. 476). Furthermore, statistics show that about 20 Veterans in the United States complete suicide daily (Spiva, 2019, p. 8). The Department of Veterans Affairs is urgently seeking successful approaches to addressing the high incidence of suicides among all veterans along with the low retention …


Cyberbullying And Suicide Among Lgbtq Youth: Is There A Connection?, Holly Wright, Victoria Wilson Townley Apr 2019

Cyberbullying And Suicide Among Lgbtq Youth: Is There A Connection?, Holly Wright, Victoria Wilson Townley

Thinking Matters Symposium Archive

The suicide rate among children and teens has been rising over the last decade, and members of the LGBTQ youth population are at considerably greater risk for suicide than their heterosexual peers. LGBTQ youth are also at heightened risk of being bullied due to sexual orientation. Recent technological advancements have created a new platform for bullying, that of cyberbullying, which can contribute to feelings of depression and low self-esteem. The detrimental impact that cyberbullying can have on mental health suggests the possibility of a potential connection between cyberbullying and LGBTQ youth suicide. This qualitative study examines the possible link between …


Fake Service Dogs: Leading By Example, Joshua Ferguson Apr 2019

Fake Service Dogs: Leading By Example, Joshua Ferguson

Thinking Matters Symposium Archive

This qualitative research examines public awareness pertaining to the protocols surrounding service dogs and their handlers, known collectively as the service team. The use of service dogs has been on the increase as more people discover the benefits provided by service dogs. The increase in the number of service dogs fosters questions about safety, training, the dog’s purpose, and its legitimacy. Previous studies suggest that many individuals are falsely claiming their dogs as service dogs or “fake service dogs.” This research explores what trends are leading to increases in service dog use and how fake service dogs affect people involved. …


Lgbt+ Teens, Social Media Use & Depressive Symptoms, Megan Curtis, Danielle Ryder Apr 2019

Lgbt+ Teens, Social Media Use & Depressive Symptoms, Megan Curtis, Danielle Ryder

Thinking Matters Symposium Archive

Sexual and gender minority youth are statistically more likely to face severe mental health challenges than their cisgender, heterosexual peers; they consistently comprise a disproportionate percentage of youth who report experiencing depression, suicide ideation and attempted suicide in the United States every year (e.g. Abreu & Kinney, 2018). The aim of this study was to fill a gap in the current literature base by investigating the effects of social media use on sexual and gender minority youth mental health. The researchers conducted an online anonymous questionnaire targeted toward American LGBT+ (Lesbian, Gay, Bisexual, Transgender, etc.) youth ages 14 to 18, …


Convolutional Neural Networks For Protein Image Classification, Nick Littlefield Apr 2019

Convolutional Neural Networks For Protein Image Classification, Nick Littlefield

Thinking Matters Symposium Archive

A solution to the Kaggle competition: Human Protein Atlas Image Classification. Using microscopic images of cells provided by the Human Protein Atlas, convolutional neural networks, CNNs, were used to analyze and predict the location of protein patterns. Challenges included working with an unbalanced dataset, finding a correct learning rate, and choosing a correct architecture to solve the problem. To learn how to overcome these challenges and gain more understanding of the problem, various kernels and discussion posts for the competition, as well as papers on different CNN architectures were used.


A Thematic Analysis Of Adults’ Reflection On Childhood Experiences Being Parented By An Adult With Mental Health Issues, Jennifer Luja, Meg O'Malley Apr 2019

A Thematic Analysis Of Adults’ Reflection On Childhood Experiences Being Parented By An Adult With Mental Health Issues, Jennifer Luja, Meg O'Malley

Thinking Matters Symposium Archive

Children are impacted by their relationships with caregivers. The objective of this research was to develop awareness of the impact on children being cared for by caregivers with mental health issues by examining the experiences of individuals who had a caregiver with severe and persistent mental health issues during childhood. Researchers also gained insight on how social workers can be more supportive to children in these circumstances. The researchers conducted interviews with five participants, the recordings of which were then transcribed and coded to identify themes. Prevalent themes include critiques of available services, resiliency and challenges of family members as …


Benefits Of Onsite Health Programs In The Corporate Setting, Nathan Cook Apr 2019

Benefits Of Onsite Health Programs In The Corporate Setting, Nathan Cook

Thinking Matters Symposium Archive

Worksite health care clinics and corporate wellness programs are becoming a staple of companies at all levels. Companies are finding that having onsite healthcare clinics as well as comprehensive wellness programs are not only good incentives for employees but actually able to save large amounts of money with injury prevention, decrease in lost productivity and a number of other factors. A 2010 meta- analysis looking at the Return-Of Investment (ROI) found that there was an average of $3.27 per dollar spent on wellness initiatives ROI. Yearly savings can be upwards of $225,000 in some cases as the Sygenta Crop Production …


Accuracy Of Self-Collected Vaginal Swabs In The Diagnosis Of Bacterial Vaginosis, Vaginal Candidiasis, And Trichomoniasis, Anna Chase Apr 2019

Accuracy Of Self-Collected Vaginal Swabs In The Diagnosis Of Bacterial Vaginosis, Vaginal Candidiasis, And Trichomoniasis, Anna Chase

Thinking Matters Symposium Archive

Vaginitis is the most common gynecological problem seen in primary care. It is estimated to account for 10 million primary care visits each year. The most common causes of vaginitis - responsible for up to 90% of cases - are bacterial vaginosis (BV), vaginal candidiasis (“yeast infections”), and trichomoniasis. The purpose of this evidence-based project was to evaluate whether self-collected vaginal swabs are as accurate as those collected by a provider during a speculum exam in the diagnosis of BV, yeast infections, and trichomoniasis.

In order to appropriately diagnose and treat vaginitis, samples from a vaginal swab are often required. …