Medicine and Health Sciences Commons^™

Slow Foods For Health Increasing Knowledge Of Glycemic Index In Adolescents For Healthier Food Choices, Meredith Kayleigh Sooy

Family Medicine Clerkship Student Projects

Obesity has reached epidemic proportions through the United States affect all age groups, genders, and races. This is especially troubling in the pediatric population where 12.5 million children were found to be overweight in 2010. Many adolescents have inadequate knowledge of nutrition basics to make healthy choices. Based on interviews within the community of Colchester, VT a need for information about the glycemic index was seen. A handout geared towards adolescents was created with information about the glycemic index and using this information to make healthy food choices. This handout was made available to all providers of Colchester Family Practice …

Increasing The Use Of Dementia Screening In The Primary Care Setting, Syed S. Shehab

Family Medicine Clerkship Student Projects

More than 5 million people have Alzheimer’s disease today and 450,000 people in the US die of Alzheimer’s every year. By 2050 the number of people living with Alzheimer’s could triple. 40% of patients living with Alzheimer's disease are undiagnosed. Early detection promotes better dementia care, lowers costs of care, and increases quality of life

Hpv Education And Prevention Amongst Danbury High School Students, Elizabeth Cochrane

Family Medicine Clerkship Student Projects

Human Papillomavirus (HPV) is currently the most prevalent sexually transmitted infection in the United States with an estimated 79 million people infected. In the state of Connecticut, HPV vaccination is not required for entrance into the 9th grade and because of this, there is less awareness of the importance of HPV prevention and immunization among high school students. As of 2013, 37.7-49.9% of females ages 13-17 living in Connecticut completed the HPV vaccine regimen. My objective for this project was to promote awareness about HPV infection and HPV vaccination among high school students.

Defining Food Agency: An Ethnographic Exploration Of Home And Student Cooks In The Northeast, Maria Carabello

Graduate College Dissertations and Theses

According to popular and academic sources, home cooking is in decline. Nutrition and public health scholars concern that a loss of cooking abilities may diminish individuals' control over their food choices, thus contributing to poor health outcomes. Yet, there are still many unanswered questions. What skills, strategies, and knowledge sets are required to cook a meal on any given occasion? What capacity separates those who cook with ease from those who struggle to incorporate cooking into their daily routines? I propose that this difference is determined by an individual's capacity to employ a range of cognitive and technical skills related …

The Health Care Provider's Experience With Fathers Of Overweight And Obese Children, Eliza Weston Anti

Graduate College Dissertations and Theses

The purpose of this study was to uncover the experience of health care providers (HCPs) as they work with fathers of children who are overweight and obese in the outpatient setting. Interpretative phenomenological analysis was used for data collection and analysis in this study. Seven HCPs were interviewed about their experiences. Two major themes emerged from the experiences of these HCPs: "dad in the backseat," and "paternal resistance." The theme of "dad in the backseat" captured to the HCPs' perception of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that …

Longitudinal Extension Of Primary Afferents Is Regulated By Spingosine 1-Phosphate Receptors And Tyrosine Kinase Receptor B In The Embryonic Spinal Cord Via A Brain Derived Neurotrophic Factor Related Mechanism, Michelle Mcnamara

Graduate College Dissertations and Theses

Primary sensory afferent outgrowth within the developing longitudinal pathway of the spinal cord is important for intrasegmental and intersegmental communication that underlies coordination and development of reflexes and contributes to sensory perception. The endogenous mechanisms that regulate primary sensory afferent extension are the primary focus of this dissertation.

This dissertation tested the hypothesis that primary sensory afferent extension in the longitudinal pathway is regulated by sphingosine 1-phosphate type 1 receptor (S1P1R) and tyrosine kinase receptor B (TrkB) through a brain derived neurotrophic factor (BDNF) related mechanism. To test this hypothesis we used embryonic day five (E5) chicken embryos, as this …

A Comparative Examination Of The Safety Programs At Ucla, Umn, And Uvm In Response To Recent Chemistry Laboratory Incidents, Victoria Carhart

Graduate College Dissertations and Theses

Laboratory safety has recently become more of an imperative in research laboratories than it has ever been in the past. Recent accidents at several universities have escalated the awareness of safety concerns in laboratory workspaces among the general public and created a greater need for a stronger culture of safety in chemistry research overall. Historically, results and publications have been the top priority of most researchers, not laboratory safety.

This thesis discusses a number of laboratory accidents. The first happened in December of 2008 at the University of California, Los Angeles (UCLA) and resulted in the death of a graduate …

A Study To Investigate The Significance Of Knowing One's Prognosis In People Diagnosed With Life-Limiting Illnesses, Erika Currier

Graduate College Dissertations and Theses

ABSTRACT

Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment.

Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between …

Inhibitory Control Efficiency In Successful Weight Loss Participants, Kathryn Curran Olds

Graduate College Dissertations and Theses

Eating unhealthy foods and eating past satiety are inappropriate behaviors that promote obesity. The ability to effectively inhibit an inappropriate behavior is a key component of cognitive restraint and its impairment has been previously linked to obesity. In this study, a Go/No-Go fMRI task was completed by a cohort of adult women that had experienced initial weight loss followed by various levels of weight regain or continued weight loss. Region of interest fMRI analysis revealed that greater total weight loss was significantly related to decreasing activation in the right inferior frontal gyrus and the right superior frontal gyrus. These results …

Mechanisms Of Seizure During Pregnancy And Preeclampsia, Abbie Chapman Johnson

Graduate College Dissertations and Theses

Eclampsia is defined as de novo seizure in a woman with the hypertensive complication of pregnancy known as preeclampsia (PE), and is a leading cause of maternal and fetal morbidity and mortality worldwide. The pathogenesis of eclamptic seizure remains unknown, but is considered a form of hypertensive encephalopathy where an acute rise in blood pressure causes loss of cerebral blood flow (CBF) autoregulation and hyperperfusion of the brain that results in vasogenic edema formation and subsequent seizure. However, eclamptic seizure can occur during seemingly uncomplicated pregnancies, in the absence of hypertension and PE, suggesting that normal pregnancy may predispose the …

A Prelimary Study Of Differences Between Voluntary And Involuntary Retirement From Driving: Quality Of Life And Depression In A Rural Population, Elizabeth Ann Pruitt Saxton

Graduate College Dissertations and Theses

Research has revealed a variety of negative health consequences for older adults who stop driving, and with the "graying of America," this will be a frequently encountered issue for healthcare providers. The purpose of this study was to determine if there are differences in quality of life and depressive symptoms between former drivers who made the decision to stop driving voluntarily and former drivers who made the decision involuntarily (either in a resistant or in a reluctant manner). In this cross-sectional cohort comparison study, community dwelling older adults were asked to complete questionnaires of depression (using the Geriatric Depression Scale), …

The Self-Perceived Impact Of An International Immersion Experience On The Cultural Competency And Professional Practice Of Recently Graduated Registered Nurses, Christopher Vaughn

Graduate College Dissertations and Theses

Significant health care disparities exist in the United States. Nurses can play an important role eliminating these disparities. International immersion experiences for undergraduate nursing students may provide long-lasting enhancements in cultural competency and improvements in professional practice. The purpose of this descriptive qualitative study is to explore how a faculty-led international immersion experience for undergraduate nursing students in public health nursing has influenced cultural competency and how this is perceived to have impacted the individuals' current professional practice. Campinha-Bacote's (2002) Process of Cultural Competence in the Delivery of Health Care Services served as a theoretical framework for the study. Participants …

Reverse Engineering The Human Brain: An Evolutionary Computation Approach To The Analysis Of Fmri, Nicholas Allgaier

Graduate College Dissertations and Theses

The field of neuroimaging has truly become data rich, and as such, novel analytical methods capable of gleaning meaningful information from large stores of imaging data are in high demand. Those methods that might also be applicable on the level of individual subjects, and thus potentially useful clinically, are of special interest. In this dissertation we introduce just such a method, called nonlinear functional mapping (NFM), and demonstrate its application in the analysis of resting state fMRI (functional Magnetic Resonance Imaging) from a 242-subject subset of the IMAGEN project, a European study of risk-taking behavior in adolescents that includes longitudinal …

Polypharmacy Management In A Rural Family Medicine Practice: View From Multiple Perspectives, Sarah Anne Kelso

Family Medicine Clerkship Student Projects

Polypharmacy is a growing problem in the United States. The elderly population is expanding, and the use of specialists to manage their healthcare is increasing. This project looks at the role of the primary care physician at a rural Family Medicine practice in reducing the risks of polypharmacy. The perspectives of patients and the local pharmacist were used to create an education tool about polypharmacy management within this community. Increased awareness of this issue and how it applies to patients within the practice were the results of this intervention.

Mental Health Screening In Nursing Homes, Meghan Breen

Family Medicine Clerkship Student Projects

Depression and dementia are two of the most common mental health conditions in nursing homes. Screening for these conditions does not have to be difficult or time consuming, but doing it can significantly improve the health of nursing home residents. The WHO-Five for depression and the Mini-Mental Status Exam are both sensitive, specific, and time-sensitive. Using these screening in a nursing home in rural Vermont helped improve the accuracy of patient records and impacted medical care.

Bridging The Gap Between The Primary Care Physician And Accessible Resources For Patients With Mental Health Needs, Tracey Dafonte

Family Medicine Clerkship Student Projects

Mental illness and maintaining mental health is a significant problem in the world, the United States, and here in Vermont. The burden of mental illness can lead to disability, lost work productivity, and at its worst, suicide. Vermont ranks 14th in the United States for rates of death by suicide. Many people struggle every day with mental health needs from depression, anxiety disorders, ADHD, and more. The aim of this project was to create a mental health resource card that can be used in primary care offices to provide patients with information to get the help they need and attempt …

Assessing Barriers To Meeting Weight Gain Goals In Obese Pregnant Women, Margo Seybolt

Family Medicine Clerkship Student Projects

Obesity is a known risk factor for complications during pregnancy and birth, as well as worse outcomes. This study looked at the health risks and outcomes of pregnancy in obese women (BMI>35) at the family medicine clinic in Bangor, ME as well as what interventions are being done know to encourage women to meet their weight gain goals. Interviews and literature searches were conducted to determine possible strategies to better get obese pregnant women to meet their weight gain goals.

Promoting Awareness Of Hepatitis C In Burlington, Vermont’S Homeless Population, Catherine M. Lapenta

Family Medicine Clerkship Student Projects

Chronic Hepatitis C infection is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Most Hep C + patients are unaware that they are infected. Chronic HCV infection represents a huge public health and financial burden. While about 1% of the general U.S. population is HCV+, the prevalence is as high as 41.7% in some homeless populations in the U.S. Awareness of Hep C is low and Vermont’s homeless patients who are HCV+ are likely severely underdiagnosed and undertreated.

From Dar Es Salaam To Dartmouth: A Case Study Of The Experiences Of Fogarty Aids International Training And Research Program Fellows At Dartmouth College, Lisa Anne Purvis

Graduate College Dissertations and Theses

From Dar es Salaam to Dartmouth: A Case Study of the Experiences of Fogarty AIDS International Training and Research Program Fellows at Dartmouth

Lisa Purvis, EdD Candidate, MPH, MBA

Background

The United States (US) is a major host nation to international college students and scholars who study a variety of disciplines (Farrugia & Bhandari, 2014). Beginning in the last decade, the demand for global health training has risen (Kanter, 2008; Kerry, Ndung'u, Walensky, Lees, Kayanjas, & Bangsberg, 2011).

Since 2000, Geisel School of Medicine at Dartmouth has been one of 26 US universities participating in a global health training program, …

Physical Activity In Nature And Children's Mental Health, Stephanie Marcia Bless

Graduate College Dissertations and Theses

The aim of this study was to determine if there is a relationship between children's physical activity and wellbeing, and if that relationship is enhanced by physical activity in nature. This study was a non-experimental retrospective multi-informant data review conducted at an outpatient pediatric psychiatric clinic in the Northeast. The theoretical framework used to guide this study was the Health Promotion Model, suggesting Advanced Practice Nursing investigate the relationship between health promoting behaviors and personal factors that support mental wellness in children and protect against mental illness. Data collected included age, sex, and exercise and wellbeing subsections of the Vermont …

Living With Aortic Stenosis: A Phenomenological Study Of Patients' Experiences And Subsequent Health Choices, Gayle Ann Hagen-Peter

Graduate College Dissertations and Theses

Symptomatic aortic stenosis (AS) is an increasing phenomenon as more adults live longer. The gold standard for treating AS is surgical aortic valve replacement (SAVR). Frequently, as older individuals with AS often have multiple comorbidities, a SAVR is determined to be too high risk. Therefore, a less invasive treatment option is available, namely a transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR). Such biomedical procedures have encouraged life extension and the decision to intervene commonplace with the aging population. Without an intervention, significant debilitating symptoms affect a person's quality of life (QoL). Multiple quantitative studies evaluating QoL …

Decreasing The Smoking Rate At Emmc Family Medicinecenter And Residency In Bangor, Me, Alex Coffman

Family Medicine Clerkship Student Projects

Maine's rate of adult current smoking is 20%, which is significantly higher than all other New England states (Connecticut 16%, New Hampshire 17%, Massachusetts 16%, Vermont 17%, and Rhode Island 17%). The national adult smoking rate in the US is 17.8%. An estimated 2,200 Maine adults die each year from their own smoking.

Implementing Developmental Screening Per Aap Guidelines, Douglas Handley

Family Medicine Clerkship Student Projects

"Fewer than half of the nation's pediatricians conduct systematic surveillance of young children's development… time and cost are among the barriers." Missing developmental delay leads to further attenuation of the problem and can lead to additional developmental problems. Developmental delay can often be corrected or treated to reduce the impact it has on the child. The AAP suggests "developmental surveillance" at every well child visit and standardized "developmental screening" at WCC 9 months, 18 months, and 24 or 30 month.

Osteoporosis: Prevention, Screening, And Treatment In The Primary Care Setting, Jeanne T. Gosselin

Family Medicine Clerkship Student Projects

Osteoporosis, with its related fragility fractures, is largely a preventable disorder, not an inevitable part of aging. Through effective education, screening, and treatement in the primary care setting, it may be possible to curb the impending rise of osteoporosis and costly fractures as the population ages. A time-conserving patient education pamphlet on osteoporosis was developed for a family medicine practice in central Vermont. The educational intervention is sensitive to the time constraints of a busy practice and may provide a much needed foundation for osteoporosis education in the primary care setting.

Lyme Disease Awareness In Downeast Maine, Justin L. Genziano

Family Medicine Clerkship Student Projects

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.

Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project …

Increasing Provider Awareness Regarding Act 39 In Middlebury Vermont, Kyle F. Concannon

Family Medicine Clerkship Student Projects

Vermont passed the Patient Choice and Control at End of Life Act (Act 39) in 2013 and as knowledge of this law is increasing in the community more patients are requesting it. To address the need for further education, an educational pamphlet was produced and provided to practitioners in Middlebury Vermont, many of whom had patients request Act 39.

Implications Of Long-Term Proton Pump Inhibitor Use: Promoting Step-Down Therapy For Management Of Gastro-Esophageal Reflux Disease In The Outpatient Setting, Sonam Kapadia

Family Medicine Clerkship Student Projects

Per the International Montreal Consensus, gastro-esophageal reflux disease (GERD) is defined as a "condition which develops when the reflux of stomach contents causes troublesome symptoms or complications". GERD is the most common disease of the gastrointestinal tract with an estimated prevalence affecting 20% of the Western population. According to the National Ambulatory Medical Care Survey, 38.53 million annual outpatient visits are related to GERD. The ABIM Foundation's "Choosing Wisely" initiative in collaboration with the American Gastroenterological Association draws attention to the evidence based recommendation: "For pharmacological treatment of patients with gastro-esophageal reflux disease (GERD), long-term acid suppression therapy (proton pump …

Barriers To Recovery For Bangor's Buprenorphine Patients, John R. Mclaren, Erin Keller

Family Medicine Clerkship Student Projects

There are several buprenorphine providers at EMMc's Center for Family Medicine serving the greater Bangor, ME region - an area of substantial opiate use. Among the patient population of outpatient buprenorphine users, both locally and nationally, there are high rates of relapse (~32%). In order to decrease relapse rates, it's first imperative to conduct a baseline review of the current buprenorphine population to identify specific types of patients who are at higher risk of relapse. By understanding the barriers to recovery, the office hopes to apply an intervention to the current program, targeting this local demographic more effectively.

Increasing The Recognition Of Generalized Anxiety Disorder In Primary Care, Sarah Rosner

Family Medicine Clerkship Student Projects

National Comorbidity Survey has shown that anxiety disorders are the most frequent disorders in the population, with a lifetime prevalence of 28.8%, and a 5.7% lifetime prevalence of Generalized Anxiety Disorder (GAD) specifically. The presence of anxiety disorders contribute in an additive fashion to poor function, reduced quality of life, and more sick days from work. Despite being as common and impairing as depressive disorders, anxiety disorders have received much less attention in terms of the media, research, and public health efforts, and are often undetected and undertreated. Only a minority of patients with anxiety, 15-36%, are recognized in primary …

Educating The Colchester Community About Measles And Its Prevention, Phildrich Teh

Family Medicine Clerkship Student Projects

Measles is a highly contagious disease with potential complications ranging from diarrhea, pneumonia, otits media, uveitis, and encephalitis. Since the introduction of the measles vaccine in 1967, incidence of measles in the United States has drastically decreased: by 1985, number of cases had fallen by 99%, by 2000, measles was declared to be eliminated from the US. Over the last decade, measles cases per year has been limited to a median of 70. In recent years however, the U.S. has seen an alarming rate of measles cases. The increasing number of measles cases per year in the U.S. highlights the …