Medicine and Health Sciences Commons^™

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

College of Agriculture and Life Sciences Faculty Publications

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

Socioeconomic Status And Cardiovascular Disease Risk In Vermont Adults, Brenden Green, Abigail Heydenburg, Maryann Makosiej, Shirley T. Plucinski, Julia Slessova, Kayla Donohue

Master of Public Health Culminating Projects

Objectives. To investigate the connection between socioeconomic status (SES) and cardiovascular disease in Vermont adults through the Behavioral Risk Factor Surveillance System (BRFSS) data.

Methods. Data from 4,231 participants from the BRFSS 2019 Vermont survey was used. Education level, income level, federal poverty status, and employment status were used to represent overall socioeconomic status. The study investigated the connection of those variables with a history of coronary heart disease (CHD) and myocardial infarction (MI) to represent overall cardiovascular disease (CVD). Simple and multiple logistic regressions were used.

Results. People aged 65 years or above, who smoke, have high blood pressure, …

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

Master of Public Health Culminating Projects

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

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

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

Bullying And Adolescent Obesity In Vermont High School Students, Lauren Blum, Marlene Colon, Matthew Gilwee, Madeline Leopold, Eva Orr, Thomas Delaney

Master of Public Health Culminating Projects

Objectives. To examine the association between bullying and obesity in Vermont high school students and to provide new insights on effective approaches for mitigating risk of both variables in the public health, healthcare, and teaching professions across Vermont.

Methods. Data came from the 2019 Vermont Youth Risk Behavior Survey (VYRBS) (n = 18,612). We analyzed the relationship between days bullied and obesity, controlling for the confounding effects of risky behaviors. We identified situations that led to increases in both primary predictor variables.

Results. Statistical analysis yielded a significant positive association between days bullied and obesity. Students bullied for 1 – …

Perceptions Of Teleophthalmology, Kisha Kalra

Family Medicine Clerkship Student Projects

One of the greatest burdens facing patients with eye-related pathologies is access to ophthalmologists in the area. Teleophthalmology is a way for eye examinations to be conducted in the easily-accessible primary care setting, with images sent to ophthalmologists for interpretation. This project addresses the perceptions of this model amongst patients and primary care physicians.

Stratifying Back Pain In Primary Care With The Start Screening Tool, Patrick Mcclurg

Family Medicine Clerkship Student Projects

No abstract provided.

Improving Patient Education Surrounding Imaging Modalities, Tayler Drake

Family Medicine Clerkship Student Projects

Musculoskeletal complaints are among the most common problems seen in family medicine clinics. Patients may expect that every musculoskeletal complaint requires imaging, however, they may leave the clinic without a referral to radiology. This discrepancy between reality and expectation may strain the patient-provider relationship. The goal of this project is to educate patients regarding imaging modalities and when it is appropriate for imaging to be ordered in the workup of a musculoskeletal complaint.

Supporting Patient Education During Infant Formula Shortage: Washington County, Vt, Rachel A. Wayne

Family Medicine Clerkship Student Projects

The infant formula shortage is a current national public health concern. Many guardians of formula-fed infants are struggling to find appropriate nutrition for their babies. Families of low socioeconomic status are being disproportionately affected because many of them rely on the Women, Infants, and Children program (WIC) to obtain formula, and their formula options through this program are limited. This project aims to provide Vermont families who have formula-fed infants with education and resources to navigate the formula shortage and keep their children healthy and fed.

Increasing Awareness Of Pharmacologic Interventions For Smoking Cessation, Jeremy Frank

Family Medicine Clerkship Student Projects

Smoking is a large cause of morbidity and mortality in the healthcare system. Many patients are interested in quitting smoking but have not found an effective strategy that works for them. There have been times when patients have been receptive to a discussion regarding medication assisted cessation but ultimately were not prescribed any medications from their provider. Despite the fact that it has been proven that pharmacotherapy increases the chances of smoking cessation. The goal of this community health project is to create a change within the healthcare system by providing evidenced based recommendations regarding pharmacologic treatment in smoking cessation …

Pelvic Floor Exercises & Pelvic Physical Therapy Directory For Pregnant & Postpartum Individuals, Matthew Breseman

Family Medicine Clerkship Student Projects

No abstract provided.

Differentiating Annual Wellness Visits And Health Maintenance Visits, Benjamin N. Price

Family Medicine Clerkship Student Projects

Due to recent changes in workflow at the office, many visits that should be Medicare Annual Wellness Visits are incorrectly scheduled as health maintenance visits (yearly physical). These mistakes are not always identified leading to confusion for both patients and providers and unnecessary bills for the patient

Improving Housing-Insecurity Screening In A Rural Primary Care Setting, Heather G. Giguere

Family Medicine Clerkship Student Projects

Housing-insecurity and homelessness have a direct impact on individual health, and are well established causes of premature morbidity and mortality (6). Screening for housing-insecurity leads to earlier identification, and more extensive engagement of services, which can help to mitigate the individual and public health ramifications of these social determinants of health (8). The aim of this project was to improve the screening process for housing-insecurity within an rural primary care setting.

911 Or Primary Care - Who Should I Call?, Jack F. Mangn

Family Medicine Clerkship Student Projects

US emergency departments (EDs) are overcrowded & overwhelmed - especially in Vermont. An estimated 37% of all ED visits are for non-urgent complaints. Factors associated with frequent ED use for non-urgent complaints include overestimation of disease severity and lack of understanding of services provided.

Hiv Pre-Exposure Prophylaxis (Prep): Increasing Awareness In Primary Care, Carl W. Brasch

Family Medicine Clerkship Student Projects

Primary care is a setting that has great potential for screening and reducing the rate of HIV transmission.

Pediatric Anxiety - A Guide For Parents, Paul Mccleary

Family Medicine Clerkship Student Projects

As of April 2022, the United States Preventive Services Task Force (USPSTF) recommends that all children age 8-18 be screened for anxiety. Whether this recommendation is due to the many changes and stress stemming from Covid-19, the community was left with a need for insight into properly addressing this issue. Whether it be for parents at home or physicians in the clinic, clear educational pamphlets identifying alarm signs and home recommendations will benefit the community.

Improving Dental Health Screening In The Primary Care Setting, Kali Amoah

Family Medicine Clerkship Student Projects

Oral health is an important part of systemic health that is often overlooked by patients due to various barriers to dental care. Dental caries is a public health crisis and one of the most common chronic diseases globally. Poor oral health and the resulting inflammation caused by oral bacteria is associated with cardiovascular disease, pregnancy complications, poor glycemic control in diabetes mellitus, and many more conditions. The goal of this project is to increase dental health screening in the primary care setting and to provide a list of affordable dental clinics in Vermont that take Medicaid/ Medicare and offer sliding …

Circumcision For The Male Infant: Patient Education And Cultural Humility, Grace E. Eisenbiegler

Family Medicine Clerkship Student Projects

Male circumcision is a religious and cultural decision that has become increasingly medicalized. Many families make decisions about circumcision based on culture and family without true informed consent. There is a need for unbiased information, prior to delivery, about circumcision, so that families may make an informed decision that is right for them. A one page document was created as an addition to the clinic's pregnancy guide with information on risks and benefits of circumcision, complications associated with the uncircumcised penis, cultural significance, and care of the uncircumcised penis.

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

Master of Public Health Culminating Projects

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

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

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

Conclusions: Vermont residents who …

Peri-Operative Optimization: Social Determinants Of Health, Adam F. Kohutnicki

Family Medicine Clerkship Student Projects

This project investigated how clinicians at a rural Vermont family medicine practice observed various social determinants of health (SDOH) of their patient population affected patients' preparedness for surgery. Two clinicians involved in the community, a practicing family medicine physician and a practicing social worker, were interviewed to collect qualitative data on how various SDOH they have observed through their clinical practice have influenced patients' preparedness for surgery. This information was then utilized to create a "dot-phrase" that clinicians can use as part of a patient's pre-operative visit in the outpatient setting to assess SDOH and plan subsequent targeted interventions to …

Improving Identification Of Dermatological Conditions In Skin Of Color, Sam Afshari B.S., Simran Kalsi M.S.

Family Medicine Clerkship Student Projects

Vermont primary care practitioners are less likely to have experience diagnosing dark skin tones given that the state population is 94.2% white. Only 4.5% of images in general medicine textbooks and 4-19% of images in dermatology textbooks depicted darker skin. Black patients are significantly less likely to see a dermatologist, which highlights the importance of diagnosis at the primary care office.

Evaluating The Awareness Of Medical Staff In Regards To The Environmental Effects Of Single-Use, Disposable Medical Gloves, Nathaniel Moore

Family Medicine Clerkship Student Projects

This study was performed to evaluate the awareness of medical staff in regards to the environmental effects of single-use, disposable medical gloves. The volume and cost surrounding medical glove usage, waste production, and environmental effects require further attention. This research project outlines awareness as the first step in the right direction with future hopes to find a more sustainable solution.

Healthy Affordable Food In Milton, Vt, Nicholas D. Brunette

Family Medicine Clerkship Student Projects

Food insecurity disproportionately affects those of lower socioeconomic status and ultimately leads to poorer health and excess healthcare expenditures. Providing local and online resources for healthy affordable eating to patients of Milton Family Practice may help address some of these concerns.

Examining The Differences Of External Causes Of Death In Black, Indigenous, And People Of Color Versus The Non-Hispanic White Population Of Vermont, Caitlin Wilson, Yainna Hall, Jennifer Garrigan, Brigid Enright, Abby Erwin, Caitlin Quinn

Master of Public Health Culminating Projects

Objectives: Our objective in this study was to examine differences in risk of death from various external causes between the BIPOC community and individuals who identified as NHW.

Methods: 2015-2019 death certificate data accessible on the Vermont Electronic Data Registration System (EDRS) was analyzed and categorized by external causes of death. Decedent race/ethnicity was assigned as BIPOC or NHW according to the race/ethnicity listed on EDRS. Mortality rates were calculated using binary logistic regression and variable significance was calculated using multivariable logistic regression.

Results: There were varied external causes of death between BIPOC and NHW populations. The risk of external …

Effects Of Gender, Physical Activity, Weight Status, And Mental Health Symptomatology On Primary Care Utilization, John W. Carew, Jaime Cotton, Hannah Shoshan, Alex Gevirtz, Thomas Delaney, Donna O'Malley

Master of Public Health Culminating Projects

Objectives. To determine the association between weight status, gender, physical activity, and mental health symptomatology on utilizing primary care in the last year.

Methods. We used data from the 2019 Vermont Behavioral Risk Factor Surveillance System. We used multivariate logistic regression and X² tests of association to assess factors associated with primary care utilization.

Results. Gender and obese or overweight status are significantly associated with one’s likelihood of utilizing healthcare in the past year. For those with 1-13 bad mental health days, the odds of having utilized healthcare in the past year are 1.65 times greater among women than …

Covid-19, Cold, Flu? What To Know And What To Do, Ryan Cournoyer

Family Medicine Clerkship Student Projects

A review of Covid-19 symptoms vs the common cold and influenza. Discusses what to do if you think you are sick and when to seek medical care. Helping prevent community Covid-19 transmission and influx of mildly symptomatic patients into primary care clinic and emergency rooms.

Increasing Access To Advanced Care Planning Documentation, Amy B. Golinker

Family Medicine Clerkship Student Projects

The purpose of this project was to determine the percent of the adult patient population at one family practice in Vermont with completed advanced care planning documentation available to health care providers and work to increase that percentage. The majority of this project was spent completing a chart review to find the advanced care planning documentation present in the current electronic health record, Epic, the previous electronic health record, ECW, or registered with the Vermont Advance Directive Registry. Efforts were also made to increase the percent of adult patients with advanced care planning documentation through conversations with patients during wellness …

Primary Care And The Housing Insecure In Central Vermont, Hunter Goldsmith

Family Medicine Clerkship Student Projects

In this project, I performed a literature review of the research regarding the benefits of primary care on population health. I also looked at healthcare utilization and interviewed community members. I then surveyed individuals suffering from housing insecurity to determine if they were connected to primary care homes and if not the reasons they have not been able to be connected. Finally, I attempted to link interested individuals with local primary care offices to establish care.

Transgender Care Within Family Medicine: Focusing On Feminizing Hormone Therapy, Stellar Levy

Family Medicine Clerkship Student Projects

Transgender populations experience health disparities and barriers related to gender identity or expression. Many people who identify as transgender avoid or delay care because of perceived or real transphobia and discrimination by health care providers and institutions. Providers may benefit from easy access to information about people who identify as transgender and their health needs.

Dietary Effects Of Vitamin K On Inrs, Michael A. Lawson

Family Medicine Clerkship Student Projects

INR monitoring can be difficult for patients. Vitamin K plays a major role in the regulation of INR control and warfarin efficacy. Fluctuations in daily vitamin K intake can alter INR values, leading to coagulopathic adverse events. Consistent daily vitamin K intake may help patients improve INR control.

Let's Talk Menopause: A Brochure Educating And Empowering Women In Menopause, Delaney Sztraicher

Family Medicine Clerkship Student Projects

More than 6 million women in the United States experience menopausal and postmenopausal symptoms annually. Although up to 80% of women experience vasomotor symptoms, there continues to be stigma surrounding conversations of menopause and its associated symptoms. Due to this pervasive taboo, women often dismiss or ignore their symptoms. This neglect leads to greater utilization of healthcare resources and increased productivity losses with an ultimate economic burden of more than $810 billion in the US. Studies have shown that when empowered with education women feel better prepared to manage their symptoms. This project aims to dismantle the stigma by providing …