RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Keeping Kids Physically Active in Madras, Oregon Project Date: 12/29/2008 Childhood obesity has become a major health problem throughout the United States over the last several decades. When battling this epidemic, there is often a two-pronged approach involving nutrition and physical activity. In Jefferson County, only half of youth met the recommendations for physical activity suggested by the Center for Disease Control. In addition, Jefferson County does not have the resources for a parks and recreation division to help organize and publicize available youth sports programs. This project focused on the opportunities for children to participate in organized physical activities in Madras, Oregon. The aim of this project was to provide a resource for patients that provides information about guidelines for physical activity for children and the youth sports programs that are available in the community of Madras. Burns Biggest Loser Part 2: Finding Reliable Healthy Weight Loss Information In a Small Rural Community Project Date: 12/29/2008 Over 66% of Americans are overweight or obese. In urban areas, there are a variety of weight loss classes, clubs, and programs available to the individual motivated to lose weight. Paradoxically, in rural areas like Burns, Oregon the prevalence of overweight and obesity is greater than the national average, yet the weight loss resources are scarce. If a resident of Burns, Oregon wants healthy weight loss information there are few local resources, none of which offer free weight loss education, guidance, and monitoring. One option for such an individual is MyPyramid.gov, a free interactive web site that offers personalized diet and physical activity assessment, and encourages healthy self-monitoring behaviors. Old Believers of Silverton, Woodburn and Mt. Angel Area Project Date: 8/4/2008 10,000 Russian old believers community presents a significant percent of Marion county and especially Woodburn and Silverton area. Even though a great majority of them speak English well, their cultural specifics sometimes makes providing a health care for them difficult. Some of greatest concerns of health care providers were identified and included: culture and lifestyle of Russian old beliers; their general attitude toward medical care; family role distribution and medical decision making; women health issues, including early marriage and pregnancies as well as birth control; children health and immunizations; and end of life issues. These issues were then investigated and presented. Due to limit of time available for the project, information was collected from limited sources. Cardiovascular Risk Reduction in Hood River, OR: Availability without Access Project Date: 2/11/2008 Although preventable, heart disease remains the number one cause of death in the United States. This study sought to examine cardiovascular risk reduction in an internal medicine clinic in Hood River, OR. Methods included observation of clinic practices, interviews with health care providers, and analysis of inpatient admissions for 2007. Patient education for cardiovascular disease in the clinic included brief, informal counseling performed during the visit and focused on risks that were identified through the patient’s history, physical examination, and laboratory evaluation. No handouts for patients were in use to augment this education or encourage lifestyle modification. A comprehensive cardiovascular risk reduction program was available but expensive, minimizing its utilization. The ultimate goal of this project was to create an efficient and educational patient handout aimed at increasing awareness of modifiable cardiovascular risk factors, encouraging lifestyle modifications, increasing patient-physician dialogue, and highlighting free or insurance-reimbursed programs available in the area. Pathological and Problem Gambling in Reedsport, Oregon Project Date: 12/31/2007 Our state government and the local economy on the Southern Oregon coast are hooked on the profits from state run lottery and the jobs and tourism brought in by Indian Casinos. Unfortunately, problem and pathological gambling are a significant public health problem. Countless studies have shown an association between problem/pathological gambling and drug use, suicide, crime, bankruptcy, divorce, and job loss. Reedsport, Oregon is uniquely located within approximately 20 miles of a casino in both the North and South directions, putting its population at increased risk for these problems. Using the NODS gambling screen, this study looks at the prevalence of gambling problems in the patient population at Dunes Family Health Care in Reedsport, Oregon. After identifying this problem, a patient handout was prepared listing local resources available for those with gambling problems to get help. This handout was distributed to local casinos, shopping centers, family resource center, the family medicine clinic and the library. Assessment of the Gay Friendly Literature and Postings in the Waiting Areas of Local Eugene, Oregon Clinics Catering to Adolescent Populations Project Date: 8/6/2007 Adolescence is a time of great discovery, when important facets of our personalities are experimented with and solidified. It is also a time of great confusion and vulnerability. This vulnerability puts adolescents at increased physical and mental health risks. Gay youth, an often overlooked subpopulation of adolescents, are often at increased risk compared to their heterosexual peers for certain health problems. As medical providers, there are many things we can do to assist our young gay patients during this tumultuous time. Unfortunately, despite our best efforts to provide adequate care to this population of patients, studies show that gay youth are hesitant to disclose their identity to health care providers. Gay youth need to feel safe before disclosing their identity as this leaves them in an extremely vulnerable position. We can help increase their trust in us as providers, simply by encouraging gay friendly literature in our waiting rooms. A cursory assessment was made of local Eugene clinics. Ninety seven percent of clinics available for response did not display gay friendly literature in their waiting areas. The same percentage did not have any brochures on local gay resources to offer their patients. It was evident that if a gay adolescent was presenting at any of these clinics, they would have no obvious signs letting them know that they were in a safe place. It was also evident that a resource guide for gay youth was lacking in local Eugene clinics. Snow Safety: Preventing the most common types of injury at Mt. Ashland Project Date: 8/6/2007 Mt. Ashland is a small ski resort in Southern Oregon. Despite it's small size Mt. Ashland boasts it's share of difficult runs with approximately 50% of the runs receiving an "advanced" rating. It is primarily a "local" mountain with over 90% of user visits coming from the surrounding area. All of these factors combine to create a scenario where injuries are likely to occur, but where there is a concentrated, local population that is likely to benefit from education on injury prevention strategies. For my rural project, I contacted the ski patrol and administration of Mt. Ashland ski area. We discussed the most common causes of injury at Mt. Ashland, which correlated well with causes of injury nationwide. These causes of injury included knee injuries, head injuries, shoulder injuries and thumb injuries in skiers and ankle injuries, wrist injuries, head injuries and shoulder injuries in snowboarders. I then researched prevention strategies for avoiding these types of injuries and produced an informative poster. I then submitted the poster to the Mt. Ashland administration in order that they might use it to inform the public in hopes of reducing the number and severity of injuries at Mt. Ashland. Methamphetamine Use and Treatment Resources in Lebanon, OR and Linn County Project Date: 7/2/2007 I contacted DHS, Linn County Alcohol & Drug, and Dr. Carol Chervenak (OMA Methamphetamine (MA) Task Force/ABC House Medical Director) to inquire about MA use/abuse in Lebanon, OR and the surrounding communities. Through working with Dr. Chervenak, and educating myself in regards to MA use/abuse, I became aware of the magnitude of the MA problem in the area, and furthermore, the MA treatment problem was brought to my attention. In turn, I decided to investigate community resources available for those seeking help for themselves/family members addicted to MA. In the past, I had only heard vague references as to how difficult it was to get adequate inpatient treatment for MA use. I wanted to create a list of local resources that patients could access when confronting their addiction or the addiction of a loved one. Upon investigating this issue, I found more community resources than I anticipated. I found a variety of treatment options that were committed to treating drug users from all walks of life. I contacted DHS, Linn County Alcohol & Drug, and Dr. Carol Chervenak (OMA Methamphetamine (MA) Task Force/ABC House Medical Director) to inquire about MA use/abuse in Lebanon, OR and the surrounding communities. Through working with Dr. Chervenak, and educating myself in regards to MA use/abuse, I became aware of the magnitude of the MA problem in the area, and furthermore, the MA treatment problem was brought to my attention. In turn, I decided to investigate community resources available for those seeking help for themselves/family members addicted to MA. In the past, I had only heard vague references as to how difficult it was to get adequate inpatient treatment for MA use. I wanted to create a list of local resources that patients could access when confronting their addiction or the addiction of a loved one. Upon investigating this issue, I found more community resources than I anticipated. I found a variety of treatment options that were committed to treating drug users from all walks of life. Cattle Related Injuries in the Treasure Valley Project Date: 4/30/2007 The beef cattle industry is a $71 billion per year industry providing 28.0 billion pounds of beef to the U.S. public (USDA background statistics 2006). The beef cattle industry is also an important part of the economy of Ontario, Oregon. However, this industry is also subject to a wide variety of hazards and is considered one of the most dangerous industries in the United States and in the State of Oregon. This study attempts to identify the most common causes of agricultural injury by searching national databases, performing a local study and participating in local ranching activities. According to the national database, the most common fatal accidents were caused by tractor and machinery. The most common non-fatal accidents were related to livestock. These accidents were most commonly crush injuries followed by falls. In the local survey, there was a difference between the most common injury reported health professionals and local ranchers. This is likely due to differences in the rancher’s threshold for seeking medical attention based on the type of injury. Reach Out and Read in Baker City. Project Date: 3/19/2007 The importance of health literacy, as well as the importance of early intervention to reading acquisition, has been increasingly recognized. Baker County has a low percentage of children entering school ready-to-learn, and while there is a well-established Literary Council, more emphasis on early intervention is desired. The Reach Out and Read program has health professionals emphasize the importance of parents reading to children, and donates books to those children during well-child visits. Eastern Oregon Medical Associates (EOMA) is the largest primary care provider for children in Baker County, and recently moved to a new office, in which they were wondering how to entertain children in their waiting room. A Reach Out and Read program was developed, which included the following steps. Community data were collected and an application was submitted. Community support was generated through the local Literary Coalition. 200 book donations were collected, and a grant was drafted for submission to the Juan Young Trust. Books were placed in the waiting room with enthusiastic response from parents and children. Depression in the Elderly - Community Resources in Reedsport, Oregon Project Date: 2/12/2007 Depression is a common problem in the elderly population. Literature shows that exercise and social interaction have a tendency to improve and maintain good mood. The goals of this project are to first explore the resources in the community for the senior population, then to evaluate the utilization of these services by conducting a survey, and lastly to develop a patient handout to increase awareness of local resources and to encourage physicians to incorporate exercise and social interaction into treatment plans for elderly with dysthymic mood. Many activities and programs through the senior centers and the senior & disability services are available locally. However, only 50% of those with dysthymic mood use the senior center, while 78% of those with good mood utilize the services. In addition, those with lower mood score are less likely to have a regular exercise schedule. In a rural setting where social workers are not readily accessible, it is beneficial for physicians to know the local resources in order to effectively help their patients. Recruitment and Retainment of Rural Physicians: the difficulties found in the Frontier community of Grant County, Oregon. Project Date: 1/1/2007 Recruiting and retaining physicians in rural areas is an ongoing problem in the United States today. Physicians are trained in urban areas and often prefer to remain there to practice creating difficulty in recruiting to rural communities. If a physician does choose to practice in a rural setting they often feel isolated and overworked and usually remain for only a short time. This report analyzes the recruitment process of the Blue Mountain Hospital and a private clinic in Grant County, Oregon and identifies the difficulties in recruiting and retaining physicians in that area. Data were gathered from journal articles and interviews with local physicians and the hospital administrator. Grant County uses a variety of physician recruitment firms and word of mouth advertising, although in the last five years three of the new doctors have come through the Oregon Area Health Education Center. In the last eighteen years Grant County has had sixteen different physicians, each of them remaining only four years on average. In addition to lack of medical student exposure, local physicians identify various lifestyle and professional issues as barriers to recruiting and retaining physicians. I attempt to offer solutions to these issues including more selective recruiting and improved strategies to expose medical students to rural medicine Methamphetamine Abuse in Lane County Project Date: 10/16/2006 This project seeks to illuminate the story of methamphetamine abuse in Lane County: the drug's history, the experience of its users, its production and the effects of "meth labs" in the county, the effects on the community and on families, and resources available to help users quit. Through interviews with physicians, law enforcement officials, nonprofit organization workers, and users themselves; journal articles; and interaction with local service organizations, I discuss the history and scope of the problem in Lane County. Finally, I suggest three broad categories of solutions to the problem, and steps I would take if I were to continue this project further. Gay, Lesbian, Bisexual, and Transgender Health Resources in Madras, Oregon Project Date: 10/16/2006 Several studies have estimated between 3 and 10% of the U.S. population are gay, lesbian or bisexual. Small towns often have very few organizations or agencies to support this minority. This project looks for resources for gay, lesbian, bisexual and transgender (GLBT) individuals in the town of Madras, Oregon. Local health providers and administrators were interviewed to identify steps that have already been taken to support health needs of GLBT patients. In addition, using several national health resources, suggestions were gathered for improving the clinical atmosphere and health care for GLBT patients at one local clinic and hospital in Madras. The findings and suggestions collected during this process were presented to and discussed by a group of family practice physicians in the community. Screening for Problem and Pathologic Gambling in Coos Bay, Oregon Project Date: 8/7/2006 Pathologic gambling and problem gambling affect as many as 5 to 15 million Americans. Primary care physicians are ideally situated to screen for maladaptive gambling behaviors and assist in patient referral and treatment. Using an adaptation of the NODS DSM-IV diagnostic screen for gambling problems, this project sought to determine the prevalence and impact of problem and pathologic gambling for patients seeking primary care at Bay Clinic in Coos Bay, Oregon where no such screening been done. Of fifty-two respondents, six (11.5%) individuals were identified as being probable problem or pathologic lifetime or past year gamblers; with 50% having a history of substance use disorder and 83.3% with a history of depression or mania. For the four respondents meeting criteria for problem and/or pathologic gambling in the past year, an average of 108 days and $2,266 dollars was spent for the year. Further study is needed, particularly to resolve concerns regarding the specificity of the adapted screening tool and possible reporter bias. Still, this initial work shows a high prevalence of probable problem or pathologic gamblers in the Coos Bay region and provides impetus for continued standardized screening. "Health in Action!" in Baker County: How do we determine its effectiveness? Project Date: 8/7/2006 When you attempt to MOVE an entire county, how do you monitor your successes and failures along the way? In Oregon’s Baker County a MOVING FORCE has begun in the form of a community project titled “Health In Action!”. This paper is aimed at developing a means to which “Health In Action!” can gather and eventually begin to analyze data concerning their efforts to MOVE the county. The design was based largely on discussions amongst facilitators of “Health In Action!”. Specific needs for data collection and analysis were primary topics of conversation. Other sources of information included recent studies conducted throughout the United States that were geared toward public health surveillance and program evaluation. It was concluded that to further improve community needs assessments in Baker County with regards to “Health In Action!”, questionnaires would be developed and utilized at four specific activities sponsored by the program. In conclusion, questionnaires were categorically created to facilitate the required data collection and future analysis. Skin Cancer Educational Outreach in Harney County Project Date: 5/1/2006 Harney County is a frontier county in Eastern Oregon with a culture predominated by desert cowboy culture and outdoor recreation. At an elevation of 4148 feet, and a climate consisting of 300 days of sunshine a year and 11 inches annual precipitation, the area attracts sun and outdoor lovers who will be exposed to high levels of ultraviolet (UV) radiation. Regular physician visits are rare for much of the population and little is known about skin cancer prevention awareness among residents of the county. In addition, the incidence of skin cancer is rising rapidly worldwide. Melanoma is the 5th most commonly diagnosed cancer and the 6th leading cause of cancer deaths in Oregon. Between 1999 and 2002, Oregon's melanoma mortality rate of 29.4 deaths per 100,000 people as the second highest in the nation. Skin cancer awareness is therefore a pertinent issue for residents of Harney County. A chart review was conducted in an effort to quantify the prevalence of melanoma and non-melanoma skin cancers in the clinic's patient population. As an attempt to reach out both to High Desert Medical Center patients and community members that do not regularly visit the local health clinic, a health fair educational display was developed. The display included focused skin cancer screening information, basic medical terminology describing development of skin lesions and methods of skin protection and cancer prevention. Information for the display was included from textbooks, journal articles and the High Desert Medical Center physician staff. Patient handouts were also developed for distribution at the health fair. Contraceptives: A Survey of Jefferson County Teenagers Project Date: 5/1/2006 Jefferson County has the highest rate of teen pregnancy in Oregon. Research shows that programs that combine emphasis on delayed initiation of sexual activity as well as sexual and contraceptive education helps reduce teen pregnancy rates. In order to reduce teen pregnancy in Jefferson County, sexual and contraceptive education will need to be taught in a comprehensive way. The goal of this project was to evaluate the knowledge regarding contraceptives of teenagers in Jefferson County, where they obtain their information, who they trust regarding contraceptive information, and what myths exist surrounding contraceptives among teens in this county. Surveys were administered to four health classes to a total of 79 high school students and discussions were held following the administration of the survey. Results showed teens get most of their information from school, friends, and health care professionals. They trust doctors, nurses, and parents to provide accurate information. There is good understanding that abstinence prevents pregnancy. Knowledge of comparative efficacy of specific contraceptive methods was not good. Knowledge of new contraceptive methods such as the NuvaRing and Mirena were low. Many students did not know the window of opportunity to take emergency contraception. Myths regarding side effects of contraceptives include breast cancer risk, infertility, birth defects and weight gain. Health care professionals are trusted by teens in this county generally feel safe speaking with their health care providers. Significant room for improvement exists in the education of teens in Jefferson County regarding contraceptive methods. The Tillamook Safe Hunting Initiative: Assessment of the Hunter Education Program and Strategies for the Future Project Date: 3/20/2006 As hunting continues to be a popular recreational activity in Oregon’s Tillamook County, emphasis on safe hunting practices is necessary to ensure the safety of all persons who enter the wilderness each autumn. This study aimed to identify what safety awareness programs are available for Oregon residents in this region and to investigate the efficacy of such programs in preventing hunting-related accidents. In addition, an effort to recognize areas for improvement within hunter education was undertaken. Data on Oregon’s hunter education program was obtained through direct communication with the Oregon Department of Fish and Wildlife, personal interviews with hunters native to Tillamook County, and extensive web research. It was determined that emphasis on hunting safety (via formalized courses or independent learning) has led to a significant decrease in the number of hunting-related accidents over the past few decades in the state of Oregon. While firearm handling continues to be the mainstay of safety awareness, Tillamook County residents expressed an interest in basic life skills training and the importance of wearing hunter orange. Therefore, this project would not only provide an assessment of the Oregon hunter education program, but would also focus on the development of a small brochure providing tips on accident prevention and treatment. Food For Your Heart: Socioeconomic status and the prevalence of chronic medical conditions Project Date: 2/13/2006 Diet and exercise are lifestyle components that have long been known as a means to non-pharmacologically manage chronic medical illnesses such as hypertension, diabetes mellitus and hyperlipidemia. However, there appears to be significant knowledge gaps among certain patients. There is a need for succinct and practical nutrition education geared towards a diverse patient population that includes those with limited incomes. This prompted the question regarding the association of socioeconomic status (SES) and the prevalence of chronic medical conditions. A chart review was done on 50 patients at the Scappoose clinic comparing the prevalence of HTN, DM and hyperlipidemia among patients with private insurance compared to patients with lower SES, as measured by participation in Medicaid programs (OHP, OMAP). The scope of this study was quite limited and did not demonstrate an association between SES and these chronic conditions. However, this research question can be better answered if a larger general population was studied and more specific SES parameters such as income data and level of education are used. Based on the information and knowledge gaps identified from patient interviews, an education brochure was created for distribution at the clinic that included dietary recommendations, practical diet tips and money-saving strategies. It will hopefully serve as a useful tool to counsel patients on more optimal diet management of their chronic diseases. Are We Still a Fast Food…County? – A Look into Dining Options and Overconsumption in Madras, Oregon Project Date: 2/13/2006 Obesity continues to be a major public health concern and has become a prime target for health promotion and disease prevention efforts over the years. Previously, a rural health community research project was conducted to investigate the prevalence of obesity and metabolic syndrome in Madras, Or with results indicating rates comparable to, if not higher than those of Jefferson County and the country. I based my research off these findings and qualitatively studied how the lack of healthful dining options and societal barriers contribute to poor dietary choices and overconsumption in people in Madras. Methods for this study included utilizing the Jefferson County surveillance data with emphasis on ethnic and socioeconomic disparities to establish a background understanding of the population. Various fast food and dining locations were then visited, and managers and working staff interviewed to obtain subjective perspective on the dietary preferences of members in the community. Findings from this research included consumer interests in heartier portions, meatier options with condiments, special value meals, and cheaper, highly advertised items, regardless of their nutritional value. Furthermore, literature reviews demonstrated correlations between culture and socioeconomic status with rates of obesity, specifically a higher percentage of Hispanics and lower income households with poorer dietary habits. Based on these findings, a brochure on weight loss and management was designed in both English and Spanish to increase community awareness in a culturally sensitive and population-specific manner. Emphasis was placed on preventive measures, proper diet, exercise and healthy lifestyle choices to minimize risk factors for obesity and its related comorbidities. Baker County Sexual Health Education: The Good, The Bad and The Ugly Project Date: 2/13/2006 Baker County has a several high-risk sexual health populations, including high school students, patients in inpatient alcohol and drug treatment facilities, and prisoners. Sexual health education for these groups has been limited in the past. A focus group of public health RNs identified a problem with poor resources for delivering STD education in these settings. They expressed a desire for an easy-to-give and easy-to-understand presentation that they could use to give educational talks to these high risk groups. They also described the lack of resources in the clinics for sexual education during family-planning or sexual health visits. They described a need for an easily accessible photographic flip-book for use with patients in the clinics. With their guidance, I developed a one hour Power Point presentation and a short color photo flip-book about STD risks, prevention and treatment in Baker County. Together we discussed a plan for putting these new resources to use in the community. The Problem of Obesity in Coos Bay, OR Project Date: 10/17/2005 This Community Project studies the prevalence and impact of obesity among internal medicine patients of the Bay Area Clinic (BAC) in Coos Bay, OR, and provides a convenient source of patient education in the form of a brochure. The first 50 internal medicine patients seen by my preceptor were evaluated and were categorized according to their BMI. Patients were categorized as “healthy weight” (BMI = 19-25), “overweight” (BMI = 25-30), or “obese” (BMI > 30). Of the 50 patients evaluated, 26% were of a healthy weight, 36% were overweight, and 38% were obese. Because of the high prevalence of obesity in this patient population, as well as the lack of convenient patient education materials on the topic, an informative/educational brochure was created with the goals of: 1.) informing patients of the health risks associated with obesity, 2.) providing patients with a list of useful diet and exercise resources, and 3.) providing patients with tips on weight loss. A Chronic Pain Survey: Defining chronic pain, its prevalence, and its severity Project Date: 10/17/2005 Chronic pain is an intrinsically subjective disease. There are no objective methods to measure it. Chronic pain is a disease process that involves psychosocial as much as physical pathophysiology, if not more so. Moreover, there is little consensus among the different specialties and organizations in medicine on the definition, assessment, and management of chronic pain. Because of these, the prevalence rates of chronic pain range from 10 to 55%. A larger number compared to the 10 to 15% of the general population that seeks care for chronic pain, a disparity that is worth investigating. The available studies on large populations vastly out-number those on rural communities. Originally, this project was to analyze the appropriateness of chronic pain treatment in this community as compared to standard guidelines. However, with lack of widely accepted guidelines and little epidemiological data to compare, this analysis was difficult to pursue with the allotted time. The project focus shifted to addressing the prevalence, associated factors, and description of chronic pain in the “rural” community of Burns, Oregon. To accomplish this task, a patient survey was devised that was largely based on two prior descriptive studies on chronic pain in rural communities. The definition of chronic pain used in the survey is an adaptation on the definition by the International Association on the Study of Pain. To describe the more “physical” component of the pain, the survey asks to describe the pain’s location, sensation, intensity, perceived cause, duration, and frequency. To describe a more “psychosocial” aspect of the pain, the survey asks to answer questions from the Quality of Life Scale. Though there was inadequate time, the patient survey is ready and available for implementation. From this potential pool of data, certain outcomes can be ascertained, such as: the validity of this study’s definition of chronic pain and the appropriateness of using current guidelines in the assessment and treatment of chronic pain, including the use of opioid analgesics. Finally, the current chronic pain practice of rural physicians can be surveyed to compare to these guidelines. Lifestyle Modifications to Prevent and Treat Hypertension in Reedsport, Oregon. Project Date: 9/12/2005 Hypertension is epidemic in developed countries today. In United States, 50 million adults, or approximately 25%, have hypertension (defined as blood pressure > 140/90 mm Hg) and/or use anti-hypertensive medications1. More than half of all adults aged 60 years or older have hypertension2. As Reedsport and its surrounding communities contain large proportion of elderly population, many patients at the Dunes Family Health Care (DFHC) have hypertension and its complications. Thus, hypertension is an important and common health problem treated at DFHC. The purpose of this project is to increase public awareness of hypertension by creating an informative pamphlet. The results from a survey indicate that participants place lifestyle changes, mainly diet and exercise, as best methods to prevent and treat hypertension over anti-hypertensive medications, even though almost half of participants are currently taking anti-hypertensive medications. Thus, lifestyle changes in regards to diet and exercise are emphasized in the pamphlet, with main focus on Dietary Approaches to Stop Hypertension (DASH) diet as well as community resources available to Reedsport residents to make exercise and dietary changes to lower and maintain healthy blood pressure. Recruitment of rural physicians: the challenges of a hospital and a private clinic in Klamath Falls, Oregon Project Date: 9/12/2005 A present and future healthcare concern facing the United States is the shortage of physicians practicing in rural areas. Doctors disproportionately prefer urban-suburban practices, and this makes the recruitment of rural physicians a challenging task. This report documents the hospital and clinic recruitment process of the rural town of Klamath Falls, Oregon. Data were gathered from interviews with the physicians involved in the recruitment process at the Klamath Falls hospital and private clinic, and from published journal articles. The strategies for recruiting included hiring a recruiting service and establishing a local residency program and expanding medical student clerkship programs. The recruitment incentives the hospital and clinic offer to candidates include higher salaries, assistance in setting up a practice, establishing a clientele and assistance with spousal employment. Besides attracting physician candidates with the beautiful environment, physicians are drawn to Klamath Falls because of the low cost of living, the broader scope of the medical practice, the casual lifestyle and the lack of traffic congestion. Nonetheless, the recruitment is low due to the complaints of increased on-call hours, low reimbursement and no educational loan support. I recommend two broad strategies for increasing physician recruitment. First, Klamath Falls should emphasize its stunning natural surroundings. More importantly, Klamath Falls should increase its efforts to reach out to rural training programs nationwide. Skateboarding Safety in the Community of Reedsport, Oregon Project Date: 3/21/2005 In 1996 it was estimated that approximately 5.8 million kids between the ages of five to eighteen years old participated in skateboarding. Of those 5.8 million, an estimated 750,000 skateboarded on a weekly basis (1). It is likely that this estimate will increase as the popularity of skateboarding surges. Paralleling the revival of skateboarding, there has been an increase in skateboard-related injuries. Most recently, the number of injured individuals younger than 20 years has increased from an estimated 24,000 in 1994 to approximately 51,000 in 1999 (1). Numerous studies have concluded that skateboarding-related injuries are more severe and have more serious consequences than those injured while roller skating or in-line skating (3). Reedsport has recently opened a skateboard park for its youth. The goal of my community project was threefold: 1. Assess how the skateboarding youth of Reedsport compare with national statistics regarding injury frequency and patterns. 2. Determine what methods to prevent injury were utilized among kids. 3. Promote helmet safety. Survey of Lower Umpqua Hospital’s emergency department records demonstrated that over 19 months a total of 345 encounters were recorded for trauma, ATV, and skateboarding accidents. Of the 345, 26 (8%) were related to skateboarding. The age range for skateboarding injuries was 8 – 29 years with an average of 16.6 years. 93% (23/26) were male. Skateboarding injuries were categorized by area injured including head, thorax, and extremities. 65% (17/26) of skateboard injuries were to extremities. Of extremity injuries 71% (12/17) were fractures. Alternatively stated, 46% of the 26 skateboarding injuries were fractures. Head injuries comprised 23% (6/26) of skateboard related injuries with one of these injuries also qualifying as a trauma secondary to a closed head injury. Injuries to the thorax comprised 12% (3.26) of the skateboard injuries. Multiple casual observations (> 10 occasions) of kids using the skate park revealed that most kids are not using a helmet when skateboarding, particularly older teenagers. In addition, on no occasion was a supervising adult present. To promote helmet safety and awareness I designed a locally based helmet safety pamphlet featuring many of the local skateboarders. The pamphlet was distributed to local skate shops (Pandemonium, Waxer’s), the elementary and junior/senior high schools, the local emergency department and the Dunes Family Health Care clinic. A summary of the pamphlet was also sent home to all the parents of children attending the junior/senior high school. I also collaborated with the outdoor editor of the local newspaper “The World” and wrote an article focusing on helmet safety and awareness. Lastly, I solicited sponsorship from five companies (The Tony Hawk foundation, Bell, Viking helmets, Wal-Mart, The Oprah Winfrey show) for 20 skateboard helmets. Waxer’s donated 3 helmets with elbow and knee pads. The rest of the sponsorship requests are pending at this time. If in the future more helmets are donated then I will return to Reedsport and work with the local fire department to distribute the helmets to kids in need on during the town’s annual “Skate Jam.” Gambling in John Day, Oregon: Creation of a Patient Brochure. Project Date: 2/7/2005 Gambling is a prevalent problem both nationally and in Oregon. It can have wide-ranging effects, including those on finances (like bankruptcy), higher rates of receipt of past-year unemployment and welfare benefits, arrest, incarceration, divorce, poor or fair physical health, and mental health treatment. Despite this prevalence, it is not routinely screened for in a family practice clinic in John Day, Oregon, and there is no current patient information brochure here addressing it. The purpose of this project was to develop a patient information brochure to address gambling in one rural Oregon family practice clinic. The patients of this clinic were the target population. Data was gathered by speaking to the clinic’s provider as well as a gambling counselor regarding the negative effects of gambling and things to include in a brochure. An extensive Internet search was also undertaken to gather information. This data gathering yielded the creation of a brochure that included the following information regarding gambling: basic statistics, forms and locations in which it takes place, negative effects, common myths, screening questions, and treatment resources. If there were more time in the clerkship it would have been beneficial to try and observe whether the brochure prompted any discussion between patient and provider, as well as to try and contact other providers in the area to see if they would like to display the brochure in their offices. Hypertension in Baker City, Oregon: Treatment, Awareness, Compliance, and Lifestyle Project Date: 10/18/2004 Hypertension is a major risk factor for many cardiovascular diseases, renal disease, and retinopathy. Hypertension is implicated in 800,000 deaths per year in the United States, and is highly prevalent in the portion of the American population over 60 years of age. A study of patients’ knowledge of hypertension was conducted in Baker City, Oregon in October and November 2004. Patients diagnosed with hypertension were interviewed regarding their awareness, compliance, and lifestyle choices related to hypertension. Interviewed patients are moderately aware of their condition, are compliant with physician recommendations, and have altered their lifestyles to reduce hypertension-related health problems. Summary statistics suggest that interviewed patients had similar levels of compliance compared to those reported in the literature. In most cases, the physician’s response to elevated patient blood pressure was to adjust medication dosages. Pedometers as Motivational Tools to Increase Physical Activity in Philomath Oregon Project Date: 9/13/2004 Physical inactivity has been identified as one of the top contributors to obesity. Combined with poor nutrition, it is the second highest preventable cause of mortality. In preliminary studies, pedometers have been shown to be a potential motivational tool to increase physical activity. The purpose of this study is to investigate the effects of a 7-day, pedometer-based lifestyle physical activity intervention. Participants were 10 patients from Philomath Family Clinic who volunteered to participate in the study. Participants’ perceived physical activity and actual physical activity was measured through questionnaires and by wearing a pedometer while doing typical activities. Questionnaires also examined patients’ motivation, environmental barriers, and knowledge of exercise. After completion of the 7-day trial, participants are asked to reflect on their activity level and their experience with the pedometer. Results indicate participants averaged 14,754 steps per day. Preliminary, findings from this study demonstrate that pedometers encourage most participants to want to increase their activity level. You Are What You Eat! Project Date: 9/13/2004 My community project was aimed at educating teen athletes about eating healthy diets to maximize their success in sports and to maintain their health. I picked this topic because all teens that want to play school sports must get a sports physical before they can participate in the sports. This allows physicians a good opportunity to educate the athletes before they start to train. The second reason that I decided to educate teens about a healthy diet is because it may be confusing for teens. I was also hoping to educate the teens about eating disorders so that they may recognize the signs and seek help if needed. Lastly, I wanted to educate teens about nutrition because for them, this is the time to develop proper eating habits that will serve as a foundation for healthy eating as an adult. I decided that the best way to educate teen athletes was by making an informative flyer that could easily be handed out at their sports physical. In this flyer, I provide information about main things to consider with respect to diet as an athlete, helpful eating habit hints, pre and post game eating tips, and eating disorder signs. I hope that this information will contribute to the success of teen athletes in developing healthy eating habits for the present time and for later on in life. Off Highway Vehicle Injuries at Lower Umpqua Hospital in 2002 and 2003. Project Date: 5/10/2004 Introduction: In May 2003, the US Forest Service implemented a policy banning the possession of alcohol outside of designated areas in the Oregon Dunes National Recreation Area. The goal of that policy was to reduce the risks of using Off Highway Vehicles (OHV) to both the people using them and the natural environment. Organizers of a OHV centered event called Dunefest also attempted to increase regulation of riders in an attempt to increase safety. Methods: A retrospective chart review was conducted of all patient charts presenting to the Lower Umpqua Hospital emergency room between July 1 and August 31 of 2002 and 2003. 165 charts were abstracted for the following variables: date, time, patient age, Dunefest weekend, insurance status, EMS usage, alcohol use prior to the incident, protective equipment used at time of incident, type of injury, and disposition. Chi-square and Fisher’s exact test were used to analyze the data. Results: The average age of injured riders was 27.9 with 34 patients being 16 years old or younger. No significant change in the number of OHV related injuries was found other than a decrease in the number of patients without helmets. Alcohol use was associated with higher rates of admission or transfer to higher levels of care, lack of documented insurance, presentation to the ER between 2100 and 0700, and lack of helmet usage. Thirty-one (19%) patients had no documented insurance representing a significant potential financial burden for the hospital. Conclusions: While the new US Forest Service policy did not appear to reduce the number or severity of injuries presenting to LUH ER, the number of unhelmeted patients declined. Riding OHV’s while under the influence of alcohol was associated with greater risk of injury and higher morbidity. Efforts to decrease the operation of OHV’s under the influence of alcohol should continue. Physicians may utilize the ER encounter to screen for alcohol use among injured patients and apply brief interventions to educate patients and their friends and families about risks of combining alcohol with OHV recreation. Future studies will be needed to better determine the effects of the policy. The effects of Chronic psychological stress Project Date: 5/10/2004 The relationship between psychological stress and overall general health has been well documented in many studies. Chronic psychological stress can elicit negative health effects on numerous organ systems including the immune, gastroenteral, and nervous systems. The hope for this study, via questionnaire, was to examine the prevalence of stress in a small community primary care clinic, the perception of stress and its affect on general health, how often measures are taken by patients in order to decrease chronic stress, and to identify examples of major stressors that affect the community. Furthermore, it was hoped that this study would shed insight to what degree a primary care physician can identify stress and its symptoms as well provide information in stress lowering activity. I found that 31% of the respondents indicated mild to moderate stress and 17% of patients had significant stress. 23% of respondents had severe stress levels. 28% of patients felt that stress had little or no effect on general health. Furthermore, 29% of patients indicated they never take steps to reduce stress. Examples of stressors that were listed in the survey varied in sources. These data suggest stress is substantially present in this rural community. A need to address the health concerns that may be associated with increased levels of stress and careful inquiry by primary care physicians into potential stress would likely benefit the management of patient health issues in a rural community. Identifying and addressing stress related symptoms would likely yield many benefits, i.e. productivity at the work place, increased coping strategies, etc. Television and Childhood Obesity: Spreading the Message in Harney County Project Date: 5/10/2004 Childhood obesity is a problem across the country with health implications for the present and future. Recent studies have shown that reduced time in front of the television for children and adolescents may help prevent obesity. While community groups and programs exist in Burns to promote youth fitness, no one has specifically outlined the role television viewing has on childhood obesity. The purpose of this project is to educate patients and the community about reducing time in front of the television and its potentially significant impact on childhood obesity prevention. This will be done through an article publication in the Burns Times-Herald and a public service announcement on local radio stations, KQHZ and KZZR, all in association with the physicians at High Desert Medical Center. In addition, a patient handout will be made available in clinic to help parents develop good television viewing habits with their children. Are the Diet and Exercise Habits of Middle & High School Students in Coos County Influenced by the School Environment? Project Date: 5/10/2004 The school environment has been shown to be a powerful determinant of child and adolescent diet and exercise habits. However, facets of school environment’s are believed to be unconducive to, as well as not fostering or promoting, healthy diet and exercise habits among students. In an effort to see whether the diet and exercise habits of students in Coos County School District are influenced by their school environment, 448 middle and high school students were surveyed. Specifically, their intake of fast food, candy and carbonated beverages, as well as their participation in school PE, or other physical activity was queried. They were also asked their responses to hypothetical situations where the school environment was modified, such as if vending machines were removed from campus, if they were not allowed to leave campus for lunch, or if PE were a required class. The results of the survey show that the school environment does indeed influence students’ diet and exercise habits. Furthermore, a majority of students indicated that they would relish changes to their school environment that would help foster healthier diet and exercise habits among them. Childhood Obesity: How Does Lebanon Compare to the Nation? Project Date: 5/10/2004 Background: Obesity is becoming a major public health problem that needs to be addressed in the clinical setting. The National Health and Nutrition Examination Studies (NHANES) have monitored the prevalence of overweight children in the United States for the past three decades. The most recent NHANES study shows about 15% of children ages 6-19 are overweight. Problem: The prevalence of overweight children in the Lebanon, Oregon community is unknown. Non-systematic observation would suggest the prevalence of overweight children to be greater than the national statistic. To determine the prevalence of overweight children in the Mid-Valley Family Practice Group (Lebanon, Oregon), a cross-sectional study was conducted. Methods: The sample population was derived from children who presented to the Mid-Valley Family Practice Group (Lebanon, Oregon) for well child exams during 1999 and 2000. A total of 77 charts were reviewed for height, weight, and age. Children with a body mass index (BMI) of ³ 95th percentile for age and gender were identified as being overweight. Results: In the study population, 20% of children ages 6-11, and 35% of children ages 12-19 were overweight. Conclusion: Childhood obesity is a real health problem both nationally and in the Lebanon community. Clinicians should be aware of this growing number of overweight children, monitor BMI on a yearly basis, emphasize prevention in non-overweight children, and recognize when intervention for weight loss is indicated. The Ontario Aquatic and Fitness Center Project Date: 5/10/2004 Intro: The Ontario Aquatic and Fitness Center offers opportunities for people of Malheur County to swim, lift weights, or participate in water aerobics. After arriving in Ontario, it was mentioned that funding for the center was in jeopardy. After talking with my preceptor, individuals at the center, and other local health care professionals, I decided to create a usage survey for the facility to try to help determine who was using the center and for what specific reasons. Materials/Methods: A simple survey was designed asking for age, city of residence, average number of visits to the center in a month, and the main reason for the visit to the center. Five options were listed to select from for the main reason for the trip to the center. Results: 67.4% of the respondents used the center for water aerobics, which was indicated as their main form of exercise. Average age of this group was 67, with an average number of monthly visits of 12.3. The next largest group (18.4%) used the center for its gym, which was the main place they worked out. Average age was 39.6, with average monthly visits being 15.7. The remaining groups were those using the center for water aerobics, which was not their main form of exercise (10.2%), for physical therapy (2.0%), and for recreational swim (2.0%). Conclusions/Discussion: The results of the survey indicated that the center was utilized mainly by the geriatric population for water aerobics, which was their main form of exercise. The gym was used as a main work out facility by another large group, who tended to be of a younger generation. Average number of visits per month by each group was impressive. Given the benefits of exercise in several medical conditions, such as hypertension, diabetes, and osteoporosis, the center is serving a beneficial role in the health and well-being of many of Malheur county’s residents, particularly the elderly. A Diet Habits Survey of Scappoose Oregon. Project Date: 8/18/2003 Problem: Study the diet habits of Scappoose Oregon. Population: Patrons and employees of local businesses. Methods: A diet habits survey was circulated to local business for distribution to employees and customers. General Findings: The population of Scappoose had diet habits similar to the rest of the country with the majority of people eating a diet that was approximately 37% fat. There were however several areas where the population surveyed had better than average values. For example, 41% of female respondents adhered to a 30% diet. Scappoose residents in general made healthy choices with seafood with the majority of female respondents falling in the 25% fat category, and the male respondents in the 30% category. Beverage consumption was likewise better than the national average with the majority of female and male respondendts falling in the 30% fat category. Guidelines for the Assessment of Driving Capacity in the Elderly Project Date: 8/18/2003 As the elderly population continues to grow in the United States, physicians are acquiring the difficult task of assessing their patients ability to drive. Physicians frequently encounter questions regarding an individual's driving capacity. However, many doctors are not aware of resources available to help them in their assessment. Moreover, state requirements vary significantly. Most states have permissive reporting laws regarding the doctor's role in medical evaluation and managment for fitness to drive. Such laws offer physicians little guidance and may put doctors at risk for lawsuits if they report a patient to the Department of Motor Vehicles (DMV). Seven states, including Oregon, have mandatory reporting laws. In these states, a doctor may risk legal action for not reporting a patient. The purpose of this project was to elucidate helpful guidelines for rural doctors with geriatric patients in assessing fitness to drive. Another goal was to determine how a rural community affects this decision. Obesity Project Date: 12/30/2002 Obesity is a growing epidemic in the U.S. today. Currently obesity related diseases claim 300,000 lives yearly. If this trend continues, obesity will overtake smoking as the number one preventable killer of United States citizens. Obesity costs our health care system more than 330 billion dollars annually, which is approximately 12% of the national health care budget. It is an enormous problem. At the present there are no effective “quick fix” therapies for obesity. Drug therapy has been un-affective and gastric bypass is an option for very few. Good old-fashioned dietary control through lifestyle change and physical activity seem to be the most effective and long-lasting way to prevent and treat obesity. Because treatment is so difficult, the war on obesity begins with prevention. Children who are obese become adults who are obese. Obese six-year-olds become obese adults 50% of the time, while adult obesity rates from obese teens rise as high as 70-80%. Are we succeeding at preventing this obesity epidemic? Data suggests that primary care doctors are poor at screening for and treating the complications of obesity. Childhood obesity has nearly doubled since the 60’s and we are still not actively treating this epidemic. I set out to define the gravity of this problem in the West Salem Clinic. Both low-income and Hispanic populations are the populations with the greatest increase in childhood obesity in the last 15 years. The West Salem Clinic treats mostly low-income families and the majority of the patients are Hispanic. Providers at the clinic have noticed the problem for years and I set out to define the prevalence of childhood obesity in the West Salem Clinic and compare it to the U.S. population. After defining the prevalence of this at-risk population, I developed a detection and screening process to identify and treat obese and overweight children. I provided the providers of the clinic with a checklist of evidence-based guidelines for identifying the complications associated with childhood obesity. This detailed checklist includes prevalence data to convince providers of the importance of screening. I also made up a short checklist to be inserted in the chart if any child is ever identified as overweight on the BMI growth chart. Overweight is defined as a BMI >85 percentile for age and sex while obesity is >95 percentile. This checklist contains solid evidence-based screening tests that should be done on every overweight or obese child. Identifying and treating the medical complications associated with childhood obesity is responsible but the obesity itself must be treated to truly take care of your patients. Most physicians encourage diet and exercise but most folks are unresponsive to these vague suggestions. Diet and exercise is accomplished through lifestyle change. Lifestyle change is very difficult and it must be encouraged and followed in a gradual step-wise fashion to prevent failure and assure lo The Skinny on Losing Weight: Obesity and Treatment Recommendations for Adults at Philomath Family Medicine Clinic Project Date: 3/25/2002 According to the most recent national surveys, overweight and obesity have become an epidemic in the US. The health risks associated with obesity are enormous including hypertension, diabetes, dyslipidemia, non-alcoholic steatohepatitis and sleep apnea. An information survey of patients at Philomath Family Medicine clinic showed that overweight and obesity are significant problems. 61% of adults between the ages of 18 and 63 are either overweight or obese: one third are overweight while 28% are obese (BMI>30). The combined prevalence of overweight and obesity (BMI>25) is 62% in women and 60% in men. This is consistent with recent US national population surveys from the CDC. Although a majority of those who are at least overweight reported having a discussion of the dangers of obesity with their doctors, only a handful received guidelines on how to effectively and safely lose the weight. The goal of this community project is several fold: 1) to assess the nature of the problem with obesity at Philomath Family Medicine clinic, 2) to formulate recommendations for managing and treating obesity and 3) to develop a patient education handout on healthy approaches to losing weight. Back to subject search page or search by preceptor site