RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Frequency and Types of Dermatological Diagnoses in a Rural Primary Care Practice in Klamath Falls, Oregon Project Date: 6/29/2009 Dermatological disease is frequently encountered in the primary care setting. Some studies show that up to 36.5% of patients who presented to their primary care physician (PCP) had at least one skin problem. The current literature regarding dermatological disease in primary care has mainly been done in urban areas, and little data exists regarding the frequency of dermatological diseases seen by PCPs in rural areas. The goal of this project was to determine the frequency and types of distinct dermatological diagnoses in a family practice in Klamath Falls, Oregon, from July 2006 through July 2009, in order to establish a baseline of data regarding dermatological disease in a rural primary care setting. A total of 437 unique dermatological cases were seen by the PCP during the three year interval, amounting to 2.7% of total patient visits. The diagnosis of actinic keratosis was most common (18.1%) and is attributed to the high amounts of sun exposure in many of the area's occupations and popular outdoor activities. These results will be used to inform rural primary care practices and direct continuing medical education. Due to the high number of sun-related diagnoses, a sun safety poster from the American Academy of Dermatology was chosen and offered to be placed in exam rooms as an educational tool for patients. Hearing Loss in Rural Oregon Project Date: 2/9/2009 As with many conditions, the prevalence of hearing impairment in rural areas is greater than that of urban areas. While a number of causes for this discrepancy have been identified, one prevailing and preventable reason is the increased noise exposure inherent in rural occupations such as agriculture and manufacturing as well as activities such as hunting. With prevention in mind, two populations were identified and surveyed, and a unique intervention was formulated for each group. The first group included elementary students, for whom an educational program focusing on the science of hearing and the prevention of hearing loss was introduced. The second group consisted of individuals at increased risk of hearing loss as a result of noise exposure. For this group, a patient handout was created that focused on education, prevention, and intervention, as it included a hearing impairment questionnaire and a list of local resources for those requiring further evaluation or treatment Recent Onset Cardio-pulmonary Disease in Three Fiberglass Plant Workers in Hines, Oregon Project Date: 3/17/2008 In 2007-2008 High Desert Medical Clinic in Burns, Oregon saw 3 patients who presented with acute-onset respiratory and cardiovascular illness after working with fiberglass at the Monaco Coach Corporation’s plant in neighboring Hines, Oregon. Purpose of the study: (1) identify what substances are used in fiberglass manufacturing that may cause cardio-pulmonary disease, (2) evaluate methods of protection used by the Monaco plant against occupational exposure to these substances, (3) consider ways in which the local medical community and plant management can improve public health regarding the occupational hazards associated with fiberglass manufacturing. Conclusions: (1) the Monaco plant has a thorough exposure protection policy that exceeds the requirements set by law or insurer, (2) although styrene is the principal toxin used in fiberglass manufacturing that is measured by regulatory bodies, there are other agents, such as fire retardant filler, phthylates, and fiberglass dust particles, that may be associated with respiratory and cardiovascular illness in plant workers. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. Increasing Awareness; Decreasing Risk: Hispanic farm workers and pesticide education in Hood River, Oregon Project Date: 10/17/2005 Hood River, Oregon is the largest city in the 4 county Mid-Columbia region which spans the Columbia River Gorge between northern Oregon and southern Washington. The area is famous for fruit production, with raising and harvesting of cherries, apples and pears heavily dependent upon the region's large Hispanic population of seasonal farm workers and migrants. Though all Americans are exposed to pesticides, many studies have supported the fact that farm workers and their families are the most vulnerable to both the acute and chronic deleterious health effects of the more than 16,000 different pesticide products currently in use in the United States. Studies have indicated that potential chronic adverse effects of pesticide exposure include cancer as well as reproductive and developmental, immunological, neurological and behavioral effects. Though an official system exists across the country for notification of acute pesticide poisoning events, little emphasis is currently placed upon the long-term effects associated with chronic, low-level pesticide exposure. La Clinica del Carino, a federally qualified community and migrant health center established in 1986 in Hood River, Oregon, has been an active advocate for farm worker health for 20 years. This study attempted to clarify the reasons behind the current lack of focus on this important area of farm worker health in both the clinic and the community as a whole, as well as to suggest appropriate avenues for educational interventions in the future. Assessing Occupational Asthma at Bright Wood Corp in Jefferson County. Project Date: 8/8/2005 Bright Wood Corporation is the largest employer in Jefferson County. Bright Wood, privately owned by the Stovall Family, is a group of secondary wood processing facilities that have many occupational hazards that contribute to the morbidity and mortality of the Central Oregon community. Bright Wood has done a respectable job lowering the acute injury rates, but many long-term morbidities have not been studied. Prior studies in occupational medicine highlight occupational asthma as a potentially unappreciated morbidity associated with wood dust. The objective of this study was to evaluate asthma rates within the community and comparing them to asthma rates within the Bright Wood employees seen at Madras Medical Group. Farming and Ranching Injuries in Ontario Oregon: Survey of injury occurrence and development of a patient handout on farm safety Project Date: 7/5/2004 In Ontario Oregon, where agriculture is a cornerstone of the economy, farming and ranching injuries contribute to the morbidity and mortality of the community. The main objective of this study is to understand the epidemiology of machinery, livestock and exposure related injuries that affect those patients and their families seen at Dr. David Brauer’s family practice clinic. Approximately forty percent of Dr. Brauer’s patients are part of the agriculture industry. A survey of farming and ranching patients was conducted over a four-week period that evaluated if the patient, a family member, or employee had been injured in a farm or ranch related accident in the last two years. The second part of the study reviewed a random set of hospital charts coded for occupational injuries. The same statistics were recorded for both the patient survey and the chart review, and the data was compiled for the final assessment. Only twenty eight percent of 60 patients surveyed remained free of injury over the last 2 years. The highest rate of injury in the clinic survey occurred with machinery, then livestock, and lastly exposures. In the random chart review of thirty charts, livestock related injuries were the highest, followed by machinery and exposure related. After combining the two data sets, most injuries occurred to the upper extremity, and the 25-50 year old age group was at highest risk for injury. To complete the project, a patient handout was left at the clinic that details the findings specific to Ontario Oregon in the hopes to raise safety awareness. Mechanisms to avoid injuries by age groups are discussed in the handout. In conclusion, there is a need for a more detailed evaluation of ranching and farming injuries over a longer period of time with increased subject numbers in Ontario, Oregon and the outlying areas. It will also be important in the future to understand how effective tools are in increasing safety awareness. Evaluation of Occupational Asthma in Ontario, Oregon Project Date: 7/7/2003 Asthma is a common problem in the general population. Most of us are aware of the more common precipitating factors of asthma, such as allergens, exercise, infections, medications, and emotions. Fewer of us are familiar with those associated with occupational asthma. I became interested in occupational asthma during my rotation in Ontario, Oregon because my preceptor was a pulmonologist and because much of Ontario’s economy depends on industry and agriculture that works with known occupational hazards. In comparing the estimated prevalence of occupational asthma in the literature with the actual prevalence in my preceptors practice, I began to wonder whether or not occupational asthma was being under-diagnosed in Ontario. To evaluate this, my preceptor and I came up with a three part system to crudely estimate undiagnosed cases of occupational asthma relative to general asthma. Emergency Need Occupational Injuries in a Rural Town Setting: John Day, Oregon Project Date: 7/1/2002 Work place injuries continue to be a major concern in many blue-collar industries across the United States. In rural Northeastern Oregon these blue-collar industries are the predominant basis of the economy and thus on-the-job injuries are of major importance. This study was designed to evaluate which industries have the most on-the-job injuries that require emergency room treatment in and around the town of John Day, OR. The design was observation of Blue Mountain Hospital Emergency Department visits during a six-week clinical rotation with a local physician, as well as an extensive medical records compilation for the past year of all emergency room visits classified as on-the-job injuries. In this study, it was found that many injuries occurred as a result of inexperience in high turnover positions and seasonal, long work hour positions that led to intense physical activity without proper equipment and training. Of those injuries that were preventable in nature, lack of equipment such as proper gloves and boots as well as lack of training in operation of heavy equipment led to most injuries. Therefore, the most important conclusion of this project was that although these industries carry much inherent danger, better training and equipment could significantly reduce the number of work related injuries in John Day. Occupational Medicine In Malheur County. Project Date: 1/2/2002 The purpose of this project was to study how occupational medicine is being implemented in the community, and what strategies could be employed to improve communication between physicians and employers. Interviews were conducted of both physicians, physician assistants and various major employers in Malheur county. Outcome measures include identification of reportable and non-reportable OSHA (Occupational Safety and Health Administration) injuries, and determination of health care involvement in prevention and treatment of such injuries. Results revealed that in 2001 Oregon Trail Mushrooms had 66 accidents/injuries of which 13 were reportable to OSHA. Most injuries involved strains and sprains while only one injury involved the lungs. With respect to physician-employer relations significant improvement can be made to increase respect, confidence and coopertion. The report also includes information about taking an effective occupational history and some specific discussion about what physicians can expect when they tour a work-site. The Safety of the Logging Industry in Tillamook, OR: A Comparison of Today and Yesterday. Project Date: 11/5/2001 Logging has long been a mainstay of industry in the Pacific Northwest and in Tillamook Oregon, the history spans back through generations. Many families harbor a long line of loggers and with this comes many tales and scars to show. The logging industry is known as one of the most dangerous industries in the world. The annual fatality rate is more than 23 times that for all U.S. workers and the injury rate is nearly twice that of the entire private sector. The purpose of this project is to compare the present day safety measures and attitudes among the people in the industry with those of the first half of the century. Back to subject search page or search by preceptor site