RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Childhood Obesity: A review of literature to support development of a community intervention Project Date: 10/12/2009 besity is one of the leading health concerns in the developed world. Being overweight and obese as an adult has consequences of type II diabetes, cardiovascular disease, hyperlipidemia, and exacerbates other health conditions such as arthritis. Obesity is growing not only in the adult population but also the pediatric population. More than 16% of children are obese or overweight currently, a 4-fold increase in the last 30 years. These numbers are larger in underserved and minority populations. The Community Health Improvement Partnership (CHIP) in Madras, OR has initiated a number of programs in the schools and community to fight obesity. There is interest in focusing on pregnant women and parents of young children to change behavior before it becomes habit. Background research was needed to identify which groups to target and how to have to most meaningful impact at a reasonable cost for the community. A review of the literature showed 1) the early in life the intervention, the more successful, 2) Interventions should aim at decreasing sedentary activity and unhealthy food choices 3) Anticipatory guidance and reinforcement of breast feeding, delaying introduction of solids and parental nutrition knowledge building are effective tools in preventing obesity. Interest and Barriers to a new Nutrition Curriculum in Grants Pass Elementary Schools Project Date: 10/12/2009 Obesity and the related health events have become an epidemic throughout America. Health related habits are learned at a young age and reinforced throughout childhood. There are currently multiple movements to introduce more nutrition and health education to schools in an attempt to curb this epidemic. Specifically, in Grants Pass elementary schools a group wants to implement a nutrition and health curriculum however little was known about the status of the health education system and potential barriers. The goal of this project was to assess the interest and potential barriers to implementing the “Be a Fit Kid” nutrition and health curriculum in Grants Pass elementary schools. Interest was strong among the 5 physical education teachers interviewed. Each pointed out potential barriers to consider with implementation of the curriculum. Results of these interviews were used as a foundation for writing a grant to fund the program. Harney County Tobacco Use, Perceptions, and Education: The Tar Wars Experience Project Date: 9/7/2009 Tobacco use and abuse including cigarettes, cigars, and smokeless tobacco is the number one preventable cause of death in the United States. Smoking has been linked to approximately 1 of 5 deaths annually. Each day in the United States approximately 3,600 young people between the age of 12 and 17 try tobacco for the first time. It is estimated that 1,100 of these young people will become daily users. Currently 1 in 5 Americans use tobacco on a daily basis. Oregon’s average tobacco use is similar to that of the greater United States. However regions in Oregon, like Harney County, have data illustrating much higher use in both adults and school aged children. This project was designed to investigate the perceptions and educate school-aged children in Harney County. This included epidemiological data review from Harney Behavioral Health, state data, and national data. Next, a survey investigating perceptions of 135 students, representing 80 percent 4th and 5th graders from Harney County, was created and administered. The final aspect of the project included educating 4th and 5th graders about tobacco use through the Tar Wars curriculum so young adults can make educated decisions about tobacco use. Meeting the Need: Is the Pediatric population in Coos County adequately covered by the medical community? Project Date: 8/3/2009 There are eight pediatricians in Coos County serving the Coos Bay and North Bend communities. They meet regularly to address current and emerging concerns to their patient population. At a recent meeting, it became apparent that the current coverage for the pediatric community was unknown. This analysis seeks to reveal more information about the pediatric population in Coos County, including the population of the pediatric community, the number who receive at least annual care, and the principle means of payment for healthcare received. The data was collected using US Census information, collaboration with the two pediatric clinics, and with data from the catchment clinic in the county. This data indicates that no more than 55% of the pediatric population sees a pediatrician, and less than 60% receive care either from a school based clinic, a catchment clinic, or the pediatricians. Ontario Greenhouse Project: Phase 5 Project Date: 6/29/2009 Obesity is a nationwide epidemic, and primary prevention is aimed at combating childhood obesity. Malheur County in Oregon has some of the highest risk children in the state. The Ontario greenhouse project has been in the planning process for the past year with Dr. Sandra Dunbrasky, the community pediatrician, and rotating medical students from Oregon Health Science University. The project’s goals are to implement a greenhouse at a local elementary school in order to get students involved in hands-on learning about raising, harvesting, and consuming the CDC recommended daily amount of fruits and vegetables in the hopes that obesity will be successfully prevented. The current phase of the project centers on securing funds to get the program implemented by fall of 2010. Grant proposals were submitted to various national agencies due to the shortage of local donor support in the rural setting. Non-Medical Exemptions to Immunization in Josephine County, OR Project Date: 6/29/2009 Religious and personal-belief exemptions to mandatory childhood vaccinations are increasing in states across the country with Oregon having the fourth highest overall rate. Within Oregon, Josephine County regularly ranks near the top in terms of annual "religious" exemptions to immunization. Oregon's process for attaining an exemption is easier than in most states. While Oregon does not have a "personal belief" exemption, state law defines "religion" broadly as "any system of beliefs, practices or ethical values." In this study, I looked at rates of religious exemptions within Josephine County as well as factors associated with "vaccine hesitancy". I found that vaccine-hesitant and non-hesitant parents did not differ in terms of engagement in religious or other groups. Vaccine-hesitant parents, however, were significantly more likely to use friends or the internet as sources of vaccine information but significantly less likely to use health-care providers. This student emphasizes the importance of outreach by health-care providers to vaccine-hesitant communities and stresses the importance of crafting firm but constitutional laws mandating childhood vaccines. Updating Clinic Procedures and Policy regarding VFC vaccinations at the High Desert Medical Center Project Date: 6/29/2009 Vaccines for Children is a division of DHS that offers vaccines to public and private clinics for dispersal to underserved kids. With the DHS’s current goal of vaccinating 90% of children in the US, providing vaccines at a discounted rate for economically disadvantaged children is vital for protecting the health care of many communities. 4 Up until recently, High Desert Medical Center in Burns, OR was offering VFC vaccines to their eligible clients. However, this spring the VFC recalled 2 years worth of vaccines given by the clinic from 2007 to 2009 due to a defective refrigerator. Part of the requirements of re-instating VFC vaccines at HDMC included a staff-wide review of VFC policies for administration, storage, and handling of the vaccines. The VFC guidelines were reviewed, and nurses in clinic were interviewed about current clinic vaccination procedures. An abbreviated version of VFC vaccination policy was created and presented at the clinic’s monthly nurses’ meeting. In addition, a clinic-specific SOP was created for administration and documentation of vaccinations during well-child checks for both VFC and privately insured children. Health Literacy and Readability of Patient Education Materials at the Klamath Falls Pediatric Clinic Project Date: 6/29/2009 Health Literacy is defined by the Institute of Medicine as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” Limited health literacy may affect some 90 million American adults, and has been postulated as a link between socioeconomic inequality and health disparities. In the pediatric realm, limited health literacy skills among parents or caregivers have been associated with poor health outcomes. This study assessed a measure of health literacy among the primary caregivers (usually parents) of patients at the Klamath Pediatric Clinic in Klamath Falls, OR. One concern regarding health literacy is that patient education materials may be written at levels that are inappropriate for the average patient or caregiver. To determine whether this is the case at the KPC, a number of the handouts distributed at this clinic were assessed for their readability. The average grade level at which caregivers read was compared with the average grade level at which patient handouts were written. Caretaker health literacy was approximated using the Rapid Estimate of Adult Literacy in Medicine-Short Form, administered to parents and caregivers by the medical student prior to appointments in the clinic. Common handouts given to parents, including those about well-child care, normal development and some common childhood illnesses were assessed for their readability using the Flesch-Kincaid Grade Level Formula. According to the REALM-SF, 15 out of 40 caregivers (37.5%) read at a 7th or 8th grade level and therefore are at risk of low health literacy. The average grade level of all the handouts assessed was 6.3, with a range from a 1st grade level to a 10th grade level. Thus, some of the patient education materials used in the clinic may be written at a level that is too advanced for some of the parents of children in the clinic to understand. Care Management for Foster Children at North Bend Medical Center Project Date: 4/27/2009 An improved system of implementing health care recommendations for foster children and an increased ability to track this vulnerable population would provide benefits to these children to ensure their health care needs were being met. Pediatricians at North Bend Medical Center in Coos Bay, Oregon have served at least 140 foster children in the past three years and recently hired a Care Manager to ensure adherence to health care recommendations for specific populations. I explored the specific recommendations for health care visits, tests, and referrals for foster children and developed a system to implement and track these patients. Community connections were established between the Department of Human Services and the clinic. A summary of recommendations was compiled for distribution to clinicians to increase awareness. A “health profile” was created to consolidate health information of foster children for increased accessibility for clinicians and foster families. Lastly, a series of care management plans was created to improve adherence to current recommendations for the Care Manager to utilize. The documents created and connections established will provide a framework to ensure that foster children are receiving adequate health care. Teen Driving Safety in Scappoose and Columbia County Project Date: 4/27/2009 Motor vehicle accidents (MVA) are the leading cause of death for young people in the United States and Oregon. Teen driving safety has received increased attention in recent years from national healthcare bodies such as the American Academy of Pediatrics (AAP) which recommends that primary care physicians educate teenage drivers and their parents regarding risky teen driving behaviors. Statistical analysis as well as interviews with local residents of Scappoose and Columbia County indicated the need for such a primary care educational initiative. Following the recommendations of the AAP, an educational handout was formulated providing information on teen driving risk factors and ways to avoid them. Also included was a driving contract designed to be used by parents when talking with their teen about driving risks. This contract establishes a set of restrictions on driving consistent with a Graduated Drivers Licensing program with associated punishments for bad behaviors and rewards for good behaviors. These materials were made available to patients frequenting the clinic as part of a well or ill visit and are intended to be used in the same manner as other preventative educational materials such as handouts on tobacco avoidance, guidelines for good diet and exercise, and safe sexual practices. It is hypothesized that education on the dangers and risks of teenage driving directed at parents and teens as part of a medical visit in the Scappoose OHSU Family Medicine Clinic with a physician or other healthcare provider is an important step in reducing injury and death related to MVA in the community Identifying Children Vaccinated from March 2007-April 2009 at the High Desert Medical Center in Burns, OR Project Date: 4/27/2009 When 2 years worth of vaccines from the Vaccines for Children program were retrospectively deemed defective due to refrigerator temperature irregularities, the High Desert Medical Center needed to identify the children who may need revaccination or titres from that time. 221 children were identified using billing codes for pediatric vaccine administration, representing over 1000 injections for the common childhood vaccinations. Estimated cost of VFC vaccines alone used in that period was over $45,000. Limits to identifying this population risk were an inability to identify payer type (private vs. the VFC) as only the VFC is recalling the vaccines. Ontario Greenhouse Project: Phase 4. Synthesis, Relocation, Curriculum, Design Ideas Project Date: 3/16/2009 As medical students and simply as residents of America, we have all been made aware of the nation’s increasing problems with obesity. The prevalence of adult and childhood obesity are now at the point of being called epidemics. Unfortunately, the state of Oregon and especially the children of Malheur County are leading this growing trend. Greater than 25% of the kids in Malheur County are considered obese by their screening BMIs. The Ontario Greenhouse Project is an attempt to combat this rising obesity by teaching kids about healthy food, engaging them in the growing and harvesting experience, and ultimately aiming to change the way children think about and choose the food that they eat. Ontario is the largest town in Malheur County and the hopes are that if this project is successful, more school greenhouses and gardens could be adopted throughout the county and state. The first three phases of the project consisted of 1) research into why this idea is needed, how feasible it is to accomplish, and how we could estimate the success of the project after completion; 2) research into similar programs on the West Coast and an estimate of cost; 3) gathering public support by making teacher and parent-oriented presentations, contacting local media to assess their interest in promoting this cause. By the time phase 4 of the project was initiated, the school that had agreed to be the demo school for this greenhouse announced that their principal would be leaving by the end of this school year. Phase 4 then aimed to approach another school with the idea, thus needing to summarize and condense the work already done into an efficient presentation, and to add some more specifics as far as proposed timeline, materials and recommendations for design, and ideas for curriculum in the greenhouse and in the classroom based on other programs and their successes and challenges. A presentation was made to the principal of Pioneer Elementary in Ontario and now the plan for the near future is to present the project to the superintendant and the school board over the next few months. Connecting At Risk Infants with Community Resources: Reducing abuse, neglect, and crime Project Date: 3/16/2009 Child abuse is a tragic, costly, and persistent problem; the primacy of infancy implies that these events will follow a child through the rest of his/her life. In the current economy the local population of Jefferson County has been hit hard, particularly with unemployment as major industries have closed their doors. At times like these the risk to children climbs and the need for child abuse prevention is more acute. A local program, the Ellsbury-Read Project, is trying to effect this change through new parent education on brain development in addition to promoting character development through the rest of childhood. The intention of my project is to add materials to the project to allow teaming with medical professionals. I had four main end points: 1) A simple refresher card (Spanish, and English) for new parents based a on brain development DVD the program has to show parents before discharge that will be dispensed at WCC, 2) A review of the most recent literature regarding the complications of abuse/neglect on the developing mind, particularly the hyper-sensitization of the HPA axis, 3) a complete succinct list of community resources for at-risk infants 0-2y.o. explaining services and restrictions, 4) an addendum with risk factors and programs specific info, to either add or attach to current WCC forms, was the final end point. All final products were given to the project and clinic for use as desired. Phase III of the Ontario Greenhouse Project: Gathering Public Support Project Date: 2/9/2009 The problem of obesity within the United States has reached what some have labeled as "epidemic" proportions. Over the last 30 years, the percentage of obese adults within the US had doubled, and the percentage of obese children has nearly tripled. Obesity is the result of ingesting more calories than one expends through physical activity. Hence, reshaping the food choices children make on a daily basis can have a lasting impact on both their weight and their health. The Ontario Greenhouse project strives to do exactly that. The project is a multi-phase endeavor to build a school greenhouse in which the entire student body can participate in growing fruit and vegetables that can be served in the school's cafeteria. This hands-on experience would be supplemented by classroom-based nutrition education and instructional sessions in the greenhouse run by farmers and Master Gardeners from the surrounding area. The goal of the current phase, Phase III, was to gather public support by creating teacher- and parent-oriented power-point presentations to introduce the project to administrators, teachers and parents within the district. In addition several local media outlets were contacted and asked to help garner public support by mentioning the project to consumers. Finally, a wide variety of local community members, as well as leaders in the school garden movement, were contacted and asked to participate on an advisory committee for the project. By involving the community in the nutritional education of children, the project aspires to change the way children and their families approach healthy eating, and thereby improve the overall health and well-being of Ontario's citizens. Vaccination Hesitancy in Lebanon, OR Project Date: 2/9/2009 Increasingly more Oregonian parents are hesitant to adhere to physician-recommended vaccination schedules for their children. This student attempted to a) accurately describe the rate of vaccine hesitance and b) define reasons behind this hesitancy in Lebanon, OR. Rates of non-vaccination in Lebanon were computed by data from the Linn County Public Health Office. Patient opinions regarding vaccines were collected from 30 patient interviews. The interviews were formatted on a questionnaire created by the investigator. In addition, conversations were conducted with pediatricians and DHS officials regarding this subject. Based on the data from Linn County Public Health, Lebanon has a lower rate of vaccine refusal than the state average. Parental concerns regarding vaccines appear to reflect those expressed in a large-scale statewide study, chiefly among them 1) the belief that children are generally vaccinated at too young an age and 2) concern for a link between vaccines and autism. Play it be Ear: Designing a Program of Pediatric Anticipatory Guidance for the Prevention of ED and After Hours Clinic Visits for Ear Pain Project Date: 2/9/2009 Ear pain and parental concern for acute otitis media (AOM) drive a high proportion of acute care visits for children. For the past 5 years, otitis media has been consistently among the top three most frequent reasons for pediatric ED visits at Bay Area Hospital in Coos Bay, Oregon. The ED and the urgent care pediatric After Hours Clinic are vital components of the regional health infrastructure, though with limited resources that are often strained by misuse and overuse. Recent studies have demonstrated that such reduction in after-hours and emergency resource utilization for concerns of otitis media can be achieve through directed anticipatory guidance. Consequently, it became the goal of the project to develop standardized anticipatory guidance, to be provided to parents during the most appropriate well-child visit. A survey of charts in the After Hours Clinic was performed, as well as interviews with local pediatricians and emergency room physicians. Moreover, literature review was conducted to determine most current guidelines of establishing pediatric anticipatory education, as well as current approaches to diagnosis and treatment of ear infections. The final product of this project was a comprehensive brochure on the diagnosis and treatment of pediatric ear pain and possible ear infections, which parents and legal guardians of all pediatric patients undergoing 15 months well-child visits with one of the pediatricians in the North Bend Medical Center, Coos Bay, OR. Pediatric Telephone Medical Care Project Date: 12/29/2008 Since its invention in 1876, the telephone has been used as a tool for delivering health care. The first recorded use of the telephone in pediatric practice was reported in The Lancet in 1879, describing the evaluation of an infant with croup using the newly developed telephone (Melzer et al. 2006). As the future of patient care continues to improve, the addition of telephonic medical care to the health clinic is now on the forefront of interest and debate. The opportunity for parents to call into the clinic with their child’s symptoms, speak with a physician, and receive counsel and treatment over the phone, may not only save time, but may extend care to a greater number of families. For many reasons, the pediatricians at the North Bend Medical Center are interested in establishing a telephone medical service to further extend pediatric care to their community. To better assess their current patients’ interest in such a service, we provided a survey to the parents of visiting patients that assesses the number of children, the number of visits, the number of phone calls, the length of travel time, their interest in speaking with a medical assistant or physician, and their willingness to pay out of pocket for telephone services. When asked to assess, on a scale of 1 to 5, their interest in speaking with a physician over the phone about their child’s medical needs, 88.2% marked interest levels between 3 and 5. . Of all those who took the survey, 63.5% of parents would be willing to pay for telephone medical care if their insurance does not cover it. Telephone medical care is about extending health care to a greater rural pediatric population. Its about saving families the anxiety and time that accompany last minute appointments, and helping those who cannot afford an office visit receive care from their pediatrician. Though the implementation of this service may be months in the making, forward strides are being made to increase pediatric services. 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. Eating Well on a Budget Project Date: 10/13/2008 Obesity is an epidemic in this country, affecting young people more and more. It is an epidemic that is seen in all social classes, but disproportionately affects people of lower socioeconomic status. The Coos Bay area is generally of lower income than the state as a whole. Several barriers to healthful shopping were identified throughout the project. While overweight and obese children were identified at the clinic, and all children had inquiry into their diets at each well child check, there lacked a comprehensive handout for patients who have trouble creating a menu to keep to their shopping budgets, while providing nutritious meals. This project was designed with the goal of creating an educational handout that would have nutritional information as well as a menu and recipes to demonstrate how a family of four might eat healthy meals for one month while sticking to a $400 budget, (this number based on DHS data showing that, on average, a person receiving food stamps is allotted approximately $100/month). Through working with a local chef, this pamphlet was created with the goal of being handed out in clinic, with the possibility of future distribution at local DHS offices. Childhood obesity in a rural setting Project Date: 10/13/2008 The prevalence of childhood obesity among US children has increased between 2-4 folds in the last 40 years. The state or Oregon has not been an exception from this nationwide epidemic and in fact one in four eighth-graders in Oregon are now overweight or at risk of becoming overweight. Studies have been conducted looking at the causes and origins of this potential disaster. However, few of these studies have been done in a rural setting. An array of environmental and social changes that severely challenge a family’s ability to make healthy choices for their children have contributed to this epidemic, including barriers to safe and accessible physical activity and fresh, nutritious foods, coupled with an increase in sedentary pastimes such as television and computers, known as "screen time", and more frequent use of automotive vehicles rather than walking and biking for transportation. This article is intended as a very preliminary beginning at studying childhood obesity in a rural setting with the ultimate goal of providing additional insight into this problem as well as potential possible solutions. Rate of Immunization in Florence and Parental Concerns Preventing Complete Immunization in Children at the PeaceHealth Family Medicine Clinic Project Date: 10/13/2008 Childhood vaccinations remain an important tool in preventing disease in individuals and populations. For example, since the introduction of the Hib vaccine, there has been an 80% decrease in invasive Hib disease. However, vaccines have recently been at the center of a media storm due to a hypothesized link between vaccines and autism. Much work has gone into researching this link and there is solid evidence to reject the causal hypothesis between the MMR and autism, however parents remain concerned. This project seeks to look at the rate of immunization in the rural coastal community of Florence according to the CDC vaccination schedule of 4:3:1:3:3:1 by age two and the barriers that exist to complete immunization. Here, I report that Florence has an immunization rate of 72% in 2006, which is similar to Lane County and Oregon rates, but remains below the national average. Furthermore, the physicians at the PeaceHealth family medicine clinic in Florence report the three most common concerns of parents that potentially prevent complete immunization are concern about autism, concern about the mercury-containing preservative thimerosal and concern about immune system overload. I summarized the evidence that dispels these three common myths in a brief handout for parents. Pediatric Obesity: Documentation and Intervention Project Date: 9/8/2008 Pediatric obesity is a rising epidemic that poses new challenges for clinicians to manage. The goal of this study is to design a clinic documentation tool that can be used to collect data and help focus possible interventions and subsequent progress in a Klamath Falls, Oregon pediatric clinic for patients with a BMI percentile greater than 85%. The design was gathering clinical information on how to manage obese patients, both from the literature and interviews with providers. Observations were made at Klamath Pediatric clinic on how documentation tools were implemented in the clinical outpatient workflow. This data was then synthesized into a document that could be implanted to help manage obese pediatric patients. The document consisted of a single piece of paper in which the front is filled out by the patient's family before the provider has seen the patient, and the back side is filled out by the provider during the office visit. The final product is a tool to manage overweight and obese pediatric patients by assessing obesity risk factors, probe possible interventions, and set goals. Postnatal and Well-Child Care in Grant County Project Date: 9/8/2008 Grant County is a rural area made up of 7250 residents and is primarily agricultural. The four physicians in John Day provide the primary care, obstetrics, gynecology and emergency care for these residents. Some have been under the impression that the infants they deliver do not always follow up with preventative care in the clinic. In this six week rural rotation it was also observed that some of the infants coming to the doctor were not always coming in for well-child visits. In a respective study of the two years of deliveries at the Blue Mountain Hospital it was found that 96.3% (n=107) of the infants had follow up visits. However, 11.7% of these had limited follow care, some not having any well-child visits. Grant County has the usual barriers to care, such as lack of insurance, low income, etc., but also had some unique rural barriers as well, including a long commute to see a doctor and a lack of physicians in the area. Recently John Day has lost two physicians and is looking to replace them. The absence or limited follow-up care of 15.0% could create a barrier to providing preventative care to the population in Grant County. Phase 2 of Ontario Greenhouse Project: Learning from other successful programs, estimating initial cost, and initiating community involvement Project Date: 9/8/2008 The children of Malheur County are greatly affected by obesity with a current rate of obesity that is 13% greater than the rest of Oregon. Obesity among children can be partially explained by the fact that children of Malheur County are eating fruits and vegetables far below the USDA recommendations. The goal of this project is to work towards introducing a greenhouse program at an Ontario school that will involve the student body in growing fruits and vegetables. Hopefully, such a program would curve the students’ food preferences towards more fruits and vegetables and help reduce obesity among the children. This will be a multiphase project, of which this is the second phase. The aims of this phase include: (1) learn from other greenhouse programs (2) estimate the cost of starting the program, and (3) initiate community involvement. These aims will be accomplished through review of available literature, interviews with members of the Ontario community, and contacting people from other greenhouse programs in Oregon. One can get many ideas and resources from other programs. The estimated original cost may range from $5-20K depending on the size and complexity of the greenhouse. Community involvement may be at an individual level, business level, and may include the local hospital and Malheur County Experiment Station. Juniper Junction Relief Nursery: Child Abuse Prevention in Jefferson County Project Date: 8/4/2008 Juniper Junction Relief nursery is a new organization developing in Madras, Oregon, to address the serious matter of child abuse in Jefferson County. According to the county website, in 2006, Jefferson County’s rate of child abuse was 10.5 per 1000 compared to 6.9 per 1000 in the state, and approximately half of the victims were under six years of age. Further outlined is the epidemic of alcohol and drug abuse in the county, the high rates of poverty and the effect these have on children and their health. Juniper Junction Relief Nursery’s main goal is to assist families with multiple risk factors for child abuse by providing therapeutic classrooms for children 0-5 years old, home visits from teachers, and parent education classes. The organization hopes to follow the Eugene relief nursery’s lead in also offering basic needs support, drug and alcohol support groups, respite care, mental health services and Latino outreach. All of the classes and support revolve around the family and keeping families together in a healthy, safe environment. After learning of Juniper Junction Relief Nursery, I attended a council meeting and interviewed different members to find out what needs they had and what I could do to help address them. After these interviews, a tour of the facility, review of the classes to be offered, and research of the original program out of Eugene, it was decided that pediatric health brochures based off of a class that will be offered, called, “What to do when your child gets sick” was the way I could best help advance the development of the nursery. I created 10 brochures in English and 10 brochures in Spanish that address basic healthcare concerns many parents, especially first time parents, seem to have. I also translated a Tylenol dosing chart into Spanish, that the clinic and the relief nursery both felt was needed. The main goal of the brochures is to help educate parents on the health problems their children may face and provide a source for the relief nursery to reach out to both the English and Spanish speaking population in the county. Ideally, these brochures and the knowledge provided to parents prevents unneeded emergency room visits and clinic visits for children. Phase I of the Ontario Greenhouse Project: Assessing the need for and Feasibility of a School-based Nutrition Education Program in Ontario, Oregon Project Date: 8/4/2008 The prevalence of childhood obesity in the United States has continued to increase over the last three decades to its current rate of 17%. The problem is particularly felt in Malheur County on Oregon’s eastern border, where greater than 1 in 4 children are obese. The Rural Clerkship preceptor in Ontario (Malheur’s largest town) has proposed a Greenhouse Project to address this problem, starting with a local elementary school. The aims of this phase of the project are three-fold: (1) to assess the need for such a school-based intervention, (2) to assess the feasibility of the Greenhouse Project, and (3) to estimate the successfulness of such an intervention. These aims were accomplished through review of the available literature and interviews with pertinent members of Ontario’s community, including members of an Ontario elementary school identified as a likely pilot site for the greenhouse. It also appears that the project is much needed, due to a lack of nutrition education in the targeted elementary school, as well as the aforementioned severity of the countywide childhood obesity problem. Additionally, the Greenhouse Project has potential to be a successful program; a few major concerns regarding the burden of this project on the school district were brought to light and suggestions are made herein as to how they can be addressed. It is hoped that this project can be carried through to completion with the help of other medical students that will be coming to Ontario for their Rural Clerkships in the future. Advancing Pertussis Prevention Project Date: 8/4/2008 According to recent research the incidence of “Whooping cough” is increasing in Oregon. Infants are both at the highest risk of contracting a severe infection that may be fatal and too young to be fully protected by immunization. The most common sources of pertussis in children are caregivers and loved ones, who often carry the disease and don’t realize they are passing it onto children. While most people are vaccinated against whooping cough as infants, new research suggests, that because immunity diminishes in adolescence, adolescents and adults should receive booster vaccines. Implementation of the recent CDC recommendation for adult and adolescent vaccination at NBMC will substantially diminish exposure to B.pertussis and reduce the burden of infant pertussis in Oregon. Supported by free vaccine from the DHS Oregon Tdap Special Project and the collaboration of many of the NBMC departments and providers, a system was organized so that all adolescents and adults can be vaccinated in Pediatrics clinic. The vaccine was ordered and the new Tdap program was presented at the monthly Pediatrics conference. Planting Seeds of Change: Improving the Health of the Community - an Edible Endeavor Project Date: 8/4/2008 Childhood obesity is an enormous issue facing the health care system, schools, and the community at large. This study examined a community initiative, Planting Seeds of Change, whose mission is to increase healthy eating habits and reduce childhood obesity through a garden based educational endeavor. The project entails the formation of a school based garden which grows produce used in the school lunches and serves as a classroom without walls for the children of Seven Oaks Middle School. This study hoped to gather the pertinent information about the formation, maintenance, and future aims of the project so as to consolidate this information into a working summary to be shared with others. The study also examined the statistics of childhood obesity and literature which detailed community and/or school based efforts to combat obesity. Research was conducted via interviews, observation, and literature searches. The final result was a detailed PowerPoint presentation discussing Planting Seeds of Change and the literature supporting such a community based initiative, which will be utilized at several state and nationwide meetings and conferences. Optimization of the After-Hours Clinic in Coos Bay, OR Project Date: 6/30/2008 High use of the emergency department (ED) among pediatric patients is a major medical issue in Coos County, Oregon. The Bay Area Pediatric & Adolescent After Hours Clinic (AHC) was implemented in 2006 to decrease the ED flow of pediatric patients for non-emergency health conditions. This study was designed to gain an understanding of how the AHC has impacted ED visits in Coos Bounty and to identify potential improvements to the AHC. To learn about the AHC and its effect on the local ED, interviews were conducted with the AHC sponsors and founders. To identify areas of improvement, physicians and patients participating in the AHC were surveyed. The final product of this project was the development of an AHC brochure depicting the essentials of the AHC more comprehensively than materials currently available. Insights gained through interviews and surveys were incorporated into the construction of an information sheet. The ultimate goal was to increase awareness of the AHC and to provide information about this valuable community resource. The Oregon Wellness Policy and Input from Local Providers in the North Santiam School District Project Date: 4/28/2008 Purpose: The prevalence of childhood obesity has increased over the past several decades. Wellness Policies have been developed at both the national and state levels to combat this epidemic by providing healthy food in schools, promoting nutrition education and encouraging physical activity. This project attempted to gain a solid understanding of the Oregon Wellness policy requirements and ascertain what input the North Santiam School District, which encompasses the town of Stayton, receives from local health care providers. This information was compared to nearby districts including the similar Cascade and the much larger Salem-Keizer School Districts. Design and Methods: This was an observational study. Methods included in-depth interviews with food service directors in the North Santiam, Cascade and Salem-Keizer School Districts along with the cooks at the private St. Mary’s Elementary in Stayton (Appendix B). A thorough Ovid Pub Med search of the terms “nutrition” and “school” was also conducted and papers read for background information. Results: The Oregon Wellness Policy is an evolving set of guidelines for schools relating to all food, including entrees, al la carte items and beverages served on school property during an extended school day (Appendix A). Involvement from local health care providers, in all districts interviewed, was minimal. No district had a physician currently serving on their Wellness Committee. Future: This study was intended to identify areas for future research, including: surveying clinicians’ knowledge regarding the Oregon Wellness Policy and identifying barriers to their involvement with local school wellness committees. Action should then be taken to educate local providers on areas where they could participate in school nutrition. To immunize, or not to immunize: that is the question. Project Date: 4/28/2008 Immunization continues to be a critical component of preventative care and public health. However, in recent years, there has been increasing attention on the possible negative effects of immunizations on children, contributing to decreasing immunization rates and the recurrence of several vaccine-preventable diseases. This study attempted to identify the concerns of parents of pediatric patients at North Bend Medical Center in Oregon regarding immunizing their children. The design consisted of interviews with physicians and parents, as well as a survey of 65 parents of clinic patients which inquired about their concerns about vaccines. The most common worries were related to the perceived link between vaccination and autism, as well as general safety issues such as pain and side effects. The survey results were used to create a handout for use in the clinic which briefly addressed these concerns and listed reliable, easily accessible sources for more detailed information. Childhood Obesity in John Day: Building on Previous Work and Increasing Community Awareness Project Date: 3/17/2008 Obesity is a growing problem in the United States and its rise has been well documented and publicized as are the long-term health consequences of obesity. During the fall of 2007, during her Rural Community Health Clerkship at the Strawberry Wilderness Community Clinic in John Day, OR, Logan Thomas investigated the prevalence of obesity in elementary schoolchildren in John Day by analyzing height, weight, and sex information and calculating the BMI for all children at Humbolt Elementary School in Canyon City, OR. She found that 32% of children aged 6-11 years in John Day were overweight or at risk of becoming overweight, compared to 19% nationally. She presented this data to school district administrators and helped facilitate discussions of options for future action to address the problem of childhood obesity in their community. In these discussions, the consensus reached by school administrators was that initial efforts should be focused on educating the community. Interest was expressed in developing a handout for parent-teacher conferences to educate parents about the prevalence of childhood obesity in John Day and to give parents some hints and ideas on ways they can help improve their children’s health. I sought to gauge whether there was continued interest in such a handout and coordinate my efforts with those community members already actively working in the issue of childhood obesity. I developed handout for parent-teacher conferences that revisited Logan Thomas’ data and provided tips for parents to help improve their children’s health. It is currently being reviewed by the Grant County School District #3 Superintendent. I also developed a more extensive webpage that included the same information plus additional tips for healthy eating that is posted on the Strawberry Wilderness Community Clinic Website. Opportunities For and Barriers Against Watchful Waiting as an Initial Management Strategy of Acute Otitis Media in a Rural Pediatric Practice Project Date: 3/17/2008 Over-usage of antibiotics has been identified as a source of antibiotic resistance. To combat the emergence of drug resistance many groups have sought to identify diseases in which antibiotics are frequently used where they are needed to bring out resolutions of disease. Acute otitis media (AOM) is one such disease. In fact, AOM is the most common disease for which a child is given antibiotics. A recent statement by the AAP's Subcommittee on the Management of Acute Otitis Media has stated that observation without antibiotics is appropriate initial treatment of a sub-group of patients. A study published in JAMA in 2006 that was conducted in a metropolitan ED confirmed that watchful waiting in the form of "wait-and-see prescribing" (WASP) was not associated with significant differences with regard to subsequent fever, otalgia, or unscheduled ED visits when compared to day-of-visit prescribing. I wanted to see how often patients in the office-based pediatric practice in Grants Pass, Oregon were prescribed antibiotics for AOM when watchful waiting would have been justified by AAP criteria. I chose to do this because I saw more cases of AOM than any other disease during my rotation and noticed that most children received antibiotics as an initial course of therapy. To assess physician prescribing behavior I reviewed the charts of 55 patients seen between Jan 1, 2008 - March 31, 2008 who were diagnosed with acute otitis media. The patients were selected via ICD-9 code for otitis media. 55 patients with MRIPA insurance were seen between Jan 1, 2008 - March 31, 2008 and diagnosed with AOM. Six patients were excluded. Of the remaining 49 patients (provider breakdown: Ayoli = 18, Crispen = 12, Marshak = 14, Burnett = 5), 31 (63%) were eligible for watchful waiting according to the AAP. The remaining 18 (37%) fit criteria for immediate treatment. 46/49 patients were prescribed antibiotics immediately. 3/49 were offered antibiotics under WASP. All 3 WASP patients were eligible according to the AAP guidelines. Physicians were interview about barriers to WASP. Most common responses were financial burden of additional visits and fear of compromise to customer service element of modern practice. In the end a handout was created to facilitate the WASP discussion. Infant and Children's cough and cold medications - a handout for parents Project Date: 3/17/2008 The common cold, while a limited minor illness, is a frequent source of distress in new parents of infant children and accounts for millions of doctor visits. Children can average 6-8 colds a year. Over-the-counter children's cough and cold medications have been associated with visits to emergency departments and death in children under the age of 2 years old and as a result are no longer recommended for children <2 years old. Educating parents on the appropriate treatment of cold symptoms in their infant can reduce the use of cold medicines and adverse events from cold medicines. This study reviewed risks and benefits of cold medicines and other non-pharmacologic treatment options and appropriate recommendations were compiled in a patient handout. Childhood Obesity in Coos Bay, Oregon Project Date: 3/17/2008 Childhood obesity has become a significant health problem in the United States. The kids in Coos County, Oregon have not escaped this trend. With more unemployment and a smaller proportion of residents with a high school diploma, the children of Coos Bay are in fact at a higher risk of becoming overweight, and all the co-morbidities associated with that, than the rest of Oregon. How can the pediatricians of Coos Bay help combat this problem in the context of a busy clinic? Are there other resources available within the community to help? This project attempted to create a patient handout addressing these questions. To do this, research was done through the internet and medical journals. Community organizations like the public health department, the Boys and Girls Club, WIC and the school district were consulted. Furthermore, advice was elicited from local dietitians, social workers, nutritionists, physicians and other health care providers. In the end, a patient handout was created synthesizing the most relevant information for parents. They were taught how to recognize childhood obesity, the health consequences of this problem, suggestions for healthy living and contact information for programs that reinforced these healthy living tips. Furthermore, information was included for physicians who wish to refer their patient on to further counseling. Reedsport Elementary: What health complaints occur at school? Project Date: 2/11/2008 Taking care of the health needs of America's children seems to be a shifting priority over the last several decades. Health care concerns for children are not limited to the medical community but also affects school system. Reedsport Elementary has been able to secure a school nurse position which has been financed by a two year federal grant, and the specific health problems suffered by the school's children was quantified and categorized. Incidence logs from 33 consecutive school days were reviewed and data extracted. Data separated into health complaints and outcome of visit. An accurate, though limited, snapshot of health concerns at elementary school given in report. School nurse benefit difficult to quantify based on cases seen due to mass of other work that they do that is unseen. If school nurses contribute to overall safety and education of children at school they will always be an asset to staff and curriculum. Menos Pesticidas para los Ninos Felices Project Date: 12/31/2007 La Clínica del Cariño is a community health center dedicated to serving migrant agricultural workers and other community patients who would otherwise be without health care. Children in agricultural households have been shown to have higher levels of pesticide degradation products than both their urban counterparts and their own parents. Long term sequelae of these exposures are not uniformly accepted, however, reports have been made in humans that chronic exposure to pesticides can cause malignancy, neuroendocrine deficiencies, and sterility. Pesticides enter the homes of agricultural workers on clothes, boots, skin, and dust. Levels of household pesticides correlate with children’s urine levels of pesticide degradation products. It is reasonable to expect that reducing these sources of exposure for children could reduce their risk of serious long term sequelae. Currently, few providers at La Clínica assess their patients’ level of pesticide exposure and educate their patients regarding how to avoid exposing their children. This study uses a questionnaire to assess the attitudes of providers regarding pesticide education, identify barriers to pesticide education, and establish solutions to these barriers. Providers are interested in educating their patients, but they do not feel that they have enough time to do so and often forget. These issues will be addressed by changing the well child visit forms to include prompts to address pesticide exposure and educational handouts regarding pesticide avoidance strategies. Additionally, parent questionnaires have been added to screen for pesticide exposure, lead exposure, TB exposure, autism, and failure to meet developmental milestones. Development of the Jefferson County School Wellness Policy Project Date: 12/31/2007 During the past 20 years, there has been a dramatic increase in the prevalence of obesity in the United States, with more and more children becoming overweight and/or obese. It is thought that as much as 14% of 2 - 5 year old children and 19% of 6 - 11 year old children in the U.S. are overweight. This is becoming a growing health concern as there is a clear increase in morbidity and mortality associated with being overweight and obese due to increased risks of coronary heart disease and type 2 diabetes. Although obesity-associated morbidities occur most frequently in adults, overweight children and adolescents are more likely to become overweight or obese adults. Conversely, health-conscious and active children are more likely to maintain these habits into adulthood. The Jefferson County school district has received federal funding for a Community Health Improvement Project (CHIP) aimed at reversing the growing trend of childhood obesity in Central Oregon. To complete the first objective of the CHIP, a Wellness Policy was developed to be presented to the 509J school district for approval. This Wellness Policy is aimed to motivate and assist students aged kindergarten through twelfth grade to maintain and improve their health and prevent disease by shaping the children’s attitudes toward physical fitness, nutrition, and health. It focuses on improving district-wide school policy in four main areas: health and nutrition education, physical activity and physical education, nutritional standards, and policy review. What Are The Barriers To Childhood Vaccinations In Lebanon, Oregon, And What Can We Do About Them? Project Date: 12/31/2007 Undervaccination of children is a nation-wide problem. Every year, children die from vaccine-preventable diseases as the nation fails to increase the average up-to-date (UTD) at 24 months vaccination rate above 71%. Many resources are being developed to overcome barriers to increased vaccination rates, including computerized immunization programs that collect vaccination records on children in a geographical area rather than in a particular clinic. Mid Valley Medical Plaza (MVMP) in Lebanon, Oregon, is fortunate to live in a state with an established computerized immunization record, Oregon Immunization Alert (OIA). At MVMP, however, this valuable resource was not being fully utilized. The purpose of this project was to examine the current vaccination delivery system at MVMP and design a simple, efficient, and effective protocol to implement the use of OIA into the care of the family physicians’ pediatric patient population. The hope was that this would lead to increased vaccination rates. The study began with a quantitative study to determine the UTD rate of a small sample of the patient population, which revealed similar vaccination rates between MVMP and the nation. Interviews with healthcare workers revealed similar barriers in the clinic in Lebanon, Oregon as are faced in clinics across the nation. An extensive literature search on the barriers and solutions to vaccination delivery supported the integration of OIA to help improve vaccination rates in the pediatric patient population of MVMP. The protocol was then designed. In order to effectively convey the need for change, and therefore the worth of creating and implement a solution, a formal proposal to implement the simple protocol was developed. Fluoride Varnish: Parent Educational Pamphlet for Baker City. Project Date: 10/15/2007 Early childhood dental decay can lead to a variety of continuing health problems including extreme pain, difficulty chewing, poor weight gain, malocclusion, spread of dental infection into the body, and a decrease in overall health. Many communities in the United States add fluoride to the water supply to help decrease dental disease in their community. Oregon is ranked 48th out of 50th in the amount of citizens who receive fluoride in their water supply, which places Oregon children at a high risk for early childhood dental decay. Other risk factors for dental decay include low socioeconomic status and children living in rural communities. Fluoride varnish is one way to increase the fluoride a child can receive to prevent early childhood caries. Fluoride varnish has been used in European countries for the past 25 years to prevent early childhood caries. Fluoride varnish is also endorsed by the American Dental Association. Although the use of fluoride varnish is not approved for the use of caries prevention by the FDA, it is a common "off-label" use of the product. Early in 2007, Baker County began a fluoride varnish program for children within the county starting at the age of 9 months. Although the program has been enrolling children, there is little parent education on the benefits of fluoride, the services available to their children, and the importance of early dental health. Therefore, my project included producing a parent brochure with educational material about dental health and the benefits of fluoride varnish. Hopefully, the handout will help to increase enrollment in the fluoride varnish program. “Healthy Futures: Nurturing Children’s Development.” Project Date: 10/15/2007 A child’s early experiences profoundly influence his brain development and how he will interact with the world throughout his life.1 Increasingly, instruction and support in providing the nurturing and stimulation that children require for proper brain development is imparted to inexperienced parents by community resources. 2 One such resource, the Maternal Case Management program at the Jefferson County Health Department in Oregon, has just been eliminated due to low utilization. The Healthy Start program in Jefferson County is facing the same fate, also due to low utilization. The fact that both the teen pregnancy and child abuse rates in Jefferson County are higher than the Oregon state average suggests that lack of need of these social services is not the reason for their low utilization.3,4 Rather, lack of awareness of these social services is to blame for their low utilization, according to the local Community Health Improvement Partnership (CHIP) in Jefferson County. To increase awareness, and thus increase utilization, of social services available to infants and children in Jefferson County, I created a comprehensive list of these resources and made it available at the nurse’s station at the Labor and Delivery Department of Mountain View Hospital, the major hospital in the county. To encourage new parents to access this list of resources, I also created a video that explains the neurodevelopment that results from adults’ early interactions with infants, and the importance of enlisting social services when necessary to ensure that these interactions are positive and promote a child’s healthy development. This video is available in both English and Spanish, and will be required viewing for patients who deliver at Mountain View Hospital, prior to their discharge. Childhood Obesity Prevalence in John Day: A Project of Data Collection and Dissemination. Project Date: 10/15/2007 With more data and continued discussion of health effects, the obesity epidemic has become perhaps the largest health problem facing the American population today. Despite its prevalence and its proven health consequences, many communities continue to believe that obesity is not an issue. This belief is not easily altered. This study was designed to collect height and weight data from all children attending Humbolt Elementary School, calculated BMIs for each child, and then graph them on the CDC growth charts to determine the number of overweight and at risk of being overweight children in each age and gender category. On average, 32% of children in John Day are either overweight or at risk of being overweight. Research into national data, rural data, and rural Oregon data was done to provide context for the data collected in John Day, and this was presented together to the school district administration. After the presentation, a discussion of possible ways in which schools can enact change and various options for funding these changes was discussed with the school district administration. The end result of the project led to an increased awareness of the extent of the obesity issue in John Day and an increased interest in enacting change within the community to address this issue. Resources for Children with Autism Spectrum Disorders in Ontario, OR: Development of Resource Planning and Information Brochure Project Date: 10/15/2007 In Malheur County, the number of children with an autism spectrum disorder is estimated to be the highest in Oregon.1 The purpose of this project was to determine what resources were available to the population in theory and in actuality from interviews with healthcare providers, schools, therapists, and parents. The state provides for therapy as needed for each child to be delivered through the school, but the limited number of therapists in the area demonstrated that only a bare minimum of services were actually delivered, leaving many parents frustrated and hopeless. Furthermore, due to limited education resources, many parents did not fully understand the disorder, itself, or the services that were available to them. This project focused on determining what services existed and what could be further offered. In addition, a brochure was developed to give to parents, educating them on the basics of the disease, techniques to use at home, and resources that were available to them. Analysis of average body weights in selected pediatric populations between 1997 and 2007 in John Day, OR Project Date: 10/15/2007 The number of children in the United States who are overweight, or at risk of becoming overweight has reached epidemic proportions. Annual obesity-related costs in 6-17 year-olds exceed $127 million per year and project to far exceed this value in the future as these children mature into adults as obesity is a key risk factor for the development of many adverse health conditions including: hypertension, dyslipidemia, Type 2 diabetes, cardiovascular disease, sleep apnea and orthopedic pathologies. Increased consumption of foods high in calories and fat combined with decreased amounts of physical activity are environmental factors identified as key contributors to this obesity epidemic. As these environmental factors have become more prevalent in rural communities, the effect upon the body weight of children in these communities is a concern. The goal of this project was to evaluate changes in the average body weights of 5-6 year-old children, 9-10 year-old children and 13-14 year-old children in 1997, 2002 and 2007. The results of this study show that the weights of 5-6 year-old children in John Day, OR have significantly increased over the past 10 years and that the weights of both 9-10 and 13-14 year-old children are trending upwards. These results of this study were discussed with the medical community with the goal that increased awareness of this trend will lead to improved screening and implementation of preventative measures. Reminders to providers and parents as an intervention to address below-goal immunization rates Project Date: 9/10/2007 Rates of immunization at the Strawberry Wilderness Family Clinic were compared to those of other rural providers in Oregon and found to be lower than expected. The clinic staff was consulted to identify aspects of the immunization protocol which needed improvement. This lead to 1) creating a reminder to providers in the clinic EMR for children past due on immunizations and 2) assembling postcards to be sent to parents of past due children. These methods have been shown in the literature to improve immunization rates. Impact of these changes will be determined in future reviews of the clinic's rates. Additional interventions in clinic protocol, such as standing orders, and programs, such as Oregon AFIX, should be employed if rates continue to be below goal. Improving information and support services available for parents of autistic children Project Date: 9/10/2007 The prevalence of autism in the United States has increased over the last ten years. Parents of an autistic child face many challenges, as their child often has additional health care needs such as physical, occupational, and speech therapy, and requires specialized educational programs. Parental support and education about autism are important aspects of caring for an autistic child, as a child’s home environment can greatly improve his/her overall functioning. The goal of this study was to evaluate what kind of information and resources parents of autistic children at Siskiyou Pediatrics in Grants Pass, Oregon were given. Interviews with pediatricians and parents revealed the need for a concise patient brochure with information on local and regional autistic services. Through an internet search, different agencies providing parental workshops and support groups in the southern Oregon region were located. As a result, a patient brochure was created which the pediatricians at Siskiyou Pediatrics can give to parents of autistic children. Hopefully, this information will be beneficial to parents as they will be equipped with the tools they need to understand, manage, and improve their child’s condition Pertussis Outbreak in Union County Project Date: 9/10/2007 Whooping cough is a highly contagious respiratory illness caused by the bacteria Bordetella Pertussis. Classic symptoms include bursts of coughing followed by a large inspiratory effort, cyanosis, apnea, and post-tussive vomiting. complications of the disease are most common in children less than one year old and include pneumonia, encephalopathy, pneumothorax, and seizures. Due to waning immunity from childhood vaccines, adolescents and adults, who experience milder symptoms, often transmit the disease to younger and more susceptible people. While I was completing my rural rotation in LaGrange, OR, Union County was battling its first pertussis outbreak in recent history. I used the pertussis outbreak in Union county learn about the community-wide management of communicable diseases. In addition to doing an extensive literature review, I interviewed personnel from the Union County Center for Human Development (CHD) who were intimately involved in management of the outbreak. I then summarized the results and offered suggestions for improvement. I also developed a condensed handout to which physicians can easily refer when they encounter potential pertussis cases in their offices. Evaluation of Childhood Immunization Delivery in John Day, OR Project Date: 9/10/2007 Childhood immunizations are an important public health initiative in preventing what were once common causes of childhood morbidity and mortality. Rural children may face increased barriers to immunizations due to living in medically underserved areas. In John Day, OR, the Grant County Health Department provides and tracks the immunizations for all of the patients seen by Dr Holland. The objective of this study was to evaluate immunization delivery, compare records between the clinic and the health department, and suggest strategies by which immunization rates can be improved. An analysis of all of Dr Holland’s patients aged 19-35 months (22 children) was conducted using patient charts and health department immunization records to determine immunization status at 24 months, as well as percentages of late starts and missed opportunities. These results were compared with similar data from January 2006 for Dr. Holland’s clinic recently released from the Rural Oregon Immunization Initiative (ROII). The percentage of children up to date with the recommended series of 4 DTaP; 3 IPV; 1 MMR; 3 Hib; 3HepB; 1 Varicella was 72%, which is an improvement from the rate of 57% found by the ROII. The percentage of children up to date by 35 months was 77%, that of late starts was 18% and of missed opportunities 9%. While these rates are all improved from the ROII data from 2006, they are not yet reaching the Healthy People 2010 goal of 80% or better coverage. The rates could be improved by decreasing the percentages of late starts and missed opportunities, by improving communication between the health department and the clinic, and by addressing parents concerns and fears about immunizations. The clinic will begin using the ALERT immunization registry to better track immunizations and remind patients of due vaccines. All children found by this project to be behind on their vaccines were notified and encouraged to complete the series. Caregiver Perspectives on Childhood Obesity in the Warm Springs Community Project Date: 9/10/2007 Background: Much like other Native Americans across the United States, the Native Americans of Warm Springs, OR have high rates of obesity, regardless of sex or age. Caregivers have the opportunity to exert significant influence over the factors that contribute to obesity among their children. Methods: The BMI profiles of 600 Native American children in Warm Springs from age 5 through 14 were determined from electronic medical records. A survey tool was then developed and used to survey 19 caregiver-child pairs in the community. The survey recorded the height and weight of the child, and asked qualitative questions of the caregiver regarding the child’s weight, factors contributing to weight and general health. Results: Electronic medical records showed that 56.8% of children ages 5 through 14 were either at risk or overweight. On the caregiver survey, only 50% of caregivers of children who were at risk or overweight actually believed that their child was either “slightly overweight” or “very overweight.” For children who were at risk or overweight, 30% of caregivers agreed with the statement: “Some people are born to be fat and some thin; there is not much you can do to change this.” While the vast majority of caregivers believed that what a child eats (95%) and how much a child exercises (95%) are “very important” to their present and future health, only about two thirds of all caregivers believed that how much time a child spends in front of a TV (69%) and how much a child weighs (63%) are “very important” to their present and future health. About a third (37%) of all caregivers were “not at all concerned” that their child would get heart disease in the future. Bringing Community Connections Network To Your Practice and Patients Project Date: 7/2/2007 Continuity of care, identification and access to community resources, and care by specialists are just some of the problems children with specials needs in rural areas may face. How can these children and their families obtain what they need if their primary care provider is unaware of the help that is out there? This study attempts to identify what primary care providers in Coos County and surrounding areas know about Community Connections Network (CCN). Forty-four care providers were identified and given a survey to asses their understanding and use of CCN, and to identify ways to help them bring CCN to their patients. They were also given up to date information on what CCN offers, who they serve, and how to refer in hopes that they might someday refer a child in need. While the resources and referral process used to identify children with special needs is generally understood, there is a lack of knowledge in the community about what is available for follow up care. Upon conclusion of this study, it was discovered that a little more than half of the primary care providers had heard of CCN, and only half of those had actually made a referral. Additionally, new methods of getting up to date information out to the community were identified. Is your car or truck maintenance more current than your patients? Project Date: 7/2/2007 In Oregon we have yet to reach the Healthy People 2010 goals for Cervical Cancer screening and Colon Cancer mortality (Oregon Partnership for Cancer Control, 2005). These are only two of the multiple goals we have yet to achieve, but it shows that we need to improve the current system of patient education and motivation. Although there are many obstacles to reaching the recommended goals, my project focused on literacy, simplification, and consolidation through 3 population specific handouts. Throughout the project I found it odd that most cars are provided with a maintenance schedule that states at predetermined intervals the vehicle needs to have routine care, yet our personal health screening recommendations are not in a usable format for the general population. They are constantly evolving depending on the latest research, and the vaccine schedules can be extremely difficult to understand. While in Baker City, Oregon I created one handout each for men and women 18 and older that included vaccinations and cancer screenings based on the current recommendations of the U.S. Preventative Service Task Force (USPSTF), CDC, and American Academy of Family Physicians. I also created a schedule in a checklist format for parents that included recommendations for vaccines, well child exams, dental, hearing, and vision for children birth to 18, based on USPSTF, CDC, American Academy of Family Physicians, and American Academy of Pediatric Dentists. The goal was to assist patients in using the available resources in a simple and accurate format in order to improve screenings and vaccinations. They were provided to Eastern Oregon Medical Associates and Baker County Health Department. Increasing Childhood Literacy Through Reach Out and Read, At The West Salem Clinic. Project Date: 7/2/2007 Reading aloud to children is an important tool to increase childhood literacy. Exposure to books at a young age helps build literacy in children. Sixteen percent of parents of young children do not read to their children at all and almost a quarter only read to them once or twice a week (1). Reach Out and Read (ROR) is a national program that seeks to increase childhood literacy rates by providing a new book to a child at each well-child check health care appointment between the ages of 6 months to 5 years. The goal of this community project was to establish an ROR program at the West Salem clinic. There were three parts to the project. The first was to contact the national ROR program to request application materials, and then compile the information needed to complete the application. The second part of the project was contacting other ROR sites around the state for information about the logistics and funding for their ROR programs. The third part of the project was to establish funding sources for both the start-up costs and the continuing costs of running the program. Grants/solicitations were submitted to various businesses and funding sources. A database of possible funding sources was created for future years to help sustain the program. Does the presence of a After Hours Pediatric Clinic Reduce the number of Pediatric Emergency Room visits in a Rural Oregon Community Project Date: 4/30/2007 Increasing health care costs continue to be a major problem for the Oregon Health Plan (OHP). OHP continues to find ways to lower costs in order to provide more health care coverage to more people. The objective of this student was to evaluate the efficacy of an After Hours pediatric clinic (AHPC) in decreasing the number of pediatric emergency department visits, particularly in pediatric patients with OHP insurance. In an effort to decrease the number of ED visits OHP agreed to help subsidize the AHPC with a fixed rate per day, with the goal of decreasing the number of ED visits, by OHP patients, by an average of 4 visits per day. Two Coos County pediatric practices, consisting of 9 pediatricians, collaborated to start an After Hour pediatric clinic. The clinic was to be open from 5-8 pm on weekdays, and 8-noon on Saturdays, with the goal of decreasing pediatric emergency department visits. Traumatic injury in off-road vehicle use in rural Oregon Project Date: 4/30/2007 BACKGROUND: Rural MVA mortality is twice that of urban mortality. Pediatric ATV injuries are increasing, and new legislation is being presently debated. The study evaluated the risk of ATV injury in pediatric versus adult populations in the Blue Mountain Hospital service area over 33 months. METHODS: Emergency visits at BMH, selected by E-code E810-825. Outcomes were incidence and odds ratios. RESULTS: ATV’s accounted for 23.9% of the MVA patients. 9.4% of non-ATV injured patients and 22. 4% of ATV injured patients were pediatric. Risk factors for ATV injury include age < 16 (OR 2.85, p = 0.008), male gender (OR 3.18, p = 0.001), and white race (OR 3.408, p = 0.039). Risk of head or neck injury higher in ATV use (OR 2.637, p = 0.004). CONCLUSION: Age restriction as well as requirement of helmets, both currently proposed in the legislature, may decrease the burden of ATV-related injury on the rural pediatric population. Obesity and Delinquency in Ontario Public Schools: A prescription for better schools and healthier kids. Project Date: 4/30/2007 The pediatric population is unique in that for six-to-seven hours in a given day they spend their time in a controlled environment. The objective of this study was to review the literature and make recommendations that could be instituted by the school district to address two concerns in this population: obesity and delinquency. Many comments were made by health care professionals and community leaders about these problems, particularly the increased disruptive behavior, drug and gang activity in the middle school. Though the school district was restructuring its schools to meet these new challenges, alternative solutions were being sought. A review of the literature revealed a number of strategies that could be implemented by the school district to decrease disruptive behavior and the trend in obesity. First and foremost, returning sixth graders to the elementary schools will decrease disruptive behavior in the middle schools and will decrease the likelihood that these children will continue such behavior into later school years. In addition, scheduling recess before lunch can decrease after-lunch classroom rowdiness and increase instruction time by up to 10 minutes. In addition, children make healthier food choices and waste less food; this can translate into cost-savings for the school district. Lastly, instituting a universal school breakfast program also contributes to children making healthier eating habits during these impressionable years. Parent education initiative in Florence, OR: Development of a school newsletter that accurately addresses important child health education issues; Project Date: 4/30/2007 Lack of basic child health education is a problem in many small towns. This study attempts to determine what areas of knowledge are most lacking, as well as which topics are the most important for parents in Florence Oregon to learn about in order to improve the health of their children. Parents, children, local physicians and medical office staff were interviewed and internet research was done to answer these questions. The end goal is to create a newsletter that will be sent home to all parents of school-aged children for the purpose of improving their base level of knowledge so that they have the tools necessary to make healthy parenting decisions. Striving for Healthier Children: A Closer Look at the Scappoose School District’s Local Wellness Policy Project Date: 3/19/2007 The prevalence of obesity and its associated diseases in the U.S. has been increasing over the last decades at an alarming rate. The OHSU clinic in Scappoose was noted to have a particularly high prevalence of obesity amongst its adult patient population. Obesity rates in the U.S. of young children have doubled and that of adolescents have tripled over the past twenty years. Prevention is the most effective tool in reversing the obesity epidemic, as well as increasing overall health, and generally the earlier the intervention, the more potentially effective it is. One particularly important site for prevention measures are the public schools, since children often receive most of their nutrition, exercise, and lifelong nutritional and physical education at school. Three years ago, the federal government signed into law an act that requires each local education agency or school district participating in the National School Lunch Program and/or School Breakfast Program to develop a local wellness policy that promotes the health of students and addresses the growing problem of childhood obesity. This project focuses on analyzing and discussing the Scappoose school district Local Wellness Policy along with some of the major obstacles to its implementation. 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. Optimizing Well-Child Visits in Coos Bay, OR Project Date: 3/19/2007 Well-child visits make up a large part of a general pediatrician’s daily schedule. Due to time constraints and the plethora of information to be addressed, there is a growing desire among the pediatricians of North Bend Medical Center in Coos Bay, OR to make these visits more efficient and effective from both the physician and parents’ perspective. This project aims to identify the general structure of well-child checks (WCC) and the content covered during the visit that is important from both an educational standpoint and of concern to the parent/patient. The design involved a search through literature examining the content and purpose of WCC, improvement strategies, and barriers presenting in rural settings, as well as informal discussions with pediatricians and parents in North Bend Medical Center. As a means of pinpointing what topics directly concern the parent, a questionnaire listing common developmental, psychosocial, safety, and family issues was created. It is thought that specifying concerns through such a questionnaire will help tailor the visit to an educational discussion regarding issues that both the pediatrician and parent believe are in the best interests of the pediatric patient. Lane County’s Struggle to Help Newborns and Mothers: An Emerging Problem with Promising Solutions Project Date: 2/12/2007 The process of nurturing an uncomplicated pregnancy, delivering a viable and healthy baby, and maintaining the normal growth and maturation of the baby and health of the mother has been the focus of the field of obstetrics and one of the most important medical issues in the United States and worldwide. Previous research has shown that Lane County has the highest perinatal and neonatal mortality rates in the state of Oregon and ranks among the highest in the nation. This study attempted to identify and shed light on the challenges that face mothers and babies in Lane County which contribute to the high perinatal and neonatal mortality rates and evaluate the effectiveness and availability of resources and regional public health institutions that can best serve this specific health care population. The population studied was the female patients who came to the Junction City Medical Clinic along with their newborns for well-child examinations. Each of these patients was asked about challenges that they had faced with regard to receiving adequate prenatal care during their pregnancies. Using patient-provided information further outside research, and dataset analysis, a patient questionnaire was designed to help the expecting mother from Lane County to assess her prenatal needs and to help her better identify the prenatal care resources available to her. The ultimate goal is to be able to better unify and collect these resources and organize them into a neat and convenient handout that provides patient the information they need and also educates them on the necessary prenatal topics. This handout will be made available to Lane County Public Health Department and to the Junction City Medical Clinic to distribute to patients who need prenatal care and health care for both mother and baby after delivery. Parental safety education for infant children and implementation of the Baby Safe program in Coos County, OR Project Date: 2/12/2007 There are high rates of child abuse and neglect in Coos County, Oregon. Struggling industry and associated poverty, along with difficulties associated with resource accessibility in rural Coos County have contributed to the problem. Although poverty, drug and alcohol abuse, and low education levels will continue in the community, education of mothers regarding infant safety may help to reduce the burden of child abuse and neglect. Working with the Bay Area Hospital MOMS program and the Bay Clinic pediatricians, I updated and developed an electronic program for the new Baby Safe program, a class for mothers designed to educate them how to safely care for their infant children from birth to one year of age. Along with the Baby Safe presentation, I provided local pediatricians and their staff with an overview of National, County, and hospital-based resources for educating and supporting mothers Educating Expectant Parents: Creation of a Newborn Care Presentation Project Date: 1/1/2007 Many expectant parents anticipate the arrival of their first child with excitement and anxiety. During the months approaching the due date, in addition to advice and reassurance sought from relatives and friends, parenting and birthing classes in communities offer structured education on newborn care to these parents-to-be. In Coos County, Oregon, free educational classes on newborn care, breastfeeding, and children's home safety are offered through the Bay Area Hospital's MOMS (Management of Maternity Services) program. Local pediatricians from North Bend Medical Center and Bay Clinic give presentations on these topical issues in scheduled monthly night courses. The current newborn care class, which consists of a pediatrician talk and bathing and dressing baby demonstrations, includes a stale and outdated slide-show on common and uncommon newborn characteristics from birth marks to neonatal jaundice. MOMS program coordinators and Coos County pediatricians have sensed that this made-in-the-1970s slide-show is ineffective in educating expectant parents and have voiced a need for an engaging and effective presentation on newborn care. The aim of this community project is to create a fresh, interactive, and updated newborn care educational presentation for expectant first-time parents in Coos County. Heart Disease and Diabetes Handout for Kids Project Date: 1/1/2007 Heart disease and Diabetes are two of the most common diseases now present in the U.S. In the National Health Survey of 2004, the percent of non-institutionalized adults with diagnosed heart disease was 11.5 and the number of annual deaths was 654,092. In 2004, heart disease was responsible for 1/3 of all deaths. Diabetes is also of epidemic proportions. Approximately 7.2 million people have Type II Diabetes in the U.S.(actually diagnosed). According to the National Diabetes Statistics fact sheet, (NIDDK of 2003) approximately 1 in 17 or 5.88% or 16 million people in USA have diagnosed and undiagnosed diabetes. Diabetes is the nation's seventh leading killer and contributed to about 187,800 deaths in 1995 Two known risk factors for these diseases include smoking and obesity. Despite this, the incidence of obesity in adults and children continues to rise, and smoking has increased in young adolescents. For these reasons, we feel it is extremely important to begin educating young children about heart disease and diabetes, and give them basic tools to avoid these diseases. To accomplish this in the rural family practice setting, a children's book was created which outlines the basics of these diseases and encourages healthy eating, exercise and not smoking as three methods to help prevent heart disease and diabetes. The book will be used in the office setting as a tool to open up conversation and learning opportunities around these issues. In addition, a one-page handout summarizing the above will be given to the patients to take home as a reminder of what they learned. This is the beginning of an early education regarding the importance of lifestyle choices in the future health of our nation. Say Cheese: Public Opinion Regarding Community Water Fluoridation in Baker City, OR Project Date: 1/1/2007 Dental caries (tooth decay) poses a significant health risk to the residents of Baker County. Reputable health-professional organizations such as the CDC, WHO, AAFP, American Public Health Association, and Institute of Medicine support community water fluoridation as a safe, effective, and inexpensive way to prevent dental health problems. A majority of the US population has access to fluoridated water, but Baker County has not yet implemented this proven health improvement measure. In order to gauge public opinion regarding community water fluoridation in Baker, a survey was developed with the support and input of several local health providers, and widely distributed amongst varied segments of the community. Analysis of the survey results revealed barriers to public acceptance of water fluoridation. The gaps in dental health knowledge will be addressed as part of a following public health education campaign to be developed by nursing students. The group of local healthcare providers and students involved will organize the Baker medical community through meetings and strategy sessions in order to educate, collaborate, and hopefully unite in the campaign of fluoridation. In addition, the logistics of instituting fluoridation in the Baker County water supply was researched and outlined. Expanding Anticipatory Guidance in Columbia County Project Date: 1/1/2007 Columbia County has seen a significant increase in recent years in the number of single mothers with children younger than 5 living below the poverty level. Many parents in the community lack resources and access to parenting information. Various programs in the county provide services to young mothers and children, including Head Start, Healthy Start, and WIC. In addition, the OHSU Family Medicine Clinic at Scappoose serves patients primarily from Scappoose and St. Helens, the largest towns in the county. Providers in all facilities expressed a need for simple hand-outs to give to parents with anticipatory guidance and advice about parenting for children of different ages. Handouts were created with guidance for all well-child visits from ages 2 weeks to 5 years. Guidelines focused on age-specific information about nutrition, development, and safety. The materials were distributed to providers at the Scappoose Clinic and program directors for Columbia County Head Start, Healthy Start, and Columbia County Department of Public Health, which coordinates the county WIC program. Implementing Nurse Visits for Prenatal Care in Scappoose Family Medicine Rural Health Clinic Project Date: 10/16/2006 Prenatal care provides benefits of reduced incidence of low and very low birth weight babies, reduction of infant mortality, and decreased rates of preventable maternal complications during delivery. In Columbia County, there are two main sources of prenatal care, only one of which is provided by MDs. The goal of this project was to help to implement the vision of restructuring the way prenatal care is given at Scappoose Family Medicine Clinic to include once a trimester visits to a trained nurse who will discuss things to expect in the upcoming trimester, answer questions about common pregnancy complaints, and provide a packet of resources specially designed for the current trimester. Proper usage of child safety seats and booster seats in Baker County, OR: development of a brochure to educate patients for dispersal at the Baker County Health Department Project Date: 10/16/2006 Motor vehicle accidents are the leading cause of death and disability in children. This is often preventable with the proper use of child safety seats and booster seats. While these devices are often used by parents, in Oregon 85% of child safety seats and 51% of booster seats were installed incorrectly. Baker County has NHTSA certified child passenger safety technicians who can assist parents in inspecting and installing child safety seats and booster seats. The Baker County Health Department immunizes 97% of the children in the County and is an ideal location to reach parents and educate them regarding proper usage of child safety seats and booster seats and to direct them towards local resources for inspection and installation. A brochure was produced for dispersal at the health department which included information on local and internet resources, Oregon Law, and the proper usage of child safety seats and booster seats. Continuity of Care and Medical Information of Children in Foster Care Project Date: 9/11/2006 In 2005, more than 6000 children entered foster care in Oregon and the population is growing. Foster children are at particular risk for adverse health outcomes and these risks are exacerbated by a common failure to obtain, document, and transmit medical information to case workers, foster parents, and health and social service providers. This jeopardizes the children's health, undermines attempts to provide them with services, and risks unnecessary resource allocation and financial burden for the children's families, foster families, state and healthcare system. The purpose of this project, which was conducted in collaboration with the Josephine County branch of the Department of Human Services (DHS) Child Welfare Office and Siskiyou Pediatric Clinic, LLP of Grants Pass, Oregon, was to address this problem by creating a medical data collection tool and protocol to facilitate the recording and transmission of medical information of children in foster care. The project consists of four phases: information gathering; design and development; implementation; and evaluation, modification, and expansion. At the time of this report, the project is completing its second phase and will soon be implementing the pilot instrument and protocol. To date, the response from the pediatricians and social service providers involved in the project has been very positive. Educating Parents in Coos County, Oregon: Development of a Postpartum Class at Bay Area Hospital Project Date: 9/11/2006 Many parents of newborn infants are not receiving the information that they desire from their health care professionals. Well child care visits with the pediatrician usually occur at birth, 2 weeks, 2 months, and so forth. During these visits, anticipatory guidance is often limited by the time and preference of the physician. Mothers were indicating a desire for more information and pediatricians were confirming an increased number of phone calls and office visits regarding these same issues. In order to identify the topics of concern as well as propose an educational solution, investigatory interviews were conducted with 10 mothers, 3 pediatricians, and 4 maternal education staff members. Interview results confirmed that parents expressed to know more on the following topics: increased crying, a variety of baby health issues, mother's health issues, sibling adjustment, returning to work, feeding issues with returning to work, time management, and safety. Using the results of these interviews, as well as the published guidelines on anticipatory guidance, a class was developed entitled Postpartum 101: Practical Tips For Parents of 2-8 Week Old Infants. The hour long class consists of a powerpoint presentation, discussion questions, hands-on activities, and associated handout. The class is scheduled to be taught regularly by a local pediatrician and nurse under the auspices of the maternal education program at Bay Area Hospital. The identification and care of substance exposed newborns, a case study. Project Date: 8/7/2006 There are numerous children born in Eugene already compromised because they have been exposed to substances in utero. I identified this problem when I met Teresa Donavan who has eleven children; she has three biological children and eight foster children. All of her foster children were born to substance abusing mothers and have similar health challenges. There is a meth epidemic in Eugene and all of Oregon; the number of substance exposed newborns is on the rise. These children face similar problems such as a diminished suck reflex, increased incidence of pneumonia, minimal circadian rhythm, need for routines, and ADHD. Parents receive financial and training support from the state because children are deemed to have “special needs.” Little of the Eugene care system is organized to specifically help substance exposed newborns. However with the development of FEAT: Family Early Advocacy and Treatment, there plans to be increased identification, referral, treatment, and support of newborns exposed in utero. Identifying a need for pediatric specialists in Coos Bay, Oregon Project Date: 8/7/2006 Coos Bay, Oregon is 212 from Portland, 111 miles from Eugene and 84 miles from Roseburg. These areas serve as the three major referral centers for pediatric specialists. Due to the excessive distance from specialist care, the need for greater compliance and increased quality of healthcare in rural areas the need for particular specialists in this area must be addressed. The goal of this project was to determine the current referral base for pediatric patients of the two major clinics in Coos Bay and to identify a need for a particular specialist in the area. The population studied included pediatric patients seen by the researcher while working at Bay Clinic and North Bend Medical Center during a four week period. The data gathered included type of specialist referral, problem or reason for referral, and location of the specialist. This data was correlated with qualitative data obtained from various pediatricians at both clinics regarding specialist needs, problems referred and where patients are referred. Qualitative data gathered indicates that there is a great need for a child psychiatrist in Coos Bay. Currently, there is one part-time general psychiatrist handling all of the Oregon Health Plan (Medicaid) patients. The barriers to efficient recruitment of physicians in rural areas needs to be further studied. Improving Anticipatory Guidance in Rural Family Medicine Project Date: 8/7/2006 Anticipatory guidance is considered an important component of well-child care. Many adverse outcomes to pediatric populations are easily avoided with adequate and effective anticipatory guidance. The purpose of this project was to investigate the current practices of providing anticipatory guidance employed by health care providers at the OHSU Family Medicine at Scappoose clinic, and to seek ways of improving parental education and implementation. This project seeks to improve anticipatory guidance in rural family medicine through the development of handouts providing information for parents that correlates with verbal guidance given during the well-child visits from birth to 2 years of age. Providing good anticipatory guidance is an effective and important way to encourage health and safety in the pediatric population. Fathers of newborns: Are your new babies health care needs being met? Project Date: 7/3/2006 Many people consider the birth of a child to be a highlight of one's life. Naturally, bringing one's own offspring into the world can be a thrilling experience and much focus is spent on ensuring quality health care for both mother and child. The purpose of this community oriented primary care project is to investigate any potential problems with the health care of newborn babies by interviewing fathers of newborn children. Accessing the opinion of a father should reveal new insight into the success and comptetence of newborn healthcare from a perspective not usually considered. The project design included interviewing fathers of newborns in the medical clinic, night clinic and hospital. Determining the Efficacy of Fluoride Varnish in Preventing Caries in Children – Research Prior to the Start of a New Public Health Initiative in Baker County. Project Date: 7/3/2006 Fluoride Varnish is a widely accepted dental caries prophylactic treatment in America despite being an off-label use. It is easy to apply and regarded as safe. The Baker County Public Health Department is interested in starting a Fluoride Varnish program for children in Baker County. They enlisted me to research the efficacy, safety and technical features of such an initiative and then give a presentation to their staff. I did a literature review of articles found searching Pubmed for all the Randomized Controlled Trials published after 1999 using the terms “fluoride,” “varnish,” and “dental,” limiting my research to studies on the preventative effect on caries in children. I also reviewed the latest relevant professional and independent reviews and meta-analyses searchable under the same terms. I concluded that the evidence in favor of Fluoride Varnish was strongest for permanent teeth despite some controversy over the degree of added benefit when using a fluoride toothpaste and that the most recent evidence suggested a similar protective benefit in deciduous teeth -- though this is more controversial. Furthermore this benefit appears to be greatest in children “at risk” for poor oral health (low socioeconomic status, low fluoride water content, or poor dentition). In the end it was agreed that a biannual Fluoride Varnish program was the most practical solution that offered benefit. Incorporating Dental Health into the Role of the Primary Care Provider in Baker City, OR. Project Date: 5/1/2006 Dental disease is problematic in the United States, especially in the population of poor underserved children. Baker City, similar to many rural areas is composed of a large number of persons below the federal poverty line. The children in Baker City, therefore, are at a greater risk of developing dental caries and other dental complications. In an effort to incorporate the primary care provider into the dental screening and health of the pediatric population in Baker, a project was designed to help screen children seen in the clinic and assist in referring these patients to the appropriate dentist. The primary question that this project was intended to answer when is the best time for children to have their first dental examination, and how can primary care practitioners assist in this screening? To aid in this dilemma, a brochure was generated based on information gathered from a local dentist and an extensive literature search. In conclusion, pediatricians and family health care providers may be able to play an important role in improving the dental health of their patients who have difficulty obtaining access to professional dental care. Medical Record Documentation Project Date: 3/20/2006 Medical therapy for heart failure including ACE-I/ARB and beta-blockers extend life and improve symptoms in patients with heart failure, as well as decreasing hospitalizations. They are therefore the cornerstone of therapy for heart failure. At the Cascades East Family Practice Residency, quality assurance/ chart reviews are done on inpatients that are discharged from the hospital, but this is typically not done on their outpatient clinic population. The patient population of CEFPC has a high level of medical comorbities, polypharmacy, limited follow-up as well as substance abuse and psychiatric co morbidities. I felt this made this population high risk for not receiving appropriate medical therapy. An audit was performed on pts with the ICD-9 code for heart failure, presenting for appointments over a six month period and from this list 26 patients were selected. Of the sample 34% of patients were on ACEI/ARB and beta- blocker. 27% were on an ACE only, 12% were on a beta blocker only and 27% were on neither. In conclusion, treatment with Angiotensin agents and B-blockers could be improved. There may exist absolute or relative contraindications for some patients, however these could be better documented in the problem/med list. In addition in patients with heart failure it would be useful to briefly summarize the results of the most recent echocardiogram including ejection fraction (EF), hypertrophy, valvular lesions, bundle branch block, and atrial fibrillation. Bringing order to chaos: Improving the referral system at North Bend Medical Center Project Date: 2/13/2006 The process of referring a patient from a primary care office to a specialist has become increasingly complicated in both dealing with insurance companies as well as the office-to-office referral. This has the unfortunate consequence of creating a barrier to patient care as well as adding an enormous financial burden to medical offices in the form of administrative duties. The pediatric clinic at North Bend Medical Center identified a need to address this problem in order to increase efficiency and save money. The goal of this project was to clearly define the problem, understand its cause, and develop a potential solution. This was accomplished through a literature search to understand the problem from a broader perspective, and interviews with key people involved in the referral process throughout the state of Oregon. Ultimately two potential solutions to the problem at NBMC were identified: one, the need for appropriate staffing in order to handle the increased demands of the referral process, and two, the need for a referral guide that identified specialists that NBMC commonly refers patients to, contact information, as well as the necessary procedure one must go through in order to refer a patient. For this project, the referral resource was created and has been well received in the office. In the intervening time, an additional office staff member has been hired to handle referrals that will start in the near future. Advancing Reach Out and Read in Coos Bay and North Bend Project Date: 1/2/2006 The well-child examination offers a unique opportunity for health care providers to proactively affect the health and development of pediatric patients through efforts targeted at education, health promotion, and prevention. Time limitations of the visit, however, require that physicians tailor interventions with proven efficacy to issues of significant prevalence and impact. Reach Out and Read, a national literacy and language development program that brings reading into the well-child visit, has been effective at improving reading success, parental attitudes toward reading, parental interactions with children, and child language development. This report outlines efforts to advance the Reach Out and Read program in the Coos Bay/North Bend area through strategic planning, information gathering, resource identification, and application completion. School healthcare in Malheur & Multnomah counties: An argument for School Based Health Centers Project Date: 1/2/2006 Diabetes and asthma are two of the most common diseases afflicting children. As chronic ailments, their acute and long-term management are very important in preventing crises and slowing disease progression. With Oregon law not mandating a nurse in schools, the management of these diseases can become the responsibility of school staff, especially in underserved counties. In this study, quality of school healthcare management of type I diabetes and asthma was assessed in 9 schools in Malheur County. A survey consisting of 12 questions assessing acute critical and chronic management and education competency was conducted by telephone with each school’s primary healthcare provider. The Malheur County mean score was 2.3 out of 12 (SD 1.0). A higher score of 11.375 (SD 0.744) was obtained through survey of 8 schools in Multnomah school district, all of which have at least a part time nurse or a School Based Health Center (SBHC). This study identified that Malheur County had a sufficient database of the protocols for the acute and chronic management of asthma and diabetes, but lacked knowledge in recognizing clinical situations and educating students on disease management. Their staff consists of school secretaries who receive a health source guide and instruction from a registered nurse once annually. While financially expensive, a possibly more efficient and long-term cost-effective solution for Malheur County could be the School Based Health Center. This system has been shown to provide large savings in direct costs of healthcare for school aged children and almost double the service value of each invested tax dollar. It also offers basic healthcare to the uninsured and the intangible benefits such as improved attendance and school performance in the classroom. Parental Concerns Regarding Vaccinations in Grants Pass Project Date: 10/17/2005 Childhood immunizations are an important step in decreasing the amount of disease in communities. This study attempted to ascertain why some parents whose children receive care at Siskiyou Pediatrics in Grants Pass, Oregon choose not to immunize their children and to identify some of the concerns parents have regarding vaccines. A questionnaire and cover letter was developed to gather information from parents. After collecting the responses, it is clear that parents take the decision on whether or not to immunize their children very seriously and that misinformation about vaccines contribute a lot to parent's concerns about immunizations. These false beliefs persist despite all the pamphlets available to parents in the exam room. After speaking with a few parents about their worries, it became clear that the parents felt better about the immunizations after their concerns were heard and addressed. Babies First! in Baker County Project Date: 10/17/2005 Home visit services by public health nurses have been repeatedly shown to improve health outcomes (Olds & Kitzman, 1993). Oregon’s Babies First! Program was started in 1990 to provide public health nurse visitation services to families of infants who were at risk for poor health or developmental outcomes. In 2004, 63 of 151 births to mothers residing in Baker County (40%) were paid for by Medicaid/Oregon Health Plan (OHP), yet the Baker County Babies First! program few clients because of poor community reputation and a lack of physician referrals. This project developed a referral slip and presentations to physicians to increase awareness of the services available, and the program revisions. The information and referral slips were well-received by physicians, but further work remains to strengthen Babies First! in Baker County. Spanish and English Asthma Action Plans in Klamath Falls, OR Project Date: 10/17/2005 Asthma is a serious health concern among the pediatric population in the United States. It affects approximately 9 million children under 18 and accounts for at least 2.9 million visits to pediatricians each year. Asthma is the most common chronic illness of childhood, and hospitalization rates for childhood asthma have increased despite improvements in asthma therapy. While asthma affects people of all races and ethnicities, the under-treatment of asthma among certain racial and ethnic minorities is well documented. There are two main causes that have been found thus far as reasons for this disparity. The first reason is lack of access to appropriate health care for minorities and underprivileged populations in general. The second reason is that the health care provided is inconsistent with the guidelines of the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute (NHLBI). While the lack of provisions of adequate health care for all of the nation’s children is appalling, this paper will be focusing on the second issue, the general lack of adherence among pediatricians and family practitioners nationwide, including Klamath Falls, Oregon, to follow the guidelines of the NHLBI, by not distributing appropriate information on asthma to the Spanish-speaking population or to the general population as a whole. The purpose of my project was to assess how many primary care clinics in Klamath Falls, Oregon, provided asthma action plans in English or in Spanish to their patients and to provide asthma action plans to those clinics that didn’t have any. A Suggested Protocol for the Management of ADHD in School-Aged Children of Coquille, Oregon Project Date: 9/12/2005 Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder of childhood, affecting 3% to 12% of school-aged children. ADHD may cause children and their families significant problems; symptoms may result in academic underachievement and difficult relationships. However, pharmacologic treatment of ADHD is largely effective, and is promoted by the American Academy of Pediatrics and the American Academy of Family Physicians. As no standardized ADHD management algorithm was available to the physicians of Coquille Valley Medical Center, this study sought to merge national treatment recommendations with the community standard of care to develop an ADHD management strategy for the treatment of school-aged children with ADHD in Coquille, Oregon. Tracking Childhood Immunization Records: the Utilization of Oregon Immunization ALERT in Baker City. Project Date: 9/12/2005 In Baker City the public health department is the only entity that immunizes pediatric patients. There is no system in place for the transfer of patient information between the health department and the rest of the medical community in Baker City. Oregon Immunization ALERT is a statewide database of immunization information for Oregon’s pediatric population whose aim is to track the immunization status of every child 0-18 years of age with the ultimate goal of insuring complete and timely immunizations for all. Baker County Health Department enters each child’s records on ALERT, but the community doctors and hospital personal do not access the program. Increasing the usage of ALERT at Eastern Oregon Medical Associates (EOMA) medical office and by introducing ALERT to the St Elizabeth Hospital Emergency Department could serve to bridge this gap between the health department and the community health care providers. Practitioners at EOMA were retrained on how to access ALERT and the importance of following the immunization status of their patients was readdressed. This resulted in plans put forward to incorporate ALERT records for each patient age 0-12 into their electronic records system with the ability to update the records at each office visit. The nurses and doctors in the emergency department were introduced to ALERT, given access codes, and trained on its use with an emphasis placed on using it to determine DTaP status. The results in St. Elizabeth’s emergency department are less certain. There was resistance to the use of a computer based program and uncertainty of ALERT’s value in the emergency setting. A follow up letter with reminders of passwords and how to access ALERT will be sent to the emergency department in two months time. By accessing ALERT, physicians will be better informed on the immunization status of their patient and better able to encourage prompt vaccination or catch up immunizations as needed. By increasing the knowledge of a patient’s DTaP status in the emergency department, the risk of adverse immunization reactions will decrease. Pediatric Follow-Up for Infants of Uninsured Hispanic Women in Madras, Oregon Project Date: 9/12/2005 Pressure from restraints of the current health care system, as well as recent advancements in methods to prevent and treat disease have put preventative health care in the forefront of the minds of primary care physicians and public health professionals. Unfortunately, in the area of pediatrics, recommendations for preventative services have not always been supported with well studied and documented evidence. This is true of the current standard system for well-child visits to general pediatricians. Although routine immunization has been strongly supported with clinical trials, very few of the current accepted practices of behavioral counseling and routine screening during well child visits are supported by solid evidence. Despite the lack of evidence, the American Academy of Pediatrics' Guidelines for Preventative Pediatric Health Care have become the standard of care and are expected by pediatricians and parents alike. This study looks at a population of children born to uninsured Hispanic mothers in Madras, Oregon and attempts to answer two questions. First, chart review and a database of national health statistics were used to determine whether this particular population of young infants is receiving preventative health care at a rate equivalent to national levels. Second, two subsets of the population were compared in an attempt to assess the efficacy of well-child care in preventing disease and its usefulness in contributing to the full vaccination of this subset of children. Results show that the study population is receiving preventative healthcare services that meet the current community standards. They also suggest that children that receive higher levels of those services are more likely to be healthy, immunized and free of disease. Pediatric Poisonings- Epidemiology and Prevention. Portland Oregon Project Date: 8/8/2005 There are more than four million incidents of poisonings in the United States each year. The institute of Medicine identified poisoning as the second leading cause of injury-related mortality, with an estimate of economic cost at $12.6 billion annually based on societal lifetime cost of injury. Hospital admissions for poisoning are the second leading cause of injury-related hospitalizations for all ages in Oregon (Poison Press 2004). In this study I have evaluated the impact of poisonings in children under the age of 13 in the Portland community by reviewing hospital records, obtaining Oregon Poison Center data, and surveying and interviewing members of the community. In an effort to increase awareness of poisonings in pediatrics and decrease their prevalence and severity I have created a poster. This poster along with fliers and handouts from the poison center has been placed in local clinics and hospitals. Stickers Don't Make You Smarter: Bringing Reach Out and Read to Coos Bay Project Date: 8/8/2005 A growing body of evidence supports early childhood exposure to reading as an effective catalyst for linguistic and cognitive development. The Reach Out and Read program, established in 1989 by a group of Boston University pediatricians, promotes early literacy and language development by bringing reading into the pediatric exam room. Participating pediatricians give each patient between the ages of 6 months and 5 years a brand new book at each well-child exam. Additionally, they are trained to appropriately counsel caregivers about the importance of reading aloud with their children. Several pediatricians in the Coos Bay/North Bend area expressed a specific interest in establishing a Reach Out and Read program in their medical offices. For this community project, several critical components of this process were addressed: application submission, generation of community support for the program, and solicitation of financial assistance. A number of service organizations, businesses, and existing grants were identified as promising resources for the program. A grant proposal was drafted and submitted on behalf of the program to the Coquille Indian Tribe Community Fund. Finally, the Reach Out and Read model was presented to representatives from several organizations, each of whom expressed enthusiastic support for the program. Bipolar Education in Klamath Falls Project Date: 7/4/2005 Current prevalence estimates of bipolar disorder in the pediatric population are thought to be about the same as those in the adult population, approximately 1%. Existing evidence indicates that bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent- and adult-onset bipolar disorder. Recently, as the understanding of childhood bipolar disorder has grown, provider education about bipolar disorder has increased the rate at which diagnoses occur. With this large rise in the number of bipolar cases, physicians need to utilize all resources available to help them treat their patients including the patients themselves. The purpose of this project was to improve patient education about their disease. To accomplish this a survey was conducted of current patients and their parents to determine their current knowledge of the disorder. Reporting on these questionnaires showed that all parents sought out alternative resources to fill gaps in their knowledge. Information from the questionnaire was used to help in the creation of an educational brochure about bipolar disorder. This document was given to the Klamath Pediatric Clinic for distribution to current and future patients. Assessment of Fluoride Concentration in the Drinking Water in Ontario, Oregon and Surrounding Areas and Recommendations for Fluiride Supplementation for the Pediatric Population in this Community. Project Date: 3/21/2005 Tooth decay is one of the most common problems facing the population. Fluoride has been shown to be an effective means of helping slow or reverse the progression of disease. Excessive fluoride intake can lead to fluorosis, a poor cosmetic result. This risk necessitates optimization of fluoride intake. The average intake of fluoride in the community, based on its concentration in drinking water, was assessed by phoning various water treatment plants in the surrounding communities. Then, using extensive research data complied from multiple sources, a specific set of recommendations for fluoride supplementation in the pediatric population were made based on fluoride intake in the community in which the patient lives. 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.” Identifying Obstacles to On-time Childhood Immunization in Baker County Project Date: 3/21/2005 Background: 77.6% of Baker County’s 24-month-old children were fully immunized with the CDC’s recommended 4:3:1:3:3 series of vaccines (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB) in 2004 (vs. 69.8% of all Oregon children vs. 90% Healthy People 2010 goal). Objective: Identify obstacles to full immunization coverage of children at 24 months of age in Baker County. Methods: Telephone survey of parents of the 130 children ages 12 to 24 months in the Baker County Health Department immunization records regarding obstacles to on-time immunization. Interviews with the county immunization nurse, Baker City family practitioners, and Oregon state immunization program staff. Literature review for vaccination rate improvement methods. Results: One nurse at the Baker County Health Department immunizes 96.3% of that county’s children. Parents cite difficulty getting an appointment within the month and the need for reminders for vaccination schedules and for individual appointments. Cost and transportation are not common obstacles. Children’s immunization records are not checked at their doctor appointments. Conclusions: Baker County’s child immunization coverage may be improved by decreasing the appointment wait time, instituting a recall/reminder system for all children, and checking immunization status at every encounter with the health care system. Prevention of Traumatic Pediatric Falls in Grant County Oregon Project Date: 3/21/2005 Trauma is the number one cause of mortality and morbidity in children ages 0- 14 years old. This study compares national and Grant County trends in fatal and nonfatal trauma focusing on unintentional fall injury in a rural community in eastern OR. Although MVA represent the number one cause of mortality among pediatric populations, accidental falls and fall related injury provide the number one source of morbidity and hospitalization among children aged 0-14. We sought to examine the trends of pediatric fall related injury in a rural community in order to focus efforts at prevention of morbidity amongst this vulnerable population. Systematic review of all emergency room visits among patients aged 0-14 between 1/1/1999-12/31/2004 at Blue Mountain Hospital in John Day Oregon were evaluated. Injury trends were determined by examining data included presenting complaint, primary diagnosis (ICD-9), and injury mechanism (E-code). Results: Mechanism of injury leading to ER visits in peds 0-14YO: FALLS 310 (31%), BLUNT TRAUMA 123 (12%), SHARP OBJ 101 (10%), MVA 78 (7.8%), REC VEH (3%), BIKES 62 (6.2%) HORSE REL INJ (1.7%) SPORTS 55 (5.5%) Mechanism of falls: GROUND LEVEL/NOS 102 (35%), PLAYGROUND EQUIP 31 (10%), FURNITURE/BED 30 (9.7%), ON OTHER OBJ/NOS 28 (9.1%) SPORTS 12 (3.9%) STAIRS 12 (3.5%) Types of injuries secondary to falls:OPEN WOUND OF HEAD, NECK, AND TRUNK 76 (22.7%), CONTUSION WITH INTACT SKIN SURFACE 71 (21.2%) FX OF UPPER LIMB 61 (18.2%), SPRAINS/STRAINS OF JOINTS 58 (17.3%) Falls represent a significant source of traumatic injury in the rural pediatric population of John Day, OR and surrounding communities. Prevention measures are a major public health concern and prevention efforts in Grant County should be focused at prevention of accidental falls at home (furniture/bed falls) and school (playground equip). A brochure on child safety and prevention was developed with the concerns of this rural community to be distributed at the emergency room to parents of children aged 0-14 years old. Neonatal Mortality in Josephine County: Current and Historical Perspectives Project Date: 2/7/2005 The problem of neonatal mortality and its associated risk factors in Josephine County, Oregon was examined in 1997 by OHSU Masters student and Public Health Nurse Virginia Adams. Her work demonstrated a community whose newborn babies suffered a 33% increased relative risk of neonatal mortality (death within the first 28 days of postnatal life) compared to babies born elsewhere in the state. The objective of this investigation is to compare the most current statistics regarding neonatal mortality to this historical data to identify areas of improvement and continued struggle within the community of Josephine County. Methods employed in this investigation include critical examination of health statistics and a series of interviews conducted by myself with care providers in Josephine County. To the credit of the community, this investigation found many admirable gains made by dedicated providers. Since the publication of Adams' study, neonatal mortality rates have in Josephine County have decreased significantly (from 8.6 to 5.0/1,000 live births), rates of inadequate prenatal care have dropped from 10.1% to 3.6% (well below OR state averages), and numerous other risk factors for poor neonatal outcomes have been decreased. However, despite these gains, several substantial problems exist in Josephine County which pose potential threats to newborns. Perhaps most notably is the problem of illicit drug use during pregnancy, for which Josephine County maintains the highest rate of all counties in Oregon. Other persistent risk factors for neonatal mortality identified by care providers include recent reductions in public funds which have forced clinic closures and ended subsidized housing programs for pregnant women. Improving the Infant vision screening program in Baker City, OR Project Date: 1/3/2005 Infant vision screening is an important part of infant care during the first years of life. Early screening and early treatment for infant eye deficits (e.g. strabismus, amblyopia, and retinoblastoma) provides for better long-term vision outcomes and allows for the use of less invasive treatments. Despite the common incidence of infant visual problems, many children are not examined by an eye care professional until after they fail their first visual acuity test in public school at 5-6 years of age. This study attempted to examine the current system in place for infant vision screening in the city of Baker, OR and to explore methods of improving these system. Design elements included quantifying the percentage of Baker infants receiving eye exams in 2004, identifying barriers to care within the existing system, and implementing solutions to overcome these barriers. The data indicated that fewer than 15% of infants in Baker were participating in the existing vision screening program in 2004. The major barriers to care in Baker were identified as poor parental awareness and lack of physician education in regards to the importance of infant vision screening. Solutions to these problems included educating the physicians who were caring for infants about vision screening, convincing these physicians to act as a direct referral source for the infant vision screening program, and providing these physicians with educational handouts about infant vision screening that they could give to their patients. With these additional measures in place, it is expected that a much higher percentage of Baker infants will receive vision screening exams during 2005 in comparison to all previous years. Physical Activity in Children and Adolescents in Ontario, OR Project Date: 1/3/2005 Obesity has become a major health concern in the United States over the past several decades. When attacking this overwhelming problem, two areas are often targeted in order to keep obesity at bay: nutrition and physical activity. Despite their equal importance in a healthy lifestyle, physical activity is often overlooked in favor of nutrition, hence the popularity of fad diets and the current anti-carbohydrate campaign. Unfortunately, these trends are often short-lived and allow for little long-term success. For significant and more permanent change, patient education is an absolute necessity. At the Treasure Valley Pediatric Clinic in Ontario, Oregon, the primary method of patient education came in the form of a handout, whether the health issue was constipation, acne, or nutrition. Glaringly absent from this selection of handouts was any information regarding physical activity and exercise. The aim of this project was to evaluate the level of physical activity in the community, particularly with children and adolescents, and then create a patient handout that would provide education regarding ways to improve current fitness levels. Ultimately, the level of physical activity was found to be inadequate among children and adolescents in Ontario, Oregon; therefore, a kid-friendly brochure was produced and distributed at the pediatric clinic with the hope that early education could lead to a lifetime of healthy habits. Westside Elementary School Asthma Education Project in Madras, Oregon Project Date: 10/18/2004 Asthma accounts for 14.6 million lost school days, 12 million bed rest days, and 24 million restricted activity days per year. It is the leading cause of school absences among children with chronic conditions. In Oregon, there are 74,000 children with asthma. Elementary school asthma education can assist schools in organizing a community to the needs of children, including disadvantaged and minority children whose asthma often goes undetected. A group of six previously identified Westside Elementary School children in Madras, Oregon completed an asthma education program, which consisted of five, 50-minute group lessons held during the school day. It taught the kids how to detect the warning signs of asthma, including triggers that can cause an attack, and how to respond appropriately. The program has been proven to reduce the number of asthma attacks, improve student academic performance, develop student's confidence in managing their own asthma and assist in teaching parents about better asthma management decisions. Newborn Discharge Packet for Siskiyou Pediatric Clinic Patients Project Date: 9/13/2004 This project was designed to provide a brochure of important information for parents of newborns at the Three Rivers Community Hospital in Grants Pass, OR. Multiple resources exist to provide support and advice to parents of newborn infants. However, most of these require the use of internet access or the financial ability to purchase parenting books. Pediatricians supply many free handouts that parents can collect, but many of the parents I talked with indicated a desire for a quick reference source that gave them bulleted points outlining key information and guiding them in when to access their pediatrician. Interviews were conducted with new parents, nurses in the Family Birth Center and the pediatricians at Siskiyou Pediatric Clinic in Grants Pass, OR in an attempt to determine the most important topics to include and what the best format to present this information. A brochure format was believed to provide the best presentation of information for this community. Further data collection determined five main areas for the newborn brochure, including newborn safety, immunizations, well-child checks, local contact numbers and guidance on when a new parent should call the pediatrician. The product of this project is a brochure entitled "Newborn Information That Every Parent Needs to Get Started" that will be given to every parent in the Family Birth Center before discharge from the hospital. Assessing the Resources Available to At-Risk Pediatric Patients Project Date: 8/9/2004 Individuals under the age of eighteen comprise approximately one fourth of the population of Baker County, Oregon. Nearly one fifth of these individuals live below the poverty line, which produces significant ramifications on this society as a whole. Physicians serving this population may offer not only medical services, but also refer other resources to these patients. Through interviews with representatives of community organizations and literature review, services available to pediatric patients who are of low-income families in Baker County were researched. In order to facilitate the awareness and utilization of these resources, patient education material highlighting medical, educational, social, spiritual, and recreational resources available to low-income Baker County pediatric patients was developed and distributed to various agencies in Baker City. Hyperbilirubinemia: Incidence, Accuracy, and Compliance with Guidelines in a Clinical Setting. Project Date: 7/5/2004 Jaundice, which occurs in most newborn infants, is usually benign. Still, the potential neurotoxic effects of bilirubin, which can cause jaundice, are serious enough that newborns must be identified and monitored for severe hyperbilirubinemia, kernicterus, or acute bilirubin encephalopathy. This project attempts to determine the incidence of jaundice in the Klamath Pediatric Clinic in Klamath Falls, Oregon, as well as the accuracy of computer records on jaundice compared to charts in the clinic. Recently, the American Academy of Pediatrics published updated clinical practice guidelines on the management of hyperbilirubinemia. Therefore, this project also attempts to review how the clinic follows these new guidelines and gives recommendations for improvement. 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. 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. ADHD vs. Bipolar Affective Disorder: a Comparison of the Two Mental Health Problems in the Pediatric Population of Klamath Falls. Project Date: 5/10/2004 Mental illness is an important medical problem in the pediatric population that affects communities ranging from large metropolitan areas like Portland to small towns such as Klamath Falls. Although the prevalence of attention deficit hyperactivity disorder (ADHD) and bipolar affective disorder (BAD) are significantly different in the pediatric population, they are often confused with one another due to the overlap of common symptoms. Therefore it is important to identify children with these disorders and make an accurate diagnosis to ensure that they receive the proper medical and psychological treatment. Analysis of ICD9 codes from 2003 demonstrated almost 1,000 visits for ADHD and BAD at The Klamath Pediatric Clinic. These numbers were confirmed by my own record keeping during a three week period which showed 16% of all visits were for mental health issues. Given the number of patients with ADHD and BAD, a screening tool was utilized to try to find differences in the presentation of these two illnesses at the time of diagnosis. Results from questionnaires handed out in the clinic showed higher scores by patients with BAD (24 versus 15; p 0.011). In addition, three specific categories including irritability, thought content, and disruptive behavior were significantly higher in children with BAD. The results of this project suggest that mental illnesses, specifically ADHD and BAD are an important healthcare issue at The Klamath Pediatric Clinic and that there may be ways to better screen for and treat these patients. "Keeping Coughing Kids Home": A Description and Analysis of the 2004 Pertussis Epidemic in Benton County. Project Date: 5/10/2004 The national incidence of pertussis has gradually increased over the past several years. Since 2003, Oreogn has gained national attention as the incidence of pertussis appeared to increase at an alarming rate to a 40-year high for the state. Adults and adolescents are believed to be the primary reservoir for the bacterium whereas the disease causes the most morbidity and mortaility in infants less than 1-year-old. Benton County currently has one of the highest numbers of reported cases of pertussis in 2004 in the state. This study sought to provide a descriptive analysis of the current trends of this vaccine-preventable illness in Benton County using the most current data provided by the Benton County Health Department (BCHD) as well as an interview with departmental personnel to discuss the public heatlh measures undertaken to reign in the epidemic. The data from BCHD revealed that the majority of cases were school-associated 92% and occurred in the Corvallis school district with 34.2% of the cases occurring in Corvallis High School primarily between 3/14-4/11/04. Community physicians were responsible for treating both confirmed and presumptive cases (total 110) in addition to lowering the antiobiotic prescribing threshold for upper respiratory tract infections with a protracted cough. The BCHD has responded to the epidemic by regularly communicating with schools and parents. The department has many interventions planned during the anticipated peak months of the epidemic this summer. It is unclear whether the increased number of reported cases is simply due to increased surveillance or more disease, but is likely a combination of both. School Vending Machines and Obesity in Ontario, Oregon Project Date: 3/29/2004 Obesity is an epidemic among adolescents in America. Overweight children are at risk for many diseases as children and later as adults. There are myriad factors that have contributed to the current epidemic. These factors have been termed a “toxic environment.” I evaluated the food environment at Ontario High School to address what factors at school contribute to a toxic environment. My study found that 40.9% of students at Ontario High School were overweight or at risk to become overweight. This is well above the national rate of 30.4%. A survey assessed reasons for meal termination and the number of snacks purchased from school vending machines. Overweight adolescents were more likely to stop eating because of external cues than healthy weight adolescents. Overweight students drank nearly 2.5 times more soda pop than those of healthy weight. Using this data, a letter was sent to Ontario High School’s principal and school board members strongly encouraging the elimination of soft drink vending machines from school. Evaluation and Management of overweight children in Cave Junction, OR: development of a patient/student handout to outline behavior modification strategies for patients and students at the local schools. Project Date: 3/29/2004 Obesity is on the rise in the world, in the U.S. and in Oregon. Obesity and its complications and co-morbidities are poised to overtake tobacco as the leading “actual” cause of death in the U.S. And our children are right in the middle of the epidemic with the rate of overweight in Oregon’s teens tripling in the past 20 years. Objective: The aim of this study was to ascertain where the children in Cave Junction, OR fit in the larger picture of obesity. How many of the children in a rural Family Medicine practice are overweight and “at-risk” for overweight? Also, what interventions are available and what will be effective at helping these children maintain appropriate weights? Methods: The charts of the 208 children aged 2-20 years old that are seen at Cave Junction Family Medicine clinic were reviewed for heights, weights, gender and age of the children. Body Mass Indexes (BMIs) were then calculated using the CDC’s BMI-for-age and sex charts. Results: Of the 208 children found in the clinic’s database, only 113 of them had heights recorded. Two children (2%) were “underweight” (<5th percentile BMI for age and sex.) Seven children (7%) were “at risk for underweight” (5-10th percentiles). Fifty-eight children (51%) were “normal weight” (10-85th percentiles). Twenty-two children (19%) were “at risk for overweight” (85-95th percentiles.) And twenty-four children (21%) were “overweight” (<95th percentile.) The only BMIs in the charts were from transferred records. Conclusion: The children in Cave Junction are more overweight than the average child in the U.S. (21% in CJ vs. approx 15% in the U.S.) Also, BMIs are not currently being tracked in that clinic and there is good reason to do so. Pediatric Asthma Screening in Scappoose, Oregon Project Date: 11/10/2003 Asthma affects 15 million Americans and 4.8 million children in the United States . In Oregon, 8.2 % of adults and 7.5 % of children are asthmatic, a total of 275,000 Oregonians . Discussion with my preceptor revealed a lack of data regarding the prevalence of asthma in Columbia County and specifically the rural area around Scappoose, Oregon. This paper explores the development of a rural clinic-based pediatric asthma screening program by 1) considering the objectives for a rural screening protocol; 2) evaluating three questionnaires designed for national- and school-based asthma monitoring for their use in a clinic-based program to meet these objectives; and 3) conceptualizing a pilot study to administer this screening tool in Scappoose. The top priorities for this screening program were to detect new asthmatics as young as possible with an inexpensive, time efficient, and simple screening tool that is easily understood by all age groups. The Brief Pediatric Asthma Screen (BPAS) was best suited to achieve these objectives, as it has only five questions with a sensitivity of 75 % and a specificity of 81.2 %. A pilot study is recommended in which this questionnaire would be administered to all children visiting the clinic for one year to screen for known and unknown asthma sufferers. After the first three months of the pilot study, the questionnaire should be assessed for effectiveness in satisfying the objectives of the asthma screening tool. A permanent rural clinic-based pediatric asthma screening program could be established after this pilot year, such that the questionnaire could be administered to all children as part of the review of systems and in well child exams. This asthma screening program would be viable in the rural setting of Scappoose, Oregon in Columbia County or in any primary practice. Treasure Valley Pediatrics in Ontario "Social Stories" Project Date: 9/29/2003 Treasure Valley Pediatrics in Ontario sees a large number of autistic patients. Autism, a pervasive developmental disorder that has a wide spectrum of clinical manifestations, makes it very difficult for these children to adjust to new situations. Any change in their routine, such as visiting a doctor or dentist, especially if some procedure is to be done, is highly distressing to these children, and in many cases they cry uncontrollably, attempt to run away, and in general make it rather difficult for the clinician to care for them properly. Despite their social adjustment difficulties, autistic children are strong visual learners, and it has been shown that showing them pictures of an upcoming activity helps them adjust better to the new situation. For my community project, I visited the providers in Ontario that see autistic children, 3 dental practices, and ear, nose, and throat clinic, the outpatient surgery unit of the hospital, as well as the pediatric practice of which I was part, and photographed the staff, facility, and equipment. I then put these digital pictures into book files that can be printed for patients or emailed to other providers, at the discretion of the care coordinator for the pediatric practice. We called them “Social Stories.” On the first day the Social Stories were available, 3 families and several schools requested copies. Evaluation of Childhood Obesity in a Rural Pediatric Clinic Project Date: 11/10/2003 The incidence of childhood and adolescent obesity is rapidly increasing in the United States. Related to this is a substantial increase in the incidence of type 2 diabetes in children. The short term and long term effects this will have on both the individual and the health care system are drastic. Modifiable risk factors for obesity include sedentary lifestyle and poor eating habits. This project looks at helath behaviors among patients of a rural pediatric clinic. Grade school and high school aged patients at Klamath Pediatric CLinic were given a survey covering several healthy lifestyle issues such as exercise regiments, eating practices, and amount of time spent watching television. Those who were given the survey were also measured for BOdy Mass Index (BMI). Finally, the educational tools provided by the clinic regarding obesity and healthy eating and exercise behaviors were assessed. The findings suggest that the health behabiors that correlate with obesity in the population studied were short duration of exercise (p<0.01) and less than 3 exercise sessions per week (p<0.025). Other behaviors such as eating habits and watching television did not correlate with obesity in this population. Based on this study, it is recommended that the community work to improve child participation in physical activities. Prevalence of Overweight Among Philomath Children, Fall 2003 Project Date: 9/29/2003 Obesity is an increasing problem in the country’s adult and youth populations. Among adults in the United States, the prevalence of obesity increased from 13% to 27% between the years 1976-1980 and 1999. The problem is as substantial in the youth population. The prevalence of overweight among children aged 6-11 has increased from 4% to 15.3% between the 1960s and 1999-2000. This community project studied the data of 370 school children in Philomath, OR from grades kindergarten through 6th. Each child’s Body Mass Index (BMI) was calculated to assess the prevalence of overweight and at risk in Philomath’s youth population. It was found that only 66% of Philomath’s youth are normal weight, 16% are considered at risk, and 18% are overweight (data categorized using the CDC’s growth charts for children). The overweight problem needs to be addressed, most likely by parents and by schools. A less sedentary lifestyle as well as nutritious and moderate food consumption should be promoted. The Prevention of Firearm-Related Injury and Death in Children in Malheur County, Oregon: How One Community Promotes Gun Safety in Children Project Date: 9/23/2002 Firearms are the second leading cause of death in children in Oregon. Studies have shown that counties in Oregon with a high rate of gun ownership are more likely to have a high gunshot death rate.1 Malheur County, as well as other counties east of the Cascade range, have high gun ownership rates. Children in these counties were 39% more likely to die from gunshot wounds between 1987 and 1996.1 These statistics place children in Malheur County at high risk for gun-related injuries. My project examined measures taken in Malheur County to promote gun safety, and prevent gun-related injury and death in children age 0-19. I researched public policy and community-based interventions, school programs, hunter education and other gun safety classes, and health care provider counseling of parents and children. In general, Malheur County addresses gun safety primarily by educating parents and children on safe behaviors. National studies have shown these efforts to be surprisingly ineffective. Thus, health care providers and local community leaders must find creative, more effective ways to decrease the number of firearm-related deaths in the community. Providing a home: a place for children with special health care needs Project Date: 8/12/2002 Pediatric and adolescent patients currently have limited resources for obtaining mental health care and counseling. Three primary reasons exist for this lapse in health care. These include having only one option for Medicaid patients, the social stigma associated with going to a mental health care clinic, and limited physical accessibility. For all these reasons, these children do not obtain treatment or counseling. Another issue that has resulted in fragmented and incomplete care is the lack of communication and coordination between mental health care providers and the primary care physician. Treasure Valley Pediatric Clinic in Ontario, Oregon has become acutely aware of the shortcomings of the mental health care that is offered in our community. Nationally, children with special health care needs constitute 16-18% of all children. A low estimate shows that in the last three months alone, 14.7% of office visits at Treasure Valley Pediatric Clinic comprise seeing CSHCN. In trying to provide complete health care to children, the American Academy of Pediatrics developed the concept of the medical home. In an effort to meet the ideals of the medical home, TVPC presently employs a care coordinator. Unfortunately, this does not address many of the concerns facing mental health care in this community. TVPC wants to expand the medical home by incorporating mental health in a neutral and comfortable environment within the pediatric clinic where routine care is provided. In doing so, TVPC strives to provide accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care to children with special health care needs. Increasing Immunization Rates at Klamath Family Practice Project Date: 8/12/2002 Vaccination rates affect everyone, because each unimmunized person risks transmitting the disease to other vulnerable populations. Unvaccinated children risk acquiring serious, even fatal diseases such as tetanus, diptheria, pertussis, measles, meningitis, epiglottitis, mumps, rubella or polio. Nationwide, vaccination rates typically remain above 90% (MMWR Morbidity Mortality Weekly Report, 2001). However, as of June 2002, Klamath Family Practice Center's Immunization Coverage Rate was only 60% by babies' first birthdays (Figure 1; AFIX, 2002), and coverage rates remained below 40% through year 2 (Figure 1). It was observed that Klamath Family Practice lacked a system for encouraging parents to bring children in for immunizations, so parents were interviewed to determine reasons for failures to vaccinate. The most common were forgetting well-child appointments and misconceptions about immunication, so a protocol was developed to address these issues. Parents filled out follow-up reminders at each visit which were later mailed to them, nurses provided education brochures and immunications checklists, and doctors responded to questions and concerns. Measles and pertussis rates even in immunized children directly correlate with the number of unvaccinated children, and cases of chickenpox dramatically declined after its addition to the immunication schedule in 1995. At-risk populations are the most common cause of doctor visits already, so increased immunization rates provide a safer environment for the very young, elderly and immunocompromised residents of Klamath Falls. A Bright Future for Well-Child Checks in Coos Bay, Oregon: Implementation of National Guidelines and Survey of Parental Satisfaction Project Date: 8/12/2002 Bright Futures is a national child health promotion and disease prevention initiative that provides guidelines for health supervision visits (ie. well-child checks). The purpose of this project was to (1) compare well-child checks performed by pediatricians at NBMC & Bay Clinic in Coos bay, Oregon with Bright Futures guidelines, and (2) conduct a survey among parents regarding their satisfaction with patient education materials received during the visits. Well-child checks at NBMC and Bay Clinic correlate approximately 85% and 75% with Bright Futures guidelines, respectively. The survey completed at NBMC reveals a generally high level of satisfaction with patient education materials. Yuck Mouth: Pediatric Dental Health in Jefferson County Project Date: 7/1/2002 Tooth Decay is the most common chronic disease of childhood. Despite the significant consequences for childhood health and wellbeing, many children go untreated. Dental care has recently been cited as the most prevalent unmet health need in U.S. children, particularly amongst minorities and those living in poverty. These disparities and the prevalence of unmet need often goes unrecognized by physicians, in part due to the traditional separation of medicine and dentistry. Primary care physicians, however, play an important role in child and family development at precisely the time where dental guidance is needed. In an effort to increase parental education about dental disease prevention, a pamphlet was constructed for the Highlakes Clinic and the surrounding area. The pamphlet was constructed utilizing reviews of journal and internet sources as well as interviews of community members. The role of primary care physicians in oral health and disease prevention was then explored. It was found that by incorporating education about preventative oral health physicians could compliment existing dental services and help better meet the health care needs of area children, particularly the underserved. Examination of risk factors for the development of osteoporosis in adolescent girls at the Woodburn Pediatric Clinic. Project Date: 7/1/2002 Osteoporosis is a major health issue in America, affecting 30% to 40% of adults older than 60. Although osteoporosis is most prevalent in the older population, it is now understood that its roots lie with the pediatric population. The failure to achieve an adequate peak bone mass is a significant risk factor for future development of osteoporosis, and this process is almost complete by the onset of adulthood. This study attempts to identify the prevalence of risk factors in 9 to 13 year old girls that may predispose them to the development of osteoporosis. Data was collected by surveying girls regarding their dietary habits, exercise routine, medication use, and family history of osteoporosis. A chart review of well child exams for children of the same age was completed to assess how the Woodburn Pediatric Clinic addresses the issue of bone health. The findings of this study estimate that 60% of female patients in this age range were not consuming the recommended 1300 mg of calcium daily, 50% were not participating in regular weight-bearing exercises, and 33% already had a known family history of osteoporosis. The chart review demonstrated that the Woodburn Pediatric healthcare team is addressing nutrition and exercise in a broad sense, but fail to specifically evaluate and educate patients about the risk of developing osteoporosis. It is recommended that clinicians begin screening girls for inadequate calcium intake and exercise and providing counseling regarding preventing osteoporosis beginning at the 5-year-old well child exam. Children and Grief: Resources for Pediatricians in Coos County Project Date: 2/11/2002 Children grieve according to their developmental stage and individual personalities. There is no "right" way to grieve and each child will go through the process in their own way. Pediatricians can be a vital source of support and information for families dealing with the loss of a loved one. In Coos County pediatricians also have the additional resource of the Light House Center, a support program for grieving children, teens, and families. Working with the Family Services Manager, I developed an educational and fund-raising presentation as a service to the Light House Center and the pediatricians of Coos County. "Assessing the Understanding of Respiratory Syncytial Virus in a Rural Community" Project Date: 2/11/2002 The major cause of lower respiratory infections in children worldwide is a virus, respiratory syncytial virus (RSV). Usually self limited, RSV can be treated at home, but up to 3% of infants infected require hospitalization. The purpose of this community project was to gain an understanding of the Reedsport, Oregon, area residents' comprehension of a viral respiratory illness symptoms and treatments. From this information, an educational handout specifically about RSV bronchiolitis was created. 124 patients at the Dunes Family Health Care Clinic ranked various "cold and flu" symptoms by frequency of office visits and answered different true/false questions. Results showed the symptoms of difficulty breathing, a cough with phlegm, and fever greater than 101F accounted for the greatest number of clinic visits. Results from the "true/false" section of the questionnaire revealed over one half of the responders (51%) erroneously answered "true" to the following question: "A viral respiratory infections needs antibiotics to be treated properly." Based upon the results, it was concluded that many patients probably don't understand the difference between viral and bacterial respiratory infection and the subsequent treatments. From this conclusion, a handout was created to educate patients about infant bronchiolitis and RSV. Breast Feeding As A Possible Protective Factor In Children Diagnosed With ADHD. Project Date: 1/2/2002 This study sought to look at a possible connection between the lack of breastfeeding and the diagnosis of ADHD, in the Treasure Valley Pediatric Clinic in Ontario, Oregon. The design is retrospective case control study involving all patients being seen for ADHD in the clinic. When charts were reviewed in the ADHD population, 39% of that population received a diet containing breast milk within the first six months of life, as compared to 67% in the control population. This report discusses the protective effects of breastfeeding versus non-breastfeeding and how this might affect the diagnosis of ADHD. A Survey Of Teacher Satisfaction With The Woodburn Pediatric Clinic's Monitoring Practices Of Students Diagnosed With Attention Deficit-Hyperactivity Disorder. Project Date: 11/5/2001 Attention-deficit/hyperactivity disorder is the most common school-aged behavioral problem with a prevalence of 3-5%. The Woodburn Pediatric Clinic has a large subset of these patients on its census. Management and monitoring included a questionnaire sent to the teachers and counselors of these patients concerning AD/HD-specific behaviors. This study investigated the efficacy of this questionnaire by employing a teacher survey. Generally, feedback concerning the questionnaire was positive. Suggestions for improvement centered on changing the format from fax to e-mail and giving respondents more lead time in completing the questionnaire. Firearms and Parental Perceptions on Gun Safety in Grant County. Project Date: 5/6/2002 This study sought to examine parental perceptions on firearm safety among Grant county residents. A 6-item questionnaire was distributed to all patients visiting the Strawberry Wilderness Family Clinic from May 20 to June 10, and customers at two local supermarkets on the weekends of June 1-2 and 8-9. Outcome measures are prevalence of firearms in households, practice of safe storage, history of firearm safety discussion with children, and parent's opinion on hypothetical situations involving a child and firearms. Among the 148 participants in the survey, 82% reported having at least one piece of firearm in their household. Of these, 60% stored loaded firearms in the house without a secured or locked cabinet. Among parents owning one or more guns, 75% have discussed firearms safety with their children, 38% thought their less than 6 year-old child can distinguish a real gun from a toy gun. Use of Anthropometry in an Outpatient Office Setting: Screening for Fetal Alcohol Syndrome and Fetal Alcohol Effects. Project Date: 5/6/2002 Fetal alcohol syndrome (FAS) is a pattern of physical, behavioral, and cognitive defects seen in individuals exposed to alcohol in utero. Fetal alcohol effects (FAE) consists of more subtle symptoms sometimes presenting as poor academic achievement and behavioral problems. The FAS and especially the FAE phenotype is highly variable and may be difficult to distinguish from other conditions such as attention-deficit hyperactivity disorder (ADHD). ADHD is a common childhood psychiatric disorder consisting of behaviors that include one of the following hallmarks of hyperactivity, inattention and/or impulsivity. Anthropometry is a technique that objectifies craniofacial features for use in plastic surgery, dysmorphology and medical genetics. Recently, Moore et. al. 2001 described a method utilizing anthropometry that was 96% accurate for differentiating between individuals with or without exposure to alcohol in utero. Using this same tool we screened 21 children and were able to correctly identify two children with known FAS, and by using less stringent criteria were able to identify 6 more children with suspected alcohol exposure in utero. Interestingly, 4 out of these 6 children had known diagnoses of ADHD. Good Touch, Bad Touch: Addressing the Problem of Child Abuse in Coos Bay. Project Date: 11/5/2001 Child abuse and neglect is a significant problem nationwide with over 1 million reported cases each year. For the past two years, Coos County has had the highest child abuse rates in the state of Oregon. In spite of these significant statistics, little is being done in Coos County in terms of primary and secondary prevention. The purpose of my community project was to bring a program into the schools that would address prevention of child abuse. Through research of resources, in collaboration with school nursing staff, I was able to develop a ready-made program for the school nurses to present to children in both the primary and intermediate grades. The program addresses good touches and bad touches, and instructs children on how to seek help if they are touched in a way that makes them feel sad or uncomfortable. The goal of this project is to reduce incidence of child abuse in Coos County by educating and empowering children. Back to subject search page or search by preceptor site