RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Harney County Influenza Strategies 2009 Project Date: 10/12/2009 This project is a general outline of the organization of local resources and planning used during the 2009 Influenza Pandemic to provide adequate and appropriate care to citizens in Harney County in relation to influenza prevention, triage, and treatment. There was a large surge of influenza-like-illness (ILI) in the community in mid-October, during which time resources including vaccines, Tamiflu, and hospital space were of limited quantity and maintaining a high level of coordination between the hospital, clinic, pharmacies, and health department were all critical. The Coca-Cola Crisis: The relationship between soda consumption and BMI in a Marion County clinic Project Date: 10/12/2009 During a time where childhood and adult obesity is reaching epidemic proportions, the American Society of Family Physicians announced a highly controversial merger with Coca-Cola to promote consumption of its products as part of a healthy life style. This raised a highly charged debate as to whether or not family physicians could ethically support soft drink consumption in the face of numerous studies linking soft drink or soda consumption to increasing BMI. In Marion County, obesity rates are even higher than Oregon in general. This study sought to create a snap shot of the current obesity trends within a specific Marion County clinic and assess the association between soda consumption and BMI. Additionally, the study sought to assess the motivational factors that contribute to soda consumption. Soda consumption was assessed through surveys that were self reported and correlated to the most recently recorded clinic BMI. Over 200 patients were surveyed with only 74 responders. Of those responding, only 18 self identified as soda consumers. When assessed, it was found that there was a statistically significant positive association between soda consumption and BMI with an average BMI for soda consumers of 33.4 with a 95% CI (29.86-36.99) compared to 29.4 in the control group with a p-value of 0.012. This positive association supports numerous studies that have addressed a caloric as well as hormonal association between BMI and soda consumption. This relationship calls into question the ethics of supporting a healthy lifestyle that includes soda consumption that is associated with obesity and its myriad of co-morbidities. Screening for Chlamydia Trachomatis Project Date: 10/12/2009 Chlamydia is the most common sexually transmitted bacterial infection in the U.S. with particularly deleterious consequences for women. Alicia Hills, communicable disease nurse and educator at the Department of Public Health in Baker County, has been tracking the rise in Chlamydia positivity throughout Baker County since 2007. Data from DHS in Oregon demonstrates an increase in the incidence of Chlamydia in Baker County overall from 2003 to the present. The rise in positivity may be attributed to greater access to female providers since 2003, an increased risk for false-positive tests due to the lower prevalence of Chlamydia in Baker County as compared to the average for Oregon state, and easier screening methods implemented by clinicians in the area. A universal Chlamydia screening protocol was discussed and implemented at the Eastern Oregon Medical Association and the Baker County Public Health Clinic. In addition, educational pamphlets from DHS discussing sexually transmitted infections will now be offered to patients being screened for Chlamydia. Emergency room physicians agreed to encourage at-risk patients to be tested at the Public Health Clinic. A powerpoint presentation used to educate adolescents and young adults in Baker County about sexually transmitted infections was revised and updated. Swine Flu Epidemic: What are patient and health care workers attitudes and knowledge of the H1N1 influenza and vaccine in Florence Oregon? Project Date: 10/12/2009 The H1N1 flu is an epidemic that has already reached 48 states, and has killed 672 people, and hospitalized over 17,000 (1). Patients are asking about the H1N1 flu and vaccine on a daily basis and many are very concerned. Health care workers are also frequently discussing these issues. Two surveys were developed to question the opinions and knowledge base of both patients and health care workers regarding the H1N1 flu and vaccines. There appears to be some lack of knowledge about the H1N1 vaccine and flu. People of all ages are concerned about the flu, and age doesn’t determine who thinks they do or do not need a vaccine. The majority of people are receiving information from the television about H1N1, and very little from their doctor’s office. There is a need for greater patient education about the vaccine and the flu. In regards to health care workers that were surveyed, doctors are well vaccinated, and MA’s are not. Many patients (on average 50% or more) are asking about the vaccine and flu. Most workers are providing very minimal information to patients regarding the vaccine and flu. Workers are being approached by family members and the community about the vaccine and flu. Only 13% of workers feel they are confident of their knowledge of the vaccine and flu. In conclusion, patients and health care workers are in need of education about the H1N1 flu and vaccine. Preparation and prevention are key concepts for health care workers and patients to understand (2). 2009 H1N1 Influenza – The Response of Klamath Falls, OR to “Swine Flu” Project Date: 9/7/2009 The 2009 H1N1 flu virus spread rapidly throughout the world and created significant concern bordering on panic wherever it went. Klamath Falls, an area with around 50,000 individuals (15,000 of them minors) in southern Oregon, was no exception. The aim of this project was to explore the effect of, and response to, the “swine flu” in the community. To this end I drew off experiences working at the Klamath Pediatric Clinic, developed an educational handout to give to patients and their families, and interviewed public health and school district officials. I was also able to participate in the local hospital’s infection control meetings as they developed their policies regarding 2009 H1N1 and sit in on lectures and webcasts from the AMA/CDC and OHSU Grand Rounds. Oregon Senate Bill 528: Expected effects on the Willamette Valley Project Date: 9/7/2009 This study discusses the principal argument for the passing of Senate Bill 528 and the impact that field burnings have on the health of the surrounding communities. While there are documented studies that look at the correlations between negative health outcomes and field burning, few studies have looked solely at the direct causative effects. Rapid Influenza Testing in the Cottage Grove Community Hospital Project Date: 8/3/2009 The goal of this project is to determine the number of positive and negative cases of influenza that have been detected with the QuickVue rapid influenza test at the Cottage Grove Community Hospital (CGCH) between 7/9/09- 8/25/09. CGCH encompasses an emergency department, medical ward, and outpatient clinics in Cottage Grove, a community of 18,000 in the southern part of Lane County, Oregon. The first screening test used by CGCH in the workup of acute influenza is the QuickVue Influenza test, which detects influenza A and B antigens directly from a patient’s nasal sample. The basic demographics of the patient population tested at CGCH during the study period is outlined, and the most common symptoms of patients presenting with influenza are identified. The sensitivity and specificity of the QuickVue test is discussed along with the prevalence of influenza (specifically the novel H1N1 influenza A virus) in the region. H1N1 Influenza: Patient Education and Preparation in Jefferson County Project Date: 8/3/2009 With the most current novel influenza virus pandemic sweeping our planet, no locale however small seems immune. Although Jefferson County has yet to confirm a case of H1N1 this year, its residents are still worried and questioning what this coming flu season will bring. After attending the H1N1 Influenza Preparedness Summit in Salem as well as meeting with local representatives from the health department and surrounding clinics, I have learned that patient education with a consistent message will be the key to preventing a widespread outbreak in this community as well as abating much of the fear surrounding this pandemic. My goal in this project was to create materials for the Madras Medical Group (MMG) clinic to use this coming season to educate its specific patient population about H1N1 in order to encourage early preventative measures and limit spread among the community. Through a presentation to the MMG on the current H1N1 status in our state, my goal was also to provide clear and accurate information on treatment and prevention to the medical staff so that they might pass this information along to their patients, families and friends. 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. Dispensing Health Literacy in Coquille: Starting a Medical Lecture Series in a Vacated Pharmacy Project Date: 6/29/2009 The town of Coquille is one of the poorest and least educated areas in Oregon and consequently has low health literacy as well. The nature of the town shows that to improve the health of the population, one must improve the basic communal knowledge about common diseases. One way to get that knowledge out is to use a spot frequented by the community, outside of the hospital, to stage a series of medical lectures. The old Barrow Pharmacy downtown had been converted to a make-shift community center where many classes were being held, including cake-decorating. I organized a series of 4 lectures, kicking off the first one as a co-speaker on diabetes, followed by talks about smoking cessation, COPD, and first-aid to take place after completion of my rotation. Seeking recommendations for speakers, I contacted professionals in the respective subjects and signed them up for consecutive Friday afternoons, helping to advertise through flyers and the local paper, and then handing off the information and structure to others who could keep the project going after I left. Despite suboptimal attendance for the first lecture, the stage is set for four lectures that will promote the health of a community that has given me great hospitality as a student. Health Provider Emergency Preparedness to Swine Flu in Lebanon Project Date: 4/27/2009 This project is a report on how health providers in Lebanon prepared and responded to the H1N1 influenza outbreak. The resources available to the health providers were the recommendation and guidelines from the CDC, the Oregon Department of Health, the Linn County Health Department and the Samaritan Health Services. Health providers encouraged patients to follow the CDC recommendations on practicing good hygiene habits. They stayed informed by following the daily updates of the Oregon Department of Health and Linn County Health department websites. Health providers implemented the triage guidelines from the Samaritan Health Service officials to prevent over utilization of the clinic. As a result of these strategies health providers in Lebanon were able to efficiently respond to the small surge in medical demand and at the same time continue providing their usual medical care. Enhancing Domestic Violence Screening and Outreach at Santiam Medical Associates by Addressing Barriers Faced by Battered Woman in Rural Communities Project Date: 4/27/2009 This project aims to evaluate the preparedness of Santiam Medical Associates to recognize and refer victims of domestic violence (DV) to resources. Another key objective was to illuminate the myriad of barriers faced by victims of DV in rural communities and the ways in which providers can become better equipped to assist these victims. It is thought that 1 in 10 women in Oregon between the ages of 20-55 (more than 85,000 women), have been physically or sexually assaulted by a current or former intimate partner in the last five years.1 Nearly one-third of American women (31%) report being physically or sexually abused by a husband or boyfriend at some point in their lives.2 Women in rural communities face specific challenges to accessing resources. Rural physicians can play an integral role in improving the lives of their battered patients if they are aware of the problem and provide a safe and confidential environment for women to disclose. During my rotation, I administered an anonymous survey to the employees of the Santiam Family Medical office to assess their awareness of DV, preparedness to ask about abuse, whether they felt equipped to refer patients to appropriate resources and their thoughts on barriers women face while seeking safety from abuse in Stayton. Based on the results of the survey, I collaborated with a non-profit domestic violence organization to develop a training workshop for the staff on addressing DV in a medical setting. In addition, I was able to provide prevention and education materials on DV for the physicians and staff to distribute to patients in need of information and community resources. Preparing a Rural Community for Emergency and Outbreak Project Date: 4/27/2009 When faced with a large scale Emergency or an Infectious disease outbreak a small community is still held to the same standards of preparedness as compared to a more urban medical community but must do so with some unique challenges. The recent global outbreak of H1N1 influenza has proved a catalyst to ensure hospitals are up to par with regards to Emergency and Outbreak response plans and Madras Mountain View Hospital is no exception. This community project has three primary endpoints including: 1) To Conduct interviews with hospital personnel to educate myself with regards to rural hospital preparedness for emergencies and infection disease 2) To identify strengths and weaknesses inherent to the response plans 3) To develop information fliers for medical staff education, outlining levels of the response plans including medical staff responsibilities. 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. Prevalence of HTN in the Pt population seen by a Clinician at the PFMC and Patient’s Attitudes towards Management of HTN Project Date: 4/27/2009 About 29% of US population has high blood pressure and only 54% of these patients are on anti-hypertensive treatment, and only 33% of these pts on treatment have good control (1). HTN is associated with a high morbidity and mortality. Even though pharmacologic treatments have shown promising results in managing HTN, the side effects, the cost, and pt’s attitudes towards taking medications limit their use in successful management of HTN. As I was doing my rural rotation, I noticed that almost a third of the pts had HTN and so I decided to do this project to determine the prevalence of HTN in this population. I was also curious to find out what patients (with/without HTN) think is the most important factor in managing a high BP. Inactivated Influenza Vaccine Rate and Implications in Diabetic Patients in John Day, Oregon Project Date: 4/27/2009 Flu vaccination is an important preventative focus of diabetic care. Deaths and hospitalization from influenza are uncommon among the general population. However, diabetes puts people at higher risk for severe flu illnesses, secondary complications and death. Given the high prevalence of diabetes and the development of the diabetic questionnaire in John Day in November 2008, I would like to use this opportunity to understand whether the influenza vaccination rate is improving with the utilization of the questionnaire. The project is designed as a retrospective study for the inactivated influenza vaccination status on diabetic patients seen for the last two years in Blue Mountain Hospital, Strawberry Wilderness Community Clinic. A total of 307 diabetic patients were selected for the study. The result shows the rate of influenza vaccination increased from 30% in 2007 to 38% in 2008. Prevalence of Antibiotic Resistant Bacteria Project Date: 4/27/2009 I studied the prevalence of antibiotic resistant bacteria among the population serviced by the laboratories at Silverton Hospital. Antibiotic resistance data for 2009 was obtained for the following species: C. feundii, E aerogenes, E cloacae, E faecalis, E coli, K. oxytoca, K pneumonia, M morganii, P. mirabilis, P. aeruginosa, S marcescens, S aureus, S epidermidis, S. saprophyticus, S. agalactiae. Sensitivity data for the following drugs was available: Amikacin, Ampicillin, Aztreonam, Cefazolin, Ceftazidime, Ceftraxone, Cefuroxime, Ciprofloxacin, Clindamycin, Ertapenem, Erythromycin, Gentamicin, Imipenem/Cilast, Levofloxacin, Nitrofurantoin, Oxacillin, Piperacillin/Tazobactam, Sulfa/Trimethoprim, Tetracycline, Vancomycin. Relevant literature was reviewed including data from national levels and from the greater Portland area. There is data in the literature to suggest that regional antibiograms provide accurate, cost effective information for local providers concerning trends in community-specific resistance trends. Providing sensitivity that is regional and accurate will help to guide empiric therapy of common infections, and can ultimately help to decrease the rate of increase in resistant bacteria. 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. Health Literacy at Dunes Family Health Care Project Date: 4/27/2009 Purpose: To determine the prevalence of patients at risk for poor health literacy at Dunes Family Health Care (DFHC), analyze the readability of the patient education materials (PEMs) provided to the patients, and determine what additional steps can be taken to ensure better physician-patient communication. Methods: Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R). The REALM-R was administered to all English Speaking patients or their caregivers, if the patient was >18 years of age, at DFHC. Those who scored <6 were considered at risk for low literacy. Results: One-third of patients were found to be at risk for poor health literacy. Males were more likely to be at risk for poor health literacy. Fifty percent of high school graduates were found to be at risk for poor health literacy. Nearly 90% of those at risk for poor health literacy had completed at least one year of high school or beyond. PEMs at DFHC were written at a mean grade level of 7.4, well below the national average of 10th grade. Conclusion: A significant percentage of patients at DFHC are at risk for poor health literacy, and therefore poor compliance and worse health outcomes. Fortunately, the PEMs are written at a level lower than that of the national average but are still written at a level too high for patients at DFHC. Health of the Klamath Tribes Project Date: 3/16/2009 The purpose of this project was to educate myself and my peers about Indian Health Service and unique health and healthcare delivery issues faced by AI/NA patients, within the context of the Klamath Tribes as sole provider of IHS services in Klamath County. The Indian Health Service (IHS) is a unique healthcare delivery system that provides health services to nearly 2 million American Indians and Alaska natives (AI/NA) residing on or near reservations and 600,000 patients in urban areas. The Portland Area Office of IHS is one of 12 area offices around the country, serving 42 federally-recognized Tribes in Idaho, Oregon and Washington State. The project population was patients at the medical clinic of the Klamath Tribes Health & Family Services Wellness Center. Investigation methods included a meeting and extended tour with the Health General Manager, observation of patients at the Wellness Center, discussion of health and healthcare delivery issues with the clinic’s primary providers and use of Internet resources. Results: common health issues included opioid dependency, diabetes, hypertension and obesity, infant mortality, substance abuse and mental illness. Healthcare delivery issues included limited funding, need for providers, limited resources for a growing patient population, and lack of an electronic health record (EHR). Virtual Office Visits in Harney County - an assessment of attitudes and access to care Project Date: 3/16/2009 Access to health care is a growing concern in the United States that disproportionately affects those in rural areas already working to overcome barriers in physical access. Technology has the ability to bridge some of these physical gaps and may be particularly effective at increasing access in geographically isolated areas. Virtual office visits – the online interaction between patient and physician – may be one of these technologies. This study was designed to evaluate patient and physician attitudes toward virtual office visits in Harney County and to gather logistical information to assist in the eventual development of a pilot project. A standardized survey was developed and data was collected over a two week period. Physicians and office staff were interviewed and models for virtual office visits in other locations were reviewed. Overwhelmingly, patients and physicians expressed interest in piloting virtual office visits in Harney County and felt that this technology would improve access to health care and consequently would improve health outcomes. Several common concerns were also identified and problem-solving strategies were discussed. At the completion of the study, a document with compiled results of the survey, synthesized data from the interviews, and suggested options for pursuing a pilot project was presented to staff at the High Desert Medical Center. Available resources for patients with mental health concerns Project Date: 3/16/2009 Mental health issues, depression and anxiety in particular, are a concern common to urban and rural populations alike. Due to the generalized scarcity of resources often found in rural and frontier settings, access to care is a major concern given difficulties with both maintaining appropriate mental health services as well as the limited ability for patients to afford them given high rates of poverty and lack of insurance. By interviewing medical and mental health providers in Coos Bay and North Bend, this project seeks to identify available resources for patients with mental health concerns and qualitatively assess how well these are being utilized by the healthcare community. Perceptions of Place, Health, and Illness Among Longtime Tillamook Residents Project Date: 3/16/2009 Cultural competence within health care systems and among providers is an increasingly important issue as public health officials and policy makers look for cost effective means to improve health. Cultural competence of medical professionals within rural American populations is particularly important in efforts to attract health professionals to rural areas, to augment the success of public health interventions, and to improve health outcomes and patient satisfaction. With this project, I added to cultural knowledge that bridges the urban medical community with rural, specifically Tillamook, Oregon, communities. I interviewed six longtime Tillamook residents who have lived in Tillamook for at least 50 years. I asked each of these participants a series of questions designed to elicit their perceptions on diverse topics, including personal history, geographic and cultural identity, occupational health, expectations of health care, experiences of illness and grief, and beliefs about depression. Three important, recurring themes included Tillamook residents’ positive perceptions of rural lifestyle and of Tillamook; their self perceptions as being independent, self-reliant, and stoic; and their shared belief that physicians should be skilled at developing high quality relationships with patients and that rural doctors are more successful at this than are urban doctors. These findings enhance our understanding of rural patients as ones who desire highly individualized health care with respect and support of their cultural values that include hard work, self-reliance and self-healing. 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. The Rural Elderly: A difficult to manage health care system? Project Date: 2/9/2009 •61 million people live in the rural U.S. and 15 % of them are 65 years of age or older. When it comes to healthcare, the shortages have even greater implications for these rural elderly. So, it is the goal of my project to examine how rural elderly manage their healthcare. By using the current literature and interviews of patients and doctors, I have set out to understand if the rural elderly in Hood River find it difficult to manage their healthcare and to provide suggestions for improvements that all healthcare providers can use. Access to Health Care in Rural Communities Project Date: 2/9/2009 Access to health care in rural communities has long been recognized as a public health concern and much effort has been expended to study and remedy the problems with access to healthcare in these areas. In our study we examine access to healthcare, and quality of health care for health care providers in four communities in the mid-Willamette Valley in Oregon. All MD’s, DO’s, NP’s, and PA’s in the communities of Stayton, Sublimity, Aumsville, and Mill City OR were surveyed anonymously about their access to healthcare and whether they receive the screenings recommended by the US Preventative Services Task Force (USPSTF). Twenty seven providers where surveyed and 21 responded. Of these, 75% had a personal PCP, but less than half have had a physical exam in the last 2 years and 3 had never had a physical exam. Only 62% of USPSTF screenings were complete for this group and over half of these were self screenings. Acute Psychiatric Care for the Underserved Population of Ontario, OR Project Date: 2/9/2009 There is an increasing demand for psychiatric care and a decreasing supply of corresponding resources in rural Oregon, including communities like Ontario and greater Malheur County. Although availability and access to psychiatric care is a problem throughout the United States, significant obstacles exist in rural areas that create unique issues that are not easily overcome. Specifically, while primary care physicians serve to treat common mental health conditions such as anxiety and depression as part of their daily practices, specialty care needed to treat more complicated mental health cases and acute psychiatric crises are becoming increasingly scarce. In the case of the emergency room, hospital staff must overcome a number of hurdles when assessing, evaluating and referring every single psychiatric patient. This is especially evident at the Holy Rosary Medical Center (HRMC) hospital in Ontario, Oregon, where numerous factors combine to make treatment for the acutely mentally ill frustrating at best and impossible at worst. The goal of this project was to: 1) formally investigate these problems and complications; 2) discuss the barriers as they exist in their current state; and 3) suggest some reasonable recommendations that could be implemented to improve present conditions. Incidence of Caesarean Deliveries In Rural and Urban Areas: Do our small towns have the answers to solve the bigger issue? Project Date: 2/9/2009 Caesarean births are rising in the US and have been for the last decade. There are likely many contributing factors, and just as likely there is no easy answer for how to reverse this trend. While we may look to patient preference, physician discretion, and changing medical standards for a part of the explanation, this paper attempts to break down this growing problem to see if there are parts of the country that are effected more than others. In the town of John Day, Oregon, the rise in caesarean deliveries has grown high above the national average and it is even higher still above Oregon’s urban center of Portland. But while the effects of this trend towards caesarean delivery is more apparent in this rural setting, the town of John Day may also be able to show us a clue to stopping this rise. In the final year of data analysis, 2007, the town saw a rapid decline in the incidence of its caesarean deliveries, interestingly enough this year also marked the highest number of deliveries, by caesarean or vaginally. While this paper does not leave its reader with the answer for how to solve the rise in caesareans, it does offer the next step in researching how John Day was able to buck the trend. Profile of First Responder Program in Harney County Project Date: 2/9/2009 Harney County Emergency Medical Services face unique challenges in providing emergency care to the remote areas of the Oregon’s largest and least densely populated county. The implementation of an all-volunteer First Responder Program around the county permits trained citizens to arrive on the scene sooner than EMS crews and begin to provide care to the patient and information to the crew en route. A profile and critical review of the First Responder Program demonstrates the importance and inherent challenges of maintaining this program that plays an integral role in providing emergency services in rural and frontier regions. Reedsport Nutrition Information Site Project Date: 12/29/2008 Good nutrition is becoming rarer and rarer in Oregon as well as the nation, leading to troubling trends in obesity. The purpose of this project was to provide an easily accessible resource that contained information on good nutrition and had tools for self-evaluation. It was decided the best medium for this project would be a website. Clinicians could then provide the site address to patients interested in nutrition or those struggling with being overweight or obese. Further, patients who benefitted from the site could refer friends as well, increasing the target population to all residents of the county and beyond. The interactive nature of the site was aimed at making it more personal than a handout and thus serving as a personal nutrition consultation. As a consolidated source of information, its utility is hoped to be greater than other sources on the web that may contain each of its individual aspects. Keeping Kids Physically Active in Madras, Oregon Project Date: 12/29/2008 Childhood obesity has become a major health problem throughout the United States over the last several decades. When battling this epidemic, there is often a two-pronged approach involving nutrition and physical activity. In Jefferson County, only half of youth met the recommendations for physical activity suggested by the Center for Disease Control. In addition, Jefferson County does not have the resources for a parks and recreation division to help organize and publicize available youth sports programs. This project focused on the opportunities for children to participate in organized physical activities in Madras, Oregon. The aim of this project was to provide a resource for patients that provides information about guidelines for physical activity for children and the youth sports programs that are available in the community of Madras. Burns Biggest Loser Part 2: Finding Reliable Healthy Weight Loss Information In a Small Rural Community Project Date: 12/29/2008 Over 66% of Americans are overweight or obese. In urban areas, there are a variety of weight loss classes, clubs, and programs available to the individual motivated to lose weight. Paradoxically, in rural areas like Burns, Oregon the prevalence of overweight and obesity is greater than the national average, yet the weight loss resources are scarce. If a resident of Burns, Oregon wants healthy weight loss information there are few local resources, none of which offer free weight loss education, guidance, and monitoring. One option for such an individual is MyPyramid.gov, a free interactive web site that offers personalized diet and physical activity assessment, and encourages healthy self-monitoring behaviors. 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. Tobacco Cessation Group Visit Project Project Date: 10/13/2008 Tobacco abuse in the United States remains a leading cause of preventable death and disproportionately affects Medicaid recipients. At my rural site, a clinic serving exclusively Medicaid and OHP patients, an approximate 45 percent of our adult patients smoke. A significant percentage of those smokers are afflicted by smoking related illnesses such as heart disease and COPD. Having identified this at-risk population, we set forth to plan and implement a tobacco cessation group visit that is consistent with principles set forth in The Chronic Care Model and the Future of Family Medicine Project (FFMP). Adult smokers with smoking related illnesses were invited to participate based on their desire to quit. Of the 7/15 patients invited participated in the group. At the visit, our care team documented vitals and spirometry values, facilitated a group discussion about quitting, provided a brief informational presentation, and counseled patients individually regarding their plans for tobacco cessation. The visit resulted in 5/7 patients setting a quit date and creating an action plan for quitting! Several barriers to participation were identified including scheduling and transportation. A follow-up group visit is planned for January 2009, and current plans are to continue with new cohorts in the future. Uncontrolled Diabetes in the Hispanic Community of Hood River, Oregon: Identifying Barriers to Good Diabetic Control Project Date: 10/13/2008 It is a well known fact that diabetes is one of the leading chronic diseases in our country today. However, it is not well known why some minorities have a higher risk to acquire this disorder. Compared with Caucasians, blacks have a 60 percent higher risk of developing diabetes, and Hispanics have a 90 percent increased risk. These numbers are astonishing. Now let us narrow our focus to the Hispanic group. Why is it that Hispanics are at higher risk? And why do they have higher rates of uncontrolled diabetes and less continuity of care for their diabetes in general? These are some of the questions that this brief study will attempt to answer. It will focus more on some of the barriers and problems faced by diabetic patients that receive their health care at La Clinica del Carino in Hood River, Oregon. Childhood Obesity Knowledge in 9th Graders at Klamath Union High School Project Date: 10/13/2008 Since the 1960's, childhood obesity has increased in the United States foru fold from 4% to 16.3% in 2006. In Klamath County, the current rate is even higher at 24.4% in 2007 making childhood obesity a serious epidemic. This is also 5% higher rate than the rest of Oregon. The Klamath Basin United Way 'Trends and Solutions of Klamath County 2006' survey noted obesity as the #8 health concern among children. In addition, a panel of experts surveyed listed obesity/eating disorders as the #1 problem not addressed in the community. Even more surprising, obesity/eating disorder education was listed as the #1 service needing the most improvement. I sought out on my project to prove the United Way study was correct with the assessment that obesity education needs improvement. In order to do so, I taught three classes on obesity to 82 ninth graders at Klamath Union High School. I gave them a survey to fill out before and after the class about their knowledge on obesity. The results showed that less than fifty percent of the students had knowledge in many of the different complications of obesity. Of those, hypercholesterolemia and sleep apnea were two complications that they learned the most about. Assessment of the Mental Health Resources in Milton-Freewater, OR Project Date: 10/13/2008 There is a universal need for mental health services in all areas of rural Oregon, including communities like Milton-Freewater. Additionally, there is an appreciable discrepancy between the services that are available for those who have private insurance, those who use state or federal plans such as OHP and Medicare/ Medicaid and those who have no health coverage. While this may be true for both urban and rural communities alike, there are other additional obstacles more unique to a rural area. Also, some of the mental health care can be provided by local primary care practitioners, however, they often lack the time and the specialized knowledge necessary for anything but maintaining patients that are already stable and in good control of their disease. Additionally, in a rural setting where social workers are not readily accessible, making it more difficult for physicians to know the local resources available in order to effectively help their patients. It was a general consensus from those interviewed for this project that the mental health resources of Milton-Freewater are lacking in many ways; however, there are still some very important services to be used. The goal of this project is to show both what resources are and are not available with the hope that those resources that still exist will be more effectively used. 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. Alcohol Use vs Dependence in Harney County Project Date: 10/13/2008 Alcohol abuse and dependence is a commonly encountered problem in communities, particularly in Oregon vs. the U.S. This project was designed to investigate potential reasons for higher rates of alcohol consumption per capita in Harney County compared to other Oregon counties but equal rates of alcohol dependence between the two. Identifying potential contributing factors toward increased consumption yet equal rates of dependence between state and county was the primary goal. The design of this investigation included data review from the state epidemiological outcomes workgroup on alcohol statistics, 6 interviews with members in the community that encounter alcohol problems, a survey review of 52 high school students in Harney county, and observations of community advertisement/marketing adds. The data was collected and analyzed. Potential factors discussed in the interviews toward the disconnect between increased alcohol consumption and dependence were identified along with the number and locations of slogans/adds in the community. The final conclusion of the project was that contributions toward increases in alcohol consumption per capita in Harney County but equal rates of alcohol dependence are multi-factorial including community attitudes, attitudes toward rights of passage, marketing/advertising, potential loose law enforcement in the past, economic strains that potentiate alcohol use, and potential under diagnosis amongst clinicians. Recommendations that was used after considering the data was an information brochure to be administered to parents of older children, adolescents, and teenagers in routine doctor office visits promoting awareness about alcohol use amongst these groups in Harney County. Underage Drinking in Southern Oregon's Illinois Valley Project Date: 9/8/2008 The U.S. Surgeon General recently addressed the country's underage drinking problem in his 2007 Call to Action to Prevent & Reduce Underage Drinking. Underage drinking is especially prevalent in rural communities like the Illinois River Valley in Southern Oregon. This project analyzed the Illinois Valley's underage drinking problem, evaluated the best approach to help ameliorate it, and attempted to improve it. It was concluded that boosting alcohol prevention education and raising awareness in the community would have the most impact. Identifying the Disparity: A Comparison of HIV Resources between Curry and Josephine Counties and Multnomah County Project Date: 9/8/2008 As with most health care resources, the HIV resources in rural communities are remarkably less available than more urban areas. This project attempts to qualify and quantify these differences and also attempts to provide an explanation for the differences in funding to these areas. Methods: The study uses interviews with patients, physicians and authorities from Josephine, Curry and Multnomah County Health Departments to identify key differences in these areas. It also uses analysis of the State of Oregon HIV Data and Analysis database. Conclusions: Although there are key differences in resources between rural and urban areas, the study concludes that the disparities are a product of supply-and-demand and a product of the algorithm used by the federal government for allocating dollars to these areas. It also concludes that there is incongruence in the incidence, prevalence and death rates of HIV in these areas, supporting the additional funding to urban areas. Development of Two Innovative Programs in Lebanon, Oregon: Build Lebanon Trails and Planting Seeds of Change Project Date: 9/8/2008 Obesity, and the myriad negative health consequences that accompany it, continues to rise throughout the US, Oregon, and especially eastern Linn County where greater than 66% of the population is overweight or obese. Medical costs for obesity-related health problems in Oregon's adults totaled an estimated $781 million in 2003 - a number that will rise much higher as the current population ages. While some changes have already been implemented to combat unhealthy weight, further work is needed. The Community Health Improvement Partnership (CHIP) program has aided in the development of two innovative programs in Lebanon, OR - Build Lebanon Trails (BLT) and Planting Seeds of Change (PSOC)- that approach this end from different angles. In meeting with the CHIP coordinator and leaders of BLT and PSOC, I found that both programs were recently created and have many obstacles to surmount before they can reach their full potential. During my time in Lebanon I worked with both to help them overcome some of these barriers and aid the programs in progressing to their final goals. Community Diabetes Education: Development of a patient handout for Madras's Diabetic Workshop Project Date: 9/8/2008 Diabetes has become an epidemic in the United States with over 7.8% of the population affected. Jefferson County is not immune to this phenomenon and Madras Medical Group (MMG) has a large population of diabetic patients. Although no cure to diabetes is currently available, much can be done to prevent complications, improve quality of life and manage the disease through patient education and vigilant care. This project will provide educational information on how diabetes is managed in the primary care setting and what patients can do to minimize complications of diabetes. This information will be presented in the form of an informational pamphlet and a power point presentation to the Madras community at a local diabetes workshop. The content of the pamphlet was a representation of most frequently asked information in the primary care setting based on observations of patient-physician interaction in the office. Information was gathered from clinic staff and online diabetes resources in order to create the educational materials to represent MMG at the workshop. The workshop was set up to introduce diabetic resources to the community and provide information to diabetic and pre-diabetic patients, their families, and those with risk factors for diabetes about the disease. 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. Complementary Health Services in the Mid-Columbia Gorge Project Date: 8/4/2008 This project is a ‘survey of the scene’ of the various alternative and complementary health services offered in Hood River Oregon, and the Mid-Columbia Gorge (MCG) area. Utilizing internet searches, telephone directories, physician and physical therapy interviews; this project first lists all currently existing complementary services in the MCG area then the initial survey is followed by site visits, and interviews of 3 different area complementary health clinics. The clinics are questioned about the unique services they offer, the basic demographics of their clients, and how they contribute to the health of the population of the MCG area. The report concludes with recommendations for future patients seeking alternative or complementary health services. Old Believers of Silverton, Woodburn and Mt. Angel Area Project Date: 8/4/2008 10,000 Russian old believers community presents a significant percent of Marion county and especially Woodburn and Silverton area. Even though a great majority of them speak English well, their cultural specifics sometimes makes providing a health care for them difficult. Some of greatest concerns of health care providers were identified and included: culture and lifestyle of Russian old beliers; their general attitude toward medical care; family role distribution and medical decision making; women health issues, including early marriage and pregnancies as well as birth control; children health and immunizations; and end of life issues. These issues were then investigated and presented. Due to limit of time available for the project, information was collected from limited sources. Dead-Man's Curves: Traffic Accident Prevention in Grant County, OR Project Date: 8/4/2008 Motor vehicle accidents (MVA's) are a significant cause of morbidity and mortality in Grant County, Oregon, and the associated expense costs individuals and the state thousands each year. This study attempted to identify the areas of recurrent traffic accidents in Grant County with the intention to advise the Oregon Department of Transportation (ODOT) to improve roadways as a means of trauma prevention. The student design included conversation with local as well as state police officials, local EMS responders and the Blue Mountain Hospital Trauma staff. In addition, systematic surveys of crash data was performed on the local police crash records, Oregon State Police Crash data, and the Blue Mountain Hospital Trauma database. Two stretches of road in Grant County were identified as being particularly dangerous - Picture Gorge and the OR 395 South of John Day. These two stretches of road have resulted in the activation of the Trauma Response System three times in the past two years, and comprise over 13% of all accidents in Grant County. The results from this study influenced the Blue Mountain Trauma staff to make recommendations to ODOT and to the Oregon Transportation Commission to investigate and improve these dangerous county roads. 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. Targeted Sexual Education in Rural Communities Project Date: 8/4/2008 Youth growing up in our countries rural communities face a multifaceted challenge as they become sexually active. Statistically they are a high risk group - often with higher rates of alcohol use, earlier sexual debut, and frequently increased numbers of sexual partners at an earlier age. Compounding and interacting with this is the political climate in which these individuals come of age. Frequently, comprehensive sexual education is discouraged in traditionally conservative communities and school districts - often favoring abstinence-only based education that downplays the importance of contraception and discourages an open dialogue on topics of sexuality and sexual practices. These issues - along with socioeconomic forces at play in our rural counties and districts - lead to disproportionably high rates of teen pregnancy and STI transmission - even in areas where resources, providers, and adequate health care education are available and accessible. My project was designed to find the missing pieces of formal sexual education and directly target a short informational session to give students the skills and knowledge they need to make informed decisions about their health, their decision of how and when to engage sexually, and for those already sexually active - to serve as a reinforcing reminder on the importance of contraception and means of STD protection. 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. Most Wanted: Clandestine Patients Project Date: 6/30/2008 There reside a substantial number of illegal immigrants in Milton-Freewater who are part of the larger Hispanic field worker community. The Hispanics in this rural area are not receiving access to medical care, and the barriers between the physician and this immigrant population in this community are complex, involving economical, social, political and legal factors. Low utilization of primary care services impedes in the prevention and early detection of disease; this negativity impacts the immigrant population as well as the community at large by potentially increasing the incidence of communicable diseases and by driving up healthcare costs due to an increased usage of emergency facilities. In order to investigate the extent to which these healthcare limitations are real and affecting the immigrant population, interviews were conducted and barriers to accessing medical care were discussed. A free blood pressure screening clinic was held three Wednesdays in the evenings at the only clinic in the town. The small turnout at these screenings despite aggressive local promotional efforts proved that the obstacles between provider and the immigrants are even greater than implicated. Traveling to the labor camp in person generated more interest in my project and greater numbers of volunteers were willing to participate in my interview and procedures. The main barriers to healthcare in this population were lack of insurance, fear of deportation, lack of time during the harvesting season, lack of transportation to the low-income clinic in Walla Walla, communication barriers, insufficient education regarding preventive medicine, and a feeling that any treatment will be unaffordable. Increasing awareness was accomplished by having a story printed in the newspaper highlighting that an entire community of field workers receive no primary care. This project has sparked new interest in starting a community-mobile outreach program targeted toward Mexican immigrants in rural areas. n=1 or n=1 x 10? An Individual Perspective on Population-based Healthcare: A Case Study Project Date: 6/30/2008 In the United States, cardiovascular disease (CVD) affects 80.7 million (37.l%) individuals, is responsible for 869 thousand deaths per year, and generates an estimated $448.5 billion in annual economic costs. There are an ever increasing number of large epidemiologic studies, trials, and meta-analyses dealing with primary and secondary prevention of cardiovascular disease and its complications. New management and treatment guidelines are constantly generated and old ones discarded, updated, or revised, but the burden of CVD continues to increase. Oregon Health Division vital statistics show that Malheur County, location of my Rural and Community Health Clerkship, has a significantly higher than average death rate due to cardiovascular disease. The goals of this inquiry are twofold: one, to develop an understanding of Community Oriented Primary Care (COPC) within the context of a disease that is as relevant to populations in Malheur County as it is those in places like Orange County or Miami-Dade County and two, to evaluate some of the strengths and weaknesses of population-based perspectives like COPC on clinical outcomes for individual patients or the economics of healthcare. Crisis Pregnancy Resources in Harney County Project Date: 6/30/2008 An unintended pregnancy can be a source of tremendous stress and angst for a woman and her family and may contribute to a poor pregnancy outcome such as preterm birth. The decision to continue the pregnancy begs the question of how one will obtain medical care, social and emotional support, childbirth and parenting education and the financial resources to support basic needs such as food, clothing, and diapers. In Harney County, resources outside of family support are limited. The goal of this project was to understand the breadth of and access to resources available in Harney County to women in a “crisis pregnancy” that choose not to abort. Crisis pregnancy was defined as an unplanned pregnancy in which a woman/family has insufficient personal financial, medical, educational, and emotional resources to provide for a healthy pregnancy and healthy child. Brief interviews were conducted with nurses, physicians, counselors, and community members that focused on what resources they had to offer in a crisis pregnancy situation, how many women access them for such resources, and what other agencies they would refer women to. Discovered resources were placed into four categories: medical, emotional/social support, educational, and financial/basic needs. All agencies could name a few other resources or programs applicable for referral, but none had detailed or comprehensive knowledge of the programs available. Recommendations were made for improvement in the access to and utilization of crisis pregnancy resources. A list of pregnancy resources and a binder of pamphlets was also compiled from the interviews for use at High Desert Medical Center. 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. "Every 15 Minutes” Program Immediate and Short Term Outcomes Project Date: 4/28/2008 Underage drinking and driving remains a problem throughout the US, including Harney County. About 8.6% of eleventh graders in Harney County had drove under the influence in 2005-2006. Harney County high schools participated in the “Every 15 Minutes” program which focuses on making responsible decisions around driving and alcohol. High school students, sophomores, juniors and seniors, were surveyed approximately thirty days after involvement in the program. After the program students were more likely to be designated drivers and less likely to ride with someone who had been drinking. In general, the “Every 15 Minutes” program has had positive immediate and short-term outcomes. This data was compared with similar data from the 8th grade Oregon Healthy Teen Survey from 2005-2006 which these students participated in. Ongoing surveys would determine long-term effects of the program. Barriers and Solutions to Receiving Adequate and Continuous Mental Health Services Among the Underserved Population in Lane County Project Date: 3/17/2008 Mental illnesses have a long history of being grossly underdiagnosed and undertreated. This is especially true for the medically underserved because they are not able to receive the health care needed to treat their mental illness. This problem stems from several major factors which were investigated during this five week clerkship. There were two main goals to this project. The first was to take a closer look at the barriers contributing to this problem, especially from the perspective of the provider. The design was to interview people in the community who treated members of the medically underserved and had a good understanding their social/mental problems. The second goal of this study was to identify what resources were available and what measures were being taken by the community to address this problem. Despite high levels of awareness in the community regarding the great need of mental health services for the indigent population, there exists many barriers preventing the progress of accessibility, availability, continuity of care, and general knowledge of services. Included is a handout summarizing mental health services in Lane County produced by the 100% Access Healthcare Initiative, a group geared towards providing services to all members of Lane County. Establishing a Needle-exchange program in Klamath County Project Date: 3/17/2008 Hepatitis C infection is increasing in incidence throughout the state of Oregon, and particularly in Klamath County. Estimates of hepatitis C rates tend to under-estimate the true incidence: because most hepatitis C infections are asymptomatic, many people do not know they are infected. A majority of acute cases of hepatitis C are associated with injection drug use. Needle exchange programs, where clients can turn in needles and syringes used for drug injection in exchange for new ones, has been demonstrated to reduce the transmission of Hepatitis C and HIV, without increasing IV drug use. The aims of this project are to justify the need for needle exchange in Klamath County, present the data for the effectiveness of needle exchange as a tactic to reduce disease, and identify the steps needed to establish such a program. 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. Recent Onset Cardio-pulmonary Disease in Three Fiberglass Plant Workers in Hines, Oregon Project Date: 3/17/2008 In 2007-2008 High Desert Medical Clinic in Burns, Oregon saw 3 patients who presented with acute-onset respiratory and cardiovascular illness after working with fiberglass at the Monaco Coach Corporation’s plant in neighboring Hines, Oregon. Purpose of the study: (1) identify what substances are used in fiberglass manufacturing that may cause cardio-pulmonary disease, (2) evaluate methods of protection used by the Monaco plant against occupational exposure to these substances, (3) consider ways in which the local medical community and plant management can improve public health regarding the occupational hazards associated with fiberglass manufacturing. Conclusions: (1) the Monaco plant has a thorough exposure protection policy that exceeds the requirements set by law or insurer, (2) although styrene is the principal toxin used in fiberglass manufacturing that is measured by regulatory bodies, there are other agents, such as fire retardant filler, phthylates, and fiberglass dust particles, that may be associated with respiratory and cardiovascular illness in plant workers. Primary Care in the Digital Age: Developing the next step of quality care delivery using computer resources in Lebanon, Oregon Project Date: 3/17/2008 Rural primary care in the United States faces a set of challenges in the upcoming years, chief among these is the lack of enough primary care providers to support a growing population, as it ages and manifests complications of chronic illnesses related to obesity. Rural areas face the added difficulty of recruiting new doctors, with a net effect of leaving fewer PCPs to care for more patients in rural areas relative to urban areas. This project explores patient and physician perspectives on using the electronic health record and on-line resources to expand and streamline the care given to the Lebanon community within the Samaritan Health System. Using a 10 question online survey administered to patients over a two-week span and discussions with IT, administration, and physicians, I attempted to quantify patient desire and ability to engage more actively in their health maintenance. I also identified several possible future steps towards streamlining the delivery of care and engaged providers to learn the barriers and opportunities to test and integrate such measures. The overall conclusions drawn from these brief surveys were 1) the community may not yet be ready for or interested in deep online participation in their care; 2) several barrier exist both at the technical (software) and administrative levels to quick and agile trials of possible streamlining measures, and 3) despite these two facts, the opportunity exists at little to no initial cost to begin implementing future electronic functions that may likely ease the transition to future clinical advances. Antibiotic resistance data for Lower Umpqua Hospital and the surrounding area for 2007. Project Date: 3/17/2008 Emerging antibiotic resistance of bacteria is a major problem in healthcare. It is a frequent cause of morbidity and mortality in hospitalized patients and is a major financial burden. As resistance patterns increase, newer and more expensive antibiotics must be used. Several strategies have been postulated to prevent these resistance patterns. They include: minimizing inappropriate use of broad spectrum antimicrobials, knowledge of local resistance patterns, prompt initiation of empirical therapy, using proper dosing and dosing regimens, prompt narrowing of antimicrobial therapy, and antimicrobial cycling. To date, antibiotic resistance in rural hospitals has not been well studied. At the Lower Umpqua Hospital (LUH) in Reedsport, OR, due to a low volume of cultures, antibiograms are not routinely done. Thus, to aid the physicians in understanding the local resistance pattern of their hospital, antibiotic resistance data was gathered for LUH between 2007-08, and 2008-present. Additionally, resistance patterns were gathered for the two nearest hospitals: Peace Harbor in Florence, OR and Bay Area Hospital in Coos Bay, OR in order to both compare the different communities and provide further information is aid in antimicrobial prescribing, since the these three hospitals often share patients. This information was presented to the physicians of LUH in order to help in the prescribing of the cheapest, narrow spectrum antibiotics possible for their patients. Generally, the resistance patterns at LUH were better than that of the surrounding hospitals. Intimate Partner Violence: Toward an Inclusive Paradigm Project Date: 2/11/2008 Background: Intimate partner violence (IPV) is an important public health concern, associated with many significant adverse psychological and physical health consequences. The Centers for Disease Control and Prevention estimates an annual national cost of IPV of $5.8 billion, with $4.1 billion attributable to direct medical and mental health services costs. A large body of evidence shows that a substantial percentage of victims of IPV are males. Despite widespread recognition of the impact of IPV on public health, and despite concentrated efforts for better prevalence data collection processes by the CDC and others, the role of male victims in prevention and treatment strategies is frequently underestimated and marginalized. To facilitate better understanding of male victimization and informed intervention strategies within the community, we sought to elucidate the services available for male victims of IPV in Eugene, Oregon. Methods: We performed a literature search on national, state and local prevalence rates of male victims of intimate partner violence. Data on community resources for IPV were gathered using the Internet, the community phonebook, and resource listings provided by the City of Eugene. We conducted interviews with staff members of community organizations providing services for IPV to ascertain service availability by patron sex. Results: We found that the majority of community IPV services were available to men and women with relatively few instances of sex-specific eligibility for services. Significant discrepancy existed between advertised sex-specific eligibility for services and actual sex-specific eligibility for services. Conclusions: Of the available resources in Eugene, Oregon dedicated to providing services to victims of IPV, nearly all of them are available to men as well as women. Nonetheless, several barriers to care were identified that may hinder access by men to these resources. These include IPV data collection processes that exclude men from survey pools, intervention strategies that seek to identify only female victims in the health care setting, and language and terminology in educational materials that phrases IPV as a gender-specific form of violence. Identification and Analysis of Barriers to Influenza Vaccination and Development of Patient Brochure as a Mode of Intervention in Stayton, OR Project Date: 2/11/2008 Seasonal influenza is a significant contributor to morbidity and mortality of Americans, particularly in at risk populations (adults > 50 years, children < 5 years, and persons with chronic disease, immunosuppression, or compromised respiratory function). The most effective means of influenza prevention remains yearly vaccination. This study attempted to identify barriers to influenza vaccination in a Stayton, OR family practice clinic. The design was five week observation of clinic and hospitalized patients with diagnosed influenza or influenza-like illness and their response to a family physician’s intervention regarding influenza vaccination. From these observations, a survey was developed and distributed over 7 clinic days, which asked patients to indicate if they received this year’s flu vaccine and if not, why? Based on survey data, gaps in patient knowledge, as well as systemic barriers to vaccination were identified. Interviews with local influenza vaccination sites were conducted in person and by phone to gather information about shot availability, cost, and type of vaccine offered. While patients were generally aware of availability of yearly flu vaccine, the majority declined due to misconceptions or lack of information regarding the influenza vaccine. No intervention, outside of physician counseling, was identified to target the local population’s low utilization of the flu vaccine during this brief observation period. Therefore, the end product of this project was the development of a patient brochure tailored to the responses of the “Influenza Vaccine Survey” to be distributed in clinic, and a recommended change in policy for local influenza vaccination sites. Your Changing Body: A Look at Sexual Education in Coos County Project Date: 2/11/2008 My goal was to design a pamphlet that would provoke a conversation between the youth and adult, which can then be used as a foundation from which they could share their own morality and perspective regarding sexual health. I also wanted this pamphlet to be used as a starting point for a conversation regarding puberty and sexual health between parents and their children, as well as between pediatricians and their patients entering puberty. My goal was to also include resources, both within the Coos County area and on the internet, that parents, teachers, and youth could access to help educate them as to the options available from within their community when facing issues such as pregnancy, terminations, adoptions, and sexually transmitted infection (STIs) prevention and treatment. Adult Obesity in a Rural Clinic: Prevalence, Comparison and Weight Reduction Strategies Project Date: 2/11/2008 The prevalence of obesity in the US has doubled in the past two decades so that now, almost two out of three adults are either overweight or obese[1]. This epidemic of excess body fat is a major public health concern since it leads to a higher risk of premature death, type II diabetes, hypertension, dyslipidemia, coronary heart disease and other serious diseases and health concerns. The state of Oregon is not immune to this epidemic, by no means. Although less obese than the U.S. average, more than 1/2 of the state’s population is either overweight or obese[2]. Upon investigating the prevalence of overweight/obese at a rural health clinic in Scappoose, OR, however, it was determined that the prevalence there was much worse than either the overall state or nation values - over 50% of clinic patients were obese and more than 3 out of 4 patients were either classified as overweight or obese. In order to begin to reverse these numbers, it was determined that a need existed to put together a concise resource, available to the clinic staff and patient population, to help increase awareness of all the resources for weight reduction strategies that can be safely used to achieve and maintain a body weight that optimizes health. 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. The War on Chronic Illness: A Questionnaire As A Weapon To Reinforce Healthy Habits and Aid Providers in Identifying Problem Areas. Project Date: 12/31/2007 Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. People who are at risk for, or have chronic disease, often have poor self-management of their health. Tools are needed to help healthcare providers efficiently assess barriers to good health management. Health questionnaires can aid providers in quickly identifying areas that need to be addressed and help provide better outcomes for the patient and community3,4 The goal of this project was to develop a health questionnaire that could be used on a trial basis to gather information, and help patients think about their own healthcare management. A Spanish/English questionnaire was developed and administered to adult patients seeking care at the Virginia Garcia Clinic. The results of the questionnaire were reviewed in the patient context when possible, and anecdotal observations along with overall outcome trends were noted. 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. Pathological and Problem Gambling in Reedsport, Oregon Project Date: 12/31/2007 Our state government and the local economy on the Southern Oregon coast are hooked on the profits from state run lottery and the jobs and tourism brought in by Indian Casinos. Unfortunately, problem and pathological gambling are a significant public health problem. Countless studies have shown an association between problem/pathological gambling and drug use, suicide, crime, bankruptcy, divorce, and job loss. Reedsport, Oregon is uniquely located within approximately 20 miles of a casino in both the North and South directions, putting its population at increased risk for these problems. Using the NODS gambling screen, this study looks at the prevalence of gambling problems in the patient population at Dunes Family Health Care in Reedsport, Oregon. After identifying this problem, a patient handout was prepared listing local resources available for those with gambling problems to get help. This handout was distributed to local casinos, shopping centers, family resource center, the family medicine clinic and the library. Zostavax and Hood River, OR: Raising Awareness of the Efficacy, Availability, and Cost of the Herpes Zoster Vaccine Project Date: 10/15/2007 Herpes Zoster and its all too common complication of postherpetic neuralgia is widely recognized by the medical community as having a significant impact on the well being of the general population. Within the first week alone of the Hood River Rural and Community Health Rotation, four separate patients inquired about the nature of herpes zoster and the available vaccine. As the vaccine has only just recently received FDA approval, the public’s knowledge of its efficacy and availability is quite poor. A small community project was formulated to determine the prevalence of herpes zoster and the efficacy, availability, and cost of the herpes zoster vaccine as it relates to the patient population seen by the Providence Hood River Internal Medicine Clinic. Literature searches, brief health practitioner interviews, and development of a simple but informative fact sheet to be given to inquiring patients were the focus of this community project. Primary Prevention of Child Sexual Abuse in Coos County, Oregon Project Date: 10/15/2007 Child abuse is a significant problem in Coos County, OR, where child abuse and neglect rates are persistently higher than average for the state of Oregon. Despite the high prevalence of child abuse, there are no primary prevention programs that educate and empower adults to prevent child abuse. This project focused on creating a primary prevention program to aid adults in preventing child sexual abuse. With the assistance of the Coos County Child Advocacy Center, I created educational materials that met three goals. First, the program helps disseminate information about child sexual abuse and increases awareness. Second, the program teaches parents and organizations that serve youth actions they can take to prevent child sexual abuse. Third, the program teaches adults how to recognize and report child sexual abuse. The ultimate goal of this program is to help adults in the Coos County area decrease the incidence of child sexual abuse. 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. 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. “Revenge of the Turquoise Blob” or "A Toxic Algae Bloom in Siltcoos Lake" Project Date: 9/10/2007 Siltcoos Lake located 6 miles south of Florence, OR is the sole source of drinking water for approximately 300 people who live on or near it. It also serves as a recreational destination for fishing, swimming, camping, and boating. On September 18th, 2007 an advisory was issued for residents to avoid all contact with the waters of Siltcoos Lake due to a toxic algae bloom. This project attempts the following; 1. Identify the potential health risks associated with contacting or ingesting waters contaminated with toxic blue-green algae. 2. Estimate the actual numbers and types of illness that might be attributable to exposure the Siltcoos waters. 3. Identify resources for health care providers that help them to recognize blue-green algae toxicity, and resources that aid in treatment of toxic exposures. “The asthma burden in Lebanon, OR: development of a patient handout for education of newly-diagnosed and current patients with asthma” Project Date: 9/10/2007 With a population of 13,940, Lebanon, Oregon comprises 13% of the total population of Linn County and is the second largest incorporated town in the area. Given the vast amount of dedicated land to farming, agriculture is the largest industry in the county. It should be no surprise then, that Linn County has a large frequency of respiratory ailments. Compared to the other 35 counties in Oregon, Linn County has the highest prevalence of asthma (11.9%), more than a one-quarter more than Multnomah County (8.9%). With an increased prevalence of asthma in the county, it is essential that patients have readily accessible resources for education on this respiratory condition. This study attempted to identify those available resources and then develop a concise and comprehensive handout for a Lebanon family practice clinic. The design was observation of family physician’s interactions with newly-diagnosed and active patients throughout the course of a six week rotation in a high prevalence setting. A cursory investigation of available handouts yielded a lack of material on respiratory ailments. Therefore, the final product of this project was the development of a basic educational patient handout for those who have been recently diagnosed with asthma and those who desire more information on asthma. The goal was that this handout would work by improving knowledge about a common disease, foster discussions between patients and physicians, and provide patients with additional resources for further education. Community Based Diabetic Retinopathy Screening: Non-mydriatic Imaging and Telemedicine Project Date: 9/10/2007 Diabetic retinopathy ranks as the leading cause of preventable blindness in the United States. Early detection and treatment can preserve vision, yet a fraction (~25%) of those at the highest risk receive annual screening for diabetic retinopathy. A new process that combines non-mydriatic retinal imaging with telemedicine at the primary care level promises to change this discrepancy. Within ten years of widespread implementation, Australia now screens most of its populace annually. Comparable success in being reported in this country where the strategy is gaining acceptance. Virginia Garcia Memorial Health Center now annually screens ~55% of its diabetic registry after it teamed up two years ago with Pacific University's School of Optometry for remote retinal reading. The feasibility of setting up an analogous program at the WSC was investigated here. Barriers were identified to avoid pitfalls in process set-up to allow smooth integration of retinal image capture within a scheduled diabetic visit. Funds from a CareOregon grant will be used to purchase a non-mydriatic camera. With the aim of preventing blindness due to retinopathy, the goal is increase annual eye exam screening among the WSC diabetic registry from 37% to >70%, a national standard set by the Diabetes Disparities Collaborative. The Role of the Primary Care Provider in Identifying And Treating Postpartum Depression Project Date: 2/12/2007 Postpartum depression (PPD) is a significant public health problem in the US affecting approximately 1 out of 8 women. Antenatal depression can also occur and when present, is a risk factor for PPD. Although the prevention and treatment of PPD (or perinatal depression) is a public health priority, screening for the disorder is not typically standard of care and therefore PPD is often under diagnosed and inadequately treated placing women, infants and families at risk. Because multidisciplinary primary care providers usually have the most mother/child contact, they are in a prime position to screen for depression and identify risk factors that might lead to PPD. Risk factors such as poor partner/family relationships, lower socioeconomic status, unemployment of self/partner and lack of social support are not uncommon in Eugene, Oregon. The purpose of this project was to: 1. Increase the awareness among the PeaceHealth system (PHS) primary care physicians and midwives of the importance of identifying, treating and/or referring cases of PPD. 2. Introduce a validated screening tool for identifying women at risk of developing or suffering from PPD. 3. Provide a referral list for the treatment and support of PPD. 4. Invite clinician participation in the Lane County PPD Consortium, 5. Provide a PPD screening tool for the PeaceHealth Sacred Heart Hospital labor and delivery social workers. Methods: The patient statistics justifying this project came from 2006 and reflect the number of all PHS physicians’ patients who gave birth at the PHSHH. Information was gathered through conversations with PHS physicians, ancillary staff, the Lane County PPD Consortium and several others. An informational packet (IP) was prepared and distributed to individuals involved with the identification, treatment, referral and quality care of patients with PPD. Findings/Results: Last year, the percentage of diagnosed cases of PPD among PHS primary care physicians’ patients who gave birth at PHSHH was .18%. This is far short of the estimated prevalence of 10-20%. Screening for PPD is not standard of care for primary care doctors in the PHS. Many doctors reported they did not have time to use the IP screening tool and there was a general lack of knowledge of the importance of the role of the primary care provider in addressing the problem of PPD. There were no reported cases of PPD diagnosed during the five week clerkship. Acceptance and Use of the HPV Vaccine in Lebanon, OR: Creation of an educational patient handout to increase awareness, acceptance, and use of HPV vaccines. Project Date: 1/1/2007 A vaccine against HPV and Cervical Cancer was recently FDA approved for use in the United States, representing a major public health advancement and effective method for decreasing the prevalence of an aggressive malignancy. This study attempted to assess the educational resources available for patients about the HPV vaccine as well as the use of the vaccine in a rural family practice clinic in Lebanon, Oregon. The design was to observe current methods of patient education for the HPV vaccine and the number of times the vaccination was given over a five week rotation. Informal interviews with physicians in the clinic, as well as patients, were conducted to access common questions and concerns about the new vaccine. The process of obtaining the vaccine as well as the rate of administration was assessed with the physician interviews, as well as talking with clinic staff. Due to the relatively short duration of vaccine availability and lack of informative yet concise materials, patients were uniformly unaware of the accurate details about the HPV vaccine and no vaccines had been given. Since the vaccine had a designated target population, those eligible were easy to identify and the barrier to patient education was seen to be the lack of an educational handout. Not only does the possible recipient need information, but the captive audience includes young females starting at age 9, which often includes parents in the educational equation. Therefore, the final product of this project was a concise yet appropriately informative patient handout to explain HPV; it’s relation to Cervical Cancer, and the HPV vaccine to adolescent females 9-15 years old and their parents to increase accurate awareness and subsequently utilization of the vaccine. West Nile Virus in Malheur County Project Date: 1/1/2007 Malheur County, Oregon recorded 52 cases of West Nile virus (WNV) infection during the 2006. This was a dramatic increase from 8 cases the previous year. Cases were investigated by the Malheur County Health Department (MCHD) and forwarded to the state Department of Human Services (DHS). No summary document was generated locally for the epidemic. This left providers without up-to-date information regarding risk for infection and treatment of lasting effects. My project was to generate a provider education pamphlet that included 1) a summary of the 2006 epidemic in Malheur County 2) a review of journal articles regarding the lasting effects of WNV 3) information on clinical trials currently enrolling cases, and 4) predictions for the 2007 season. This pamphlet will be printed and distributed to Malheur County providers by the MCHD Mental Health Resources in Grant County, Oregon: Current Status, Recent Changes and Accessibility to Patients Project Date: 10/16/2006 In 1973, the state of Oregon established a regional system of county community mental health programs to provide basic mental health services to all residents and alternatives to hospitalization for certain residents needing higher levels of mental health care. Since then, the movement of deinstitutionalization and the Oregon Health Plan, have contributed greatly to the number of people who seek care at county mental health programs across the state. Grant County’s community mental health program, the Center for Human Development (CHD), located in John Day, Oregon, is the only resource providing solely mental health services for the county’s 7,800 residents. Interview with CHD administrators identified the following challenges: lack of and difficulty retaining trained mental health professionals at CHD, ever decreasing funding and reimbursement for services, social stigma regarding mental health care, and difficulty perceived by CHD with interfacing with the existing family practice clinics in John Day. Additionally, the Strawberry Wilderness Community Clinic (SWCC) family practitioners have difficulty making successful referrals to CHD, getting progress reports from CHD on referred patients, and staying current in diagnosis and treatment of less common psychiatric conditions. Therefore: 1) an informational patient handout about CHD was prepared for distribution to SWCC patients, 2) conversations between CHD and SWCC were initiated to establish designated SWCC space and time for a CHD counselor to see referral patients, and 3) conversation was initiated to establish a designated family practitioner who could be contacted for medication prescription in the event of psychiatric crisis. Successful Aging: Does Reedsport have what it takes to help its citizens over 65 age successfully. Project Date: 9/11/2006 In 2004, there were 36.3 million Americans over 65 years old; by 2030 this number will reach 71.5 million, a whopping 20% of the U.S. Population. In order for the aging population to age successfully - to have low incidence or risk or disease, to maintain mental and physical function and to actively engage in life - there must be certain community resources in place to help this happen. Reedsport is a community with many resources in the areas of community involvement, transportation and housing all of which influence how well people age. Reedsport offers those over 65 many opportunities to stay connected to the community, but the transportation and housing have room for improvement. The O & C: Unhealthy Drama in Rural Counties Project Date: 9/11/2006 Josephine County is one of many Oregon counties facing the permanent loss of multimillion-dollar "O&C" federal funding, with resulting deterioration of services in public health and safety. Funding is currently set to expire October 1, 2006, midway through my rotation in Josephine County. To examine the impending problem, I attempted to answer whether Josephine County would suffer a severe undermining of its public health because of its largely rural population, and to pursue promising courses of action. Methods: Research involved interviewing the public health departments of Josephine, Douglas, Curry, Jackson, Lane and Clackamas counties on the projected changes, as well as a literature review about the determination of support for health programs and the relevance and precedents of public polls. Findings: While there are unique challenges and few recourses associated with being a rural county, Josephine County appears particularly unprepared. Discussion: The ideal strategy involves a tripartite approach of (1) population education on the role of public health (2) assessment of support for additional tax levies (3) increased alternative funding, taxes, and innovation in organizational structure. The former calls for a controlled, randomized, and validated telephone survey throughout Josephine County to assess what, if any, type of tax levy citizens would support and the demographics involved. "Health in Action!" in Baker County: How do we determine its effectiveness? Project Date: 8/7/2006 When you attempt to MOVE an entire county, how do you monitor your successes and failures along the way? In Oregon’s Baker County a MOVING FORCE has begun in the form of a community project titled “Health In Action!”. This paper is aimed at developing a means to which “Health In Action!” can gather and eventually begin to analyze data concerning their efforts to MOVE the county. The design was based largely on discussions amongst facilitators of “Health In Action!”. Specific needs for data collection and analysis were primary topics of conversation. Other sources of information included recent studies conducted throughout the United States that were geared toward public health surveillance and program evaluation. It was concluded that to further improve community needs assessments in Baker County with regards to “Health In Action!”, questionnaires would be developed and utilized at four specific activities sponsored by the program. In conclusion, questionnaires were categorically created to facilitate the required data collection and future analysis. 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. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. Public Health Interventions Regarding Sun Safety in Ontario, Oregon Project Date: 5/1/2006 Public Health Interventions Regarding Sun Safety in Ontario, Oregon Ontario, Oregon, is in the high desert and received many sunny days each year. Most of the town’s economy is based on Agriculture and therefore many citizens are required to work outside to make a living, exposing them to harmful UV rays. This project aimed to identify the magnitude of the skin cancer problem in Ontario, understand the current level of public health interventions for sun safety, and to institute new methods of public health interventions. Approximately three new melanomas of the skin are reported per year in Malheur County and one death occurs each year due to melanoma1. Currently no data is available on other types of skin cancer or other sequelae of sun damage. We used a combination of observation, interviews and a brief survey to discover that there are virtually no public health education measures on sun safety currently available in clinics, public markets or local community organizations that we could find. Approximately half of clinic-going patients wear sunscreen or sun protective clothing sometimes and roughly 1-10% of the clinic going population wears sunscreen everyday. Our community interventions included writing an educational article on sun safety for the Argus Observer, the local newspaper. We also signed up two local public schools to receive education materials on sun safety from the SunWise Program run by the EPA2.We also created a one page handout on sun protection and distributed them to local clinics and markets. In the future if given time and funding we would like to create a sun safety public service announcement for local television. Tobacco Cessation Counseling: Are We Wasting Our Breath? Project Date: 5/1/2006 Tobacco use is a major public health concern and affects 21% of all Oregonians and 29% of residents of Douglas County, a rural area in Southwestern Oregon that includes the town of Reedsport (population 4500). It is the leading cause of premature death and disability in the state, and the medical and economic consequences of its use are well-documented and well-publicized. The purposes of this project were to research current evidence-based literature and clinical practice guidelines, and compare the current recommendations to individual practices at Dunes Family Health Care (DFHC) clinic, the major health-care provider for the town of Reedsport. This was done in order to identify areas for improvement with the intent of potentially improving patient quit rates. A questionnaire detailing their current practices regarding tobacco cessation counseling was distributed to all providers at the clinic. Results demonstrated that physicians at DFHC are consistently asking their patients about tobacco use and advising them to quit. However, similar to providers around the country, they are often not assisting patients in the quitting process by recommending over-the-counter nicotine replacement therapy, prescribing approved cessation pharmacotherapy, or referring patients to tobacco quit lines, all methods that have been shown to potentially double patient quit rates. In a presentation to providers at the clinic, each of their cited barriers to effective and comprehensive tobacco cessation counseling were addressed and strategies for improvement were given. Ideally, this project will have empowered physicians to provide their patients with the tools necessary to optimize their chances for a successful quit attempt. Chronic Disease Management in Grant County Project Date: 3/20/2006 Problem: Almost half of all Americans have a chronic disease which may lead to extensive morbidity and mortality. Traditionally, diseases such diabetes mellitus (DM), hypercholesterolemia, and asthma are managed on a reactive, acute need basis. Pro-active physician-patient management of these three diseases reduces disease morbidity and mortality. The Grant County Public Health Department is writing a grant for $60,000 to try to improve Grant County’s health care of these diseases. To write and effective grant proposal, the department needs to learn what PCPs in the community are currently doing to manage the diseases and to propose ideas for improvement. Methods: An interview survey was conducted with all of the eight PCPs in Grant County about their current management of DM, hypercholesterolemia, and asthma. They were also asked what challenges they had managing each of these diseases, and what suggestions they had to improve the management of these diseases. Findings: Most PCPs actively monitored DM, many monitored hypercholesterolemia, and only one actively monitored asthma. Poor patient motivation and understanding as well as computer and time limitations were viewed as the largest challenges. Group education classes, such as the group diabetic dietitian class, were viewed as the most helpful resource. In addition, the majority of PCPs think a tickler file would be helpful. Conclusion: Grant County PCPs are currently using a variety of methods to manage DM, hypercholesterolemia, and asthma. All of expressed a desire for improve disease management, mentioning several clinical and community suggestions. 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. 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. Hypercholesterolemia and hypertriglyceridemia in Grant County, Oregon Project Date: 10/17/2005 Hyperlipidemia is well-established as an important risk factor in the development of heart disease. Estimates of the prevalence of hyperlipidemia in the US are approximately 1 in 3. Discussions with Grant County physicians and the Grant County Health Department family nurse practitioner indicated that the health care community was unaware of the prevalence of hyperlipidemia in their patient population. Lab data from the annual Health Fair sponsored by the Grant County Health Department, Blue Mountain Hospital and the US Forest Service was reviewed, and individuals with hypercholesterolemia and hypertriglyceridemia were identified. 620 blood draws were recorded, approximately 10% of the population of Grant County. 47% of participants demonstrated elevated cholesterol levels and 27% had elevated triglycerides. These results suggest that hyperlipidemia is a grave health concern in Grant County. A comprehensive educational patient handout addressing screening, prevention and treatment was developed for distribution at the next annual health fair and at the Grant County Health Department. Suggestions for future possible research projects related to this topic are included. 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. A Brief Overview of HIV/AIDS in Rural America Project Date: 10/18/2004 While still accounting for only a small fraction of total cases, the incidence of newly reported HIV infection in rural America is increasing at a worrisome rate. This growing patient population faces a different set of challenges than their urban counterparts: access to care, medical compliance, and uncurbed risky behaviors are all issues that plague the rural HIV + community to a greater extent than those who live in an urban setting. This paper examines some of the key differences between these two patient populations as reported in the literature and then briefly describes the services offered to HIV + patients in Klamath Falls, and how this community side=steps some of the most striking difficulties faced by HIV+ individuals in rural setting. The Role of a Free Clinic in a Small, Rural Town: A case study in Lebanon, Oregon Project Date: 10/18/2004 Free clinics are located all over the United States, in urban and rural areas alike. These clinics strive to serve the needs of people without health insurance, without access to care, and often, with significant medical illness. These "band-aid" measures to care for the growing access problem in this country serve a vital role in the current health care picture. Communities struggle with increasing numbers of poor and uninsured people with decreasing funds to serve their communities. In Lebanon, Oregon there is a free clinic funded by a hospital foundation that attempts to serve the needs of those without access to health care in East Linn County. While working at the free clinic I discovered a very important lesson: free care is a symbol greater than that of individual health care, it is one of community health. Hepatitis C Virus Treatment Program Project Date: 9/13/2004 There are currently no available locate treatment programs to offer patients infected with the hepatitis C virus (HCV) living on the northern Oregon coast. The majority of patients infected with HCV, from Pacific City up to Astoria, have to drive into the Willamette Valley in order to receive treatment program at the Rinehart Clinic in Wheeler, Oregon. Materials were developed based on need for patient education materials, flow sheets to monitor treatment progress, and a protocol for providers to refer to when beginning the treatment of a patient. Information used to develop these materials came from the 2002 NIH Consensus on the management of hepatitis C, researched articles, and an established hepatitis C treatment program in the Willamette Valley. Patients needing treatment were identified by clinic records. The materials developed were reviewed by the physician and found to meet the clinic's needs for establishing a hepatitis C treatment program. The effects of Chronic psychological stress Project Date: 5/10/2004 The relationship between psychological stress and overall general health has been well documented in many studies. Chronic psychological stress can elicit negative health effects on numerous organ systems including the immune, gastroenteral, and nervous systems. The hope for this study, via questionnaire, was to examine the prevalence of stress in a small community primary care clinic, the perception of stress and its affect on general health, how often measures are taken by patients in order to decrease chronic stress, and to identify examples of major stressors that affect the community. Furthermore, it was hoped that this study would shed insight to what degree a primary care physician can identify stress and its symptoms as well provide information in stress lowering activity. I found that 31% of the respondents indicated mild to moderate stress and 17% of patients had significant stress. 23% of respondents had severe stress levels. 28% of patients felt that stress had little or no effect on general health. Furthermore, 29% of patients indicated they never take steps to reduce stress. Examples of stressors that were listed in the survey varied in sources. These data suggest stress is substantially present in this rural community. A need to address the health concerns that may be associated with increased levels of stress and careful inquiry by primary care physicians into potential stress would likely benefit the management of patient health issues in a rural community. Identifying and addressing stress related symptoms would likely yield many benefits, i.e. productivity at the work place, increased coping strategies, etc. Adolescent development in the community of Harney County, what is the community concerned about, and how can a medical student contribute to their efforts. Project Date: 11/10/2003 Communitites across the US have always been concerned about how to encourage healthy- physically, socially, and mentally-development of youth. Countless programs and institutions have veen developed towards this effort, but at the same time people often feel overwhelmed with the problems facing adolescents. This project aimed to unveil the community's concerns about adolescents, establish their current efforts towards these concerns, and attempt to become effectively involved in this effort. It was identified that Harney County recently established a "Community Action Team" which is commited to creating a positive environment that will encourage and enagle the development of healthy, responsible, and caring adolescents. To become involved in their effort I met with the committee's memebers, attended their monthly meeting, and identified what role a medical student could play in working towards the goals of the committee. During this first meeting the "Community Action Team" identified and voted on the three most critical needs: underage alcohol and substance abuse, parental reponsibility, and truancy. Underage alcohol and substance abouse was the only problem voted on unanimously the the"Community Action Team", therefore, this became my project's focus. Through talking with community memebers it was decided that the greatest impact I could make was in working directly with teens. The majority of resources for teens with substance and alcohol problems and located at HBH. HBH coundsels youth who seekk counseling, but their major efforts involves a "Teen Alcohol and Drug Abuse" (A&D) group that is a court mandated group encounter for teens with criminal records involving substance use. This meeting was attended once for observation to identify educational needs of this group, and once to teach the group and ask questions to further understand how these adolescents believe they ended up in this court mandated group. During this obervation, teaching and interaction with the 6 teens in the A&D group I discovered that they too identify drugs and alcohol as the community's most critical need and saw the effects of parental influence, peer influence, and community acceptance leading them to where they currently sit. Therefore, it seems the "Community Action Team" goals coincide with those of adolescents most affected by substance use. Perhaps by working together their effort may contribute to healthier, more responsible youth. A Survey of Awareness and Practice Regarding Preventive Measures Against Mosquito-borne Disease in Philomath, Oregon. Project Date: 5/5/2003 The West Nile virus, responsible for West Nile fever and viral encephalitis, is expected to arrive in the Pacific Northwest for the summer of 2003. This anticipated event provides the healthcare community with a rare opportunity to educate the public about a disease prior to its occurrence in the community. Historically, vector control and personal protective measures have been shown to be one of the most effective approaches to minimizing the impact of vector-borne diseases. Understanding the current state of knowledge regarding these practices is a useful step in preparing educational material, for both healthcare recipients and providers. A self-selecting, self-administered anonymous survey was conducted with 109 patients at a Family Medicine clinic in Philomath, Oregon. Awareness of preventive measures, as well as actual performance of those measures, was queried, in addition to the gathering of demographic data. A secondary benefit was the passive education of the study participants, via the survey-taking process. The results demonstrate a high level of awareness of preventive measures (72%), despite a moderate level of implementation of those same procedures (55%). The provision of education material to patients as well as care providers would likely assist in achieving a greater level of compliance with preventive measures against vector-borne disease. Water Fluoridation--Surveying Attitudes of Parents in a Community Water Fluoridated Town Towards Water Fluoridation Project Date: 9/23/2002 Tooth decay is the most chronic disease of childhood (1). Early studies have shown that water fluoridation (the adjustment of the natural fluoride concentration of fluoride deficient water to the level recommended for optimal dental health) is responsible for a 50-70% reduction in dental caries in children who live in areas with community water fluoridation (2). Despite its effectiveness and ubiquity (over 60% of all public water sources in the US are fluoridated), many people are unaware of the benefits of fluoride and are resistant to its use. This study attempted to determine the attitudes of parents towards fluoride supplementation in a pediatric practice in Newport, Oregon (one of the only cities in Oregon to fluoridate the municipal water supply). Eighty patients were surveyed. Ninety-four percent of patients surveyed supported the use of fluoride to prevent tooth decay, but only 78% wanted it in their water. Almost half of patients living in Newport were unsure whether or not their water source was fluoridated. Almost half of patients living in non-fluoridated surrounding towns were also unsure. Because almost half of the patients surveyed were unsure of the fluoridation status of their hometown, a handout was developed and given to patients in order to provide simple facts about fluoride, including identification of the towns in the area that fluoridate the water supply. 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. Meningococcal Disease: The Health Department Response and Community Awareness/Education Project Date: 2/11/2002 This project was an educational experience in community public health and it was intended to gather data for improving methods for dissemination of information and awareness, following an isolated case of meningococcal meningitis. On the February 22nd, 2002, a case of Meningococcal meningitis was reported to the Josephine County Health Department, involving a 16 year old boy from the Illinois Valley High School. I observed first hand the steps taken by the health department to identify exposed contacts, notify each contact, and arrange for prophylaxis treatment. In the weeks following this case, I arranged a community forum to educate the community regarding the pathophysiology of meningococcal disease, the importance of early identification of symptoms, and the public health departments role in responding to this disease and arranging treatment to the community. It was also my goal to administer a survey at this meeting to gather data regarding the community's perspective on information dissemination and public health awareness. However, a less than expected turnout at this meeting made the survey unfeasible. Chronic Sequelae Of Pesticide Exposure Project Date: 9/24/2001 Over the past few decades, the use of pesticides for agricultural and domestic use has increased tremendously. As this has allowed for increased availability and decreased prices of various crops, it is also accompanied by serious environmental and public health expenses. While the availability of the chemicals has increased, specific toxicological data has not; currently, less than half of the 600+ active pesticide ingredients on the market have adequate toxicology reports. Animal studies and accidental human over-exposures have revealed much information about the nature of acute toxicities, but less is known about the long term effects of exposure to these various chemicals. Few studies have been performed that assess the chronic sequelae of frequent, low-level exposure to pesticides. This paper is an attempt to compile the known effects of exposure to various pesticides. To elucidate which pesticide causes specific sequelae is a difficult task. The majority of workers are exposed to a variety of chemicals; often times the exact compounds are unknown to the workers. Therefore, most effects mentioned reflect the use of a general class of pesticide. Back to subject search page or search by preceptor site