Attitudes Towards Vaccination Among Medical Students: A Two-Site Study

Introduction: Mandatory immunization for school age children in the 20th Century led to a substantial decline in infectious disease. All US states allow medical exemptions from immunizations with 49 permitting additional religious exemptions and 19 permitting additional philosophical exemptions. Vaccine exemptions have lead to an increase in the incidence of disease outbreaks. Healthcare providers play a critical role in educating parents about the benefits and risks of immunizations. This project compares student attitudes and knowledge regarding vaccination at medical schools in two distinct states: one with no additional exemptions (West Virginia) and one with both additional exemptions (Vermont).https://scholarworks.uvm.edu/comphp_gallery/1218/thumbnail.jp

Impact of Deferral for Low Hemoglobin on Donor Return

Introduction. A consistent blood supply to support life-saving transfusions relies on regular and repeat volunteer blood donations. In this study, we focused on donors previously deferred for low-hemoglobin (Hb) levels to better understand the value of supplying post-deferral educational information, and the actions donors took based on their deferral. Methods. An anonymous national survey of active and inactive donor groups (10,000 each) was conducted. The survey questions assessed post-deferral donor actions, preferences regarding post deferral education, understanding of their deferral, and demographic information. Chi-square analysis was performed to compare categorical survey results between donor groups with p \u3c 0.05 denoting statistical significance. Results. The survey resulted in 722 and 103 active and inactive donor respons- es, respectively. Active donors were more likely to recall receiving educational materials post-deferral (52% vs. 35%, p=003), take iron and vitamin supplements (54% vs. 39%, p=0.009), lived within 30 min of a donor site (94% vs. 84%, p=0.006), and more likely to be older than 45 yr (62% vs. 42%, p=0.002) than their inactive donor counter- parts. Active and inactive donors were similar (p\u3e0.05) with anemia history frequency, female-gender predominance, low-prevalence of vegans, and mixed interest in receiving information about raising hemoglobin levels. Conclusion. While active donors more frequently recalled receiving educational materials for their low hemoglobin deferral, and were more likely to take action to improve their hemoglobin, an alternative method of post-deferral recruitment should be considered given the uncertain value of post-deferral information when comparing active vs. inactive donors.https://scholarworks.uvm.edu/comphp_gallery/1253/thumbnail.jp

Naturopathic Physician Attitudes and Practices for Vaccination and Primary Care in the State of Vermont

Introduction: Recent increase in measles cases has sparked vaccination controversy. Naturopathic physicians (NDs) have been recognized as primary care providers by VT since 2012. It is not well understood how NDs address vaccination with patients. Our goal was to determine how Vermont NDs address vaccines and preventative care with their patients.https://scholarworks.uvm.edu/comphp_gallery/1234/thumbnail.jp

Addressing the Opioid Crisis in Vermont: Lessons Learned from Primary Care Physicians

Background: Opioid Misuse in Vermont: The number of Vermonters seeking treatment for opioid abuse is increasing, particularly in Chittenden County. Emergency department visits and deaths related to opioid misuse continue to increase, both locally and nationally. Opioid Addiction Treatment: The Drug Addiction Treatment Act (2000) was passed to allow physicians to prescribe buprenorphine-naloxone for opioid addiction, termed Office-Based Opioid Therapy (OBOT). OBOT has been shown to be a highly effective treatment for opioid addiction. The Hub and Spoke model was implemented in Vermont to connect specialty treatment centers with outpatient OBOT providers. Project Goal: To identify barriers to providing OBOT that primary care physicians (PCPs) face in Chittenden County, Vermont.https://scholarworks.uvm.edu/comphp_gallery/1221/thumbnail.jp

How can pregnant women safely relieve low-back pain?

Acetaminophen is safe for use in pregnancy but lacks evidence of efficacy (strength of recommendation [SOR]: C, usual practice). Both physical therapy and water aerobics reduce sick days caused by low-back pain (strength of recommendation [SOR]: B, randomized controlled trial [RCT]). Acupuncture, including auricular acupuncture, also relieves low-back pain and improves function (SOR: B, 2 RCTs). Osteopathic manipulative therapy (OMT) slightly improves disability (SOR: B, RCT). Corticosteroid injection at the sacrospinous ligament insertion decreases pain (SOR: B, RCT). Insufficient evidence of efficacy exists for support garments (SOR: B, systematic review). No serious maternal or fetal adverse effects have been reported with any of these therapies

University of Vermont Community Tobacco Use and Attitudes Survey

Introduction: Smoking remains an important public health issue in U.S. Colleges. 17.3% of U.S. smokers are 18-24 years old. 28% of U.S. college students began smoking at age 19 or older. Currently 1,104 U.S. Colleges have adopted Tobacco-Free policies.https://scholarworks.uvm.edu/comphp_gallery/1216/thumbnail.jp

UVM Tobacco Use and Attitudes After Implementation of a Tobacco-Free Policy

Introduction: Widespread public health initiatives have led to falling smoking rates. Currently, 1,620 U.S. colleges have adopted smoke-free policies. In August 2015, the University of Vermont (UVM) adopted a tobacco-free policy that bans all forms of tobacco use on university property. The purpose of this study was to compare tobacco use and attitudes before and after policy implementation.https://scholarworks.uvm.edu/comphp_gallery/1230/thumbnail.jp

Willingness To Donate Blood During the Summer

Introduction. Each year donation rates fall in the summer months straining blood banks’ capacities to meet local demands. In hopes of identifying factors to increase summer donations, our study investigated donor reported barriers which influence summer donations habits.Methods. An anonymous 16 question survey investigating various donation factors was administered across multiple American Red Cross (ARC) donation centers in Vermont. Questions addressed donor demographics, frequency of blood donation, preference in appointment making modalities including smartphone app use, summer travel habits, willingness to donate during vacation, and factors that deter donors from donating on vacation.Results. A total of 292 surveys were received. Survey respondents across multiple demographic groups cited similar barriers to summer donation, namely “Too busy” (27.5 %) and “Traveling is a time for me to relax.” (30.6 %). Of the respondents who travel in the summer, very few reported donating while traveling (3.4 %). Summer donation rates between summertime travelers (36.5 %) and non-travelers (36.4 %) were essentially equivalent. The most preferred methods of scheduling appointments were via ARC website (45.6 %) and phone (28.4%). Willingness to use the ARC app was highest among respondents ages of 18 to 34 (45-55%) and lowest among ages 55 and older (13-15%). Of respondents with no prior knowledge of summer seasonal shortages (22 %), 2/3rds indicated newfound motivation to donate.Conclusion. Regardless of travel, increasing awareness of summer shortages may increase summer donations. Use of donor websites and smartphone apps may be instrumented as part of recruitment efforts.https://scholarworks.uvm.edu/comphp_gallery/1239/thumbnail.jp

Radon, From the Ground into Our Schools: Parent/Guardian Awareness of Radon Levels in Vermont Schools

Introduction. Radon is the leading cause of lung cancer among non-smokers. Ex- posure to radon in schools may be harmful to schoolchildren, faculty, and staff, but there is currently no legislation mandating testing or mitigation of radon levels in Vermont schools. Objectives. The goal of our study was to assess Vermont parents’ awareness of radon’s harmful effects, as well as awareness of and support for testing and mitigation of radon levels in their children’s schools. Methods. We distributed paper and online surveys to Vermont parents of children grades K-12. 126 surveys were received and quantitatively analyzed. We held a focus group of two Vermont parents to gather qualitative data. Results. Most surveyed parents demonstrated general knowledge of radon, but only 51% believed that radon affects the lungs. 8% were confident that their children’s schools had informed them about radon levels. 91.2% believe their children’s schools should take action to address elevated radon levels and 87% would support mandated mitigation. There is some concern and lack of knowledge about the financial implications of radon mitigation. Conclusions. Most Vermont parents of children grades K-12 are unaware that radon is a lung carcinogen and do not know their children’s school’s radon levels or mitigation status. However, most are in favor of legislation that would require testing and dis- closure of schools’ high radon levels. Educating parents about school radon levels and their association with lung cancer could be a foundation for community support of legislation that mandates testing and mitigation of radon in Vermont schools.https://scholarworks.uvm.edu/comphp_gallery/1252/thumbnail.jp

The 2017 Vermont Opioid Prescribing Rules: Prescriber Attitudes

Introduction. In July of 2017, Vermont enacted new rules on acute opioid pre- scribing to reduce misuse, addiction, and overdose associated with prescription opioids. The new rules include requirements of non-opioid therapy use when possible, querying VPMS, patient education and informed consent, and co-prescription of naloxone. Our study objective was to gain insight into the perspectives of opioid prescribers on the new rules. Methods. The 17-item survey included closed and open-ended questions addressing prescriber perceptions about the new rules as well as demographic information about respondents. The survey was sent to Vermont-based opioid prescribers via email, to multiple healthcare organizations and professional societies, and through personal contacts. Open-ended responses were categorized using paired reviewers and group consensus, using a grounded theory approach. Results. A total of 431 responses were obtained, with MD/DOs accounting for 65%, APRNs- 14%, DDS/DMD- 7%, PAs-13%, and NDs- 1%. Of the respondents, 75% thought that more restrictive opioid prescribing rules were necessary, 74% felt the new rules would have some positive effect on the opioid crisis, but only 48% were in favor of the new rules. Barriers to implementation included co-prescribing naloxone (50% were unsuccessful), justifying exceptions to rules in medical record (46% unsuc- cessful), considering non-pharmacologic therapies (39% unsuccessful), and adhering to prescription limits (31% unsuccessful). Conclusions. Roll-out of the new rules has been criticized for implementation issues, overall reducing favorability among prescribers. Feedback obtained may be utilized by the Vermont Health Department and by other states to improve current models of opioid prescribing.https://scholarworks.uvm.edu/comphp_gallery/1264/thumbnail.jp