Global and Community Health Research
This section includes Class of 2022 Embark Projects within the Global and Community research fields. These projects include a wide range of topics with the common thread of a goal to have a positive impact within our local, regional, and/or global community.
Reporting of Concussion Symptoms in High School Aged Athletes
Aimee Hite, B.S.1, Patrick Karabon1, Neal Alpiner, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Physical Medicine and Rehabilitation, Beaumont Health System, Royal Oak, Michigan
INTRODUCTION
Each year, one to two million concussions occur in the youth populations and constitute 8.9% of all high school athletic injuries. However, current literature lacks studies that focus on concussion symptoms. This study sought to ascertain the prevalence of reporting concussion symptoms and continuing to play while experiencing symptoms in high school aged athletes.
METHODS
This retrospective cross-sectional study surveyed Oakland University undergraduate students about their experiences in high school athletics using a six-question online survey. Students were surveyed about the five major measures of concussion symptomatology (dizziness, headaches, confusion, nausea, and blacking out) in order to examine whether high school athletes are reporting and continuing to play with concussion symptoms.
RESULTS
Of the 433 students surveyed, 299 reported experiencing one or multiple concussion symptoms. Of those who reported symptoms, 37.29% were not communicated to a supervising adult and 76.09% continued to play while experiencing symptoms. This contrast was largest in the confusion symptom category: 53.12% of students did not tell a supervising adult and 37.60% continued playing while experiencing confusion. Additionally, when stratifying the data by sport, football players were more likely to experience concussion symptoms than participants of any other sport.
CONCLUSIONS
This study reveals that many concussion symptoms are being under-reported and under- recognized by high school student athletes. In those athletes who were aware of symptoms, they continued to play in spite of symptoms that would require them to refrain from contact, which increases the risk of a complicated concussion. This study demonstrates the importance of educating students on concussion symptoms and publicizes the statistics on the current status of concussion symptom reporting in high school athletes.
The divergence of medical ethics and state laws regarding life sustaining treatment
Hannah VanDusen, B.S.1, Jason Adam Wasserman, Ph.D., HEC-C2,3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Research reveals that cardiopulmonary resuscitation (CPR) rarely leads to prolonged survival in patients with chronic illnesses in whom death is expected in the relative near-term. There is strong ethical consensus favoring a physician’s right to refuse to provide CPR when it is physiologically futile or medically inappropriate. State laws governing medical treatment, however, sometimes diverge from this guidance. This study examines laws related to life sustaining treatment, analyzing both physician and surrogate authority in decision making about resuscitation orders in the national context.
METHODS
Relevant state laws were extracted from an online database or directly from state government websites. These were coded to assess physician authority in relation to surrogate authority, for the relative ambiguity they contained, and for whether and how each enabled exceptions for reasons of conscience.
RESULTS
Only 42% of states have laws that specifically protect physicians from requests for medically ineffective/inappropriate procedures, while another 48% more generally demand practice “within accepted medical standards,” and 4% provide weaker implied protections for physician medical authority. Michigan, Florida, and Arizona statutes explicitly undermine medical authority and its role in limiting inappropriate treatments. Nearly all states (94%) included provisions allowing individual physician refusal to adhere to patient or surrogate requests for end-of-life care, with 55% specifically indicating such refusals as matters of conscience.
CONCLUSIONS
There is a broad range of ways in which state laws protect medical authority and surrogate power. Michigan, Florida, and Arizona represent markedly poor protections for physicians who refuse to offer medically inappropriate CPR. Additionally, conscience laws surrounding life sustaining treatment are problematic where they allow physicians to “refuse to withhold” life sustaining treatment for reasons of conscience, effectively sanctioning the performance of unwanted procedures on patients who have indicated they do not want them, at least until the patient can be transferred.
Effects of State-Wide Mandatory Automated Prescribing System on Safe Medication Disposal
Helen E. Huetteman, B.S.1, Elie Mulhem, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Family Medicine, Beaumont Health System, Royal Oak, Michigan
INTRODUCTION
In June 2018, Michigan lawmakers passed new legislation to restrict and monitor controlled substance prescriptions, leading to a significant decrease in the prescribing of opioids. This project aims to evaluate effects of this legislation on safe medication disposal trends throughout the state.
METHODS
The Michigan Automated Prescription System (MAPS) Annual Drug Utilization Reports were used to calculate opioid prescribing rates in each county between 2016-2019. Trend models were used to predict changes in prescription rates by year. Data on safe medication disposal box use, quantified in pounds (lbs.), were obtained from the Michigan State Police (MSP) Take-Back Data Reports. Two Sample Independent T-Tests were used to compare average returned medication weight before and after policy enactment. A logistic regression model, using US Census data, was built to compare demographics between counties.
RESULTS
On average, the rate of opioid prescriptions across Michigan decreased by 18.75% per year between 2016-2019 (P=<0.0001). With the exception of Brighton and Wakefield areas, all counties had a significant decrease in the rate of opioid prescriptions during the study period (Estimated Annual Percent Change< 0%, P<0.05). Average state-wide weight of medication in MSP disposal boxes was not significantly different before and after legislation enactment (P=0.852). Of 29 MSP disposal sites, one site (Brighton) was found to have a significant increase in average disposal box weight (76.0 lbs./quarter pre-legislation vs. 105.4 lbs./quarter post-legislation, P=0.0298). Likewise, one site (Gladstone) was found to have a significant decrease in average disposal box weight (31.7 lbs./quarter pre-legislation vs. 81.7 lbs./quarter post-legislation, P=0.0429).
CONCLUSIONS
The implementation of prescribing legislation in Michigan was associated with a decrease in opioid prescriptions, with no change in the amount of medication in MSP disposal boxes in most counties. Further investigation to understand the utilization and utility of medication disposal boxes is needed.
Racial differences in Breast Cancer Screening Rates in the United States
Krupa Patel, B.S.1, Patrick Karabon, M.S.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Individuals of minority racial groups tend to experience higher mortality and incidence of breast cancer despite similar screening rates1. This study aims to understand whether there is a difference in screening rates among races in a state by state, and regional basis. The goal of this study is to assess trends in breast cancer screening between non-Hispanic White (NHW) women and Black women in the United States using the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data.
METHODS
The BRFSS is the world’s largest continuously conducted health survey collecting health-related data from residents in all 50 states. This is a telephone-based survey, covering both landlines as well as mobile users, using standardized questionnaires administered to a stratified randomized sample of the U.S. population. We looked at women between 45 and 75 as part of this project. All analysis was done in SAS 9.4 and Stata 13.1.
RESULTS
Overall, Black women had a breast cancer screening rate of 82.24% while NHW had a screening rate of 76.85% (p <0.0001). Only three states (Idaho, Wyoming, and West Virginia) had a significant positive disparity index, meaning that NHW had higher screening rates than Black women. In addition, the disparity index had remained fairly stable from 2014-2018 at about 4%.
CONCLUSIONS
The data suggests that, overall, Black women continue to have higher screening rates despite higher mortality and incidence of breast cancer. The data suggests that policy makers and healthcare providers should shift their focus from cancer screenings towards reducing mortality rates among minority women. In addition, there are three states in which there were significantly lower screening rates among Black women. This data suggests further need for increasing screening rates in these particular regions.
Changing Vegetable Eating Habits through Gardening for Lower Socioeconomic Individuals
Kunal Kedar, B.A.1, Darryl Taylor, DDS1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Poor nutrition is a contributor to the severe, persistent health issues that plague low-income communities. A component of improving nutrition is changing availability and preferences for healthier options, including produce. In “food deserts,” like Detroit, urban farms are being started to provide fresh vegetables to communities. This study examines how gardening can change the vegetable preferences of low-income high school students from Detroit and Metro Detroit who are participating in the Horizons Upward Bound (HUB) program at Cranbrook Educational Community (CEC).
METHODS
Pre-and post-surveys were conducted for students that participated in the HUB garden as part of the 6-week educational summer program at CEC. The surveys contained Likert Scale questions rating views on 16 common vegetables and gardening. The surveys were analyzed using paired t-test statistical analysis.
RESULTS
Compared to the pre-test, the averages for the post-test were not significant for 21 of the variables at the alpha significance level of 0.05. The two statistically significant results were for the average view of carrots (p-value=0.0028) and whether they enjoyed gardening (p-value= 0.0241). In both instances, the post-test averages were lower than the pre-test averages. Beets and radishes were the two vegetables that the students overall had a less than neutral view of while the rest were neutrally or favorably viewed before and after the intervention.
CONCLUSIONS
This study finds that the intervention did not have a significant positive impact on the student’s views of vegetables. Factors such as the duration of intervention, non-standardized interactions with the garden, the ability to cook the vegetables and eat them, high baseline views of the vegetables, and previous exposure to gardening, may have significantly impacted the results of this study. Future investigations can better tailor a gardening intervention to low-income students in the hopes of improving their vegetable preferences.
Emergency Department Recidivism Due to Skin Lesions Among the Homeless Population
Kylee JB Kus, B.S.1, Jason Adam Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Ample research supports the correlation between homelessness and poor health generally. Individuals experiencing homelessness face a higher risk of dermatological health problems due to exposure and sanitation concerns and comprise a disproportionately large share of emergency department (ED) visits. This study assesses whether and how the interaction between homelessness and dermatological health contributes to ED recidivism.
METHODS
The 2011-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) dataset, a weighted probability sample of more than 675 million patient encounters (130,219 actual visits), was utilized to examine patients based upon residence (homeless vs non-homeless), dermatological diagnosis (absent vs present), and ED recidivism within 72 hours. Multivariate logistic regression was used to analyze the relationship between skin condition and homeless status independently. Then a multivariate logistic regression model with an interaction term added assessed the effect of the relationship of the two on the independent effect of each. A post hoc bivariate logistic regression examined each subgroup.
RESULTS
Individuals experiencing homelessness with skin conditions are not more likely than housed individuals without skin conditions to exhibit ED recidivism (OR = .824, 95% CI = .258, 2.63; p=.743). Homeless individuals without skin conditions (OR = 2.35, 95% CI = 1.73, 3.18; p<.001), and housed persons with skin conditions (OR = 1.64, 95% CI = 1.35, 2.00; p<.001) tend to be significantly more likely to be recidivistic.
CONCLUSIONS
Individuals experiencing homelessness with skin conditions are not especially recidivistic.
Assessing chronic kidney disease knowledge, risk and beliefs among Detroit residents
Maidah Raja, B.S.1, Swathi Swathi Radhakrishnan, B.S.2, Rebecca Milan, B.S.2, Caress Dean, Ph.D.2, Deidre Hurse, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, Rochester, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Chronic Kidney Disease (CKD) disproportionately affects Detroit residents. Approximately 4% of the population has the disease, yet only 10% are aware of it. This study aimed to examine CKD knowledge and risk level among Detroit residents, and its association with preventative practices and demographic factors.
METHODS
378 Detroit residents, ages 20 years or older, were recruited from May 2018 to August 2021. Participants completed a Qualtrics survey on CKD knowledge, risk, beliefs, health behaviors, and sociodemographics. Descriptive statistics and linear regression examined the relationships between these variables.
RESULTS
The sample was majority female (58%) and African American (54.8%). African Americans (β= -1.5; p=0.002) and those with a high school education or less (β= -1.46; p=0.038) had lower knowledge of CKD. Participants with an increased risk of developing CKD had more knowledge than those not at risk (β= 0.49; p=0.009). Most participants were unaware of dry and itchy skin as a symptom of CKD (60%) and of untreated anemia as a risk factor for CKD (57%). CKD knowledge was positively associated with healthy practices (r2=0.1294; p=0.0118).
CONCLUSIONS
Additional efforts are warranted to increase Detroit residents’ knowledge of CKD; particularly about symptoms and risk factors for early disease detection. CKD education should be targeted toward African Americans and those with lower education to diminish the identified health inequities. Further research should be conducted to determine appropriate CKD education efforts for this population.
Assessing the Prevalence of Sport-Induced Urinary Incontinence and its Emotional Impact on Female Gymnasts
Nikta Rezakahn Khajeh, B.S.1, Kenneth M. Peters, M.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Urology, Beaumont Health, Royal Oak, Michigan
INTRODUCTION
Female gymnasts put strain on their pelvic floor muscles with high impact exercises that increase their susceptibility for stress urinary incontinence (SUI). Moreover, they refrain from seeking medical attention because of embarrassment. This project seeks to quantify the prevalence of SUI in female gymnasts while also influencing conversation about SUI in the gymnastics community to alleviate its stigma. We hypothesize there to be a high prevalence of SUI in young female gymnasts compared to nonathletic females.
METHODS
An electronic survey was created to address the prevalence of SUI in nulliparous, high-performance female gymnasts. A modified survey was sent to age and gender matched medical students to serve as a nonathletic control group. Chi-Square analysis was used to compare the two populations with significance value of 5%.
RESULTS
96.50% (193/200) of gymnasts experienced a urine leak while practicing gymnastics, 42.86% (42/98) of nonathletic females ever experienced a urine leak in their life (P = <0.0001). 86.01% of gymnasts deemed SUI to be a problem in their life, 22.80% reported it being an “Extreme Problem.” While 75.00% of nonathletic females reported, “No problem at all” (P value <.0001). 63.21% of female gymnasts and 20.00% of Medical students reported “Yes” (P value <.0001) when asked if a solution is of importance.
CONCLUSIONS
SUI appears to be more prevalent in the female gymnastics community compared to their nonathletic counterparts. The majority of gymnasts reported SUI to be a problem in their lives and a solution is of importance to them.
Undergraduate Students Are Not Wooed by Fad Diets
Noah Garber, B.S.1, Andrea T. Kozak, Ph.D.2, Virginia Uhley, Ph.D., RDN3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University Department of Psychology, Rochester, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
University students are at a major transition point in their lives marked by increased dietary independence with lifestyle behaviors established during this time contributing to lifelong health. Time constraints, price, stress, food knowledge, and social pressure are among the factors influencing diet choices in this demographic. This study was designed to investigate students’ knowledge, attitudes, and behaviors regarding fad diets and the impact they may have on their health. We hypothesized that college students may be susceptible to fad diets which generally promise significant weight loss in a short period of time.
METHODS
A total of 23 participants (16 females, 5 males, 2 did not respond) participated in focus groups or individual interviews. Participants had a mean age of 19.2 years, 47.8% were non-White, and the average measured BMI was 27.3. Recruitment occurred primarily via a database of students who had expressed an interest in psychology research projects. Interviews were audio recorded, transcribed, and coded using the constant comparative method.
RESULTS
Participants were able to name over 25 different fad diets with Keto being most frequently mentioned. Fad diets were overwhelmingly viewed as ineffective for healthy weight loss and contrary to healthy eating. Participants often described fad diets as an avenue for influencers to make money on Instagram, which is concerning because social media was stated as the most common method for students to learn about fad diets. Participants also identified limited healthy food options and lack of nutrition resources on campus as barriers to healthy eating.
CONCLUSIONS
The results of this study showed that undergraduate students were generally well versed in distinguishing between “fad diets” and “healthy diets” and the strong presence of fad diets on social media did not strongly influence health behaviors in this sample. Universities should examine the food options they offer students.
Barriers to Health Care Mediate the Relationship between Trauma and Health Related Quality of Life in Native Americans
Tanya Gonzalez, B.S.1, Noelle G. Mongene2, Michele R. Parkhill, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Psychology, Oakland University, Rochester, Michigan
INTRODUCTION
Previous research has found that Native Americans experience large health disparities. Access to healthcare and utilization of healthcare are also lower in Native American populations. Socio-economic status, rural location, and communication have been found to be major barriers experienced by Native Americans and they have also been found to be less satisfied and less trusting of healthcare. Further, Native Americans rate the advice of traditional healers higher than that of physicians and few communicate with their physicians about their use of traditional medicine.
METHODS
Participants were 83 individuals who self-identified as Native American. Participants completed an online survey assessing trauma, barriers to healthcare, and health-related quality of life (HRQOL) using validated measures.
RESULTS
Mediation was conducted and results indicated that trauma was positively associated with healthcare barriers (a = .392, p =.002). Healthcare barriers were found to be negatively associated with HRQOL (b = -.646, p = .000). The confidence interval for the indirect effect (ab = -.253; CI: -.511 to -.062) indicated that healthcare barriers mediate the relationship between trauma and HRQOL.
CONCLUSIONS
The results suggest that healthcare barriers are an important issue to address to improve HRQOL. Practitioners should also communicate and consider patients’ wishes concerning the use of traditional health practices.
An Evaluation of Perspectives of Individuals Participating in an Extracurricular Tutoring Program
Tiffany Nguyen, M.Sc.1, Rose Wedemeyer, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Education, as both a process and product, is a critical component of health. To reduce health disparities and break the cycle of poverty and health inequities, extracurricular tutoring programs are crucial public health interventions that provide youth with educational support allowing them to maintain healthy lives in adulthood. This study aimed to evaluate the effectiveness of a newly implemented extracurricular tutoring program at a local elementary school in order to reach conclusions of value, feasibility, and sustainability.
METHODS
Initially, our study included a participant cohort of Whitman students, parents, and teachers as well as medical student volunteer tutors. Pre- and post-surveys contained qualitative and quantitative items assessing demographics, expectations, and perceived effectiveness of the program. The quantitative and open-ended qualitative question responses were evaluated with descriptive statistics and thematic analysis, respectfully.
RESULTS
In light of the COVID-19 pandemic, investigators received IRB and program approval to use results from the pilot study administration as schools and teachers/tutors moved to virtual interactions only. Seventeen students and 9 teachers/tutors participated. Teachers and students identified transportation as a barrier to program participation. Additionally, teachers identified motivation/enthusiasm and awareness as barriers faced by the families in this community. When asked about their perceptions regarding linkages between education and health, teachers reported recognizing the reciprocal nature and that poor health can cause educational setbacks.
CONCLUSIONS
Educational programs in under-resourced communities could improve access to healthcare and enhance avoidance of risky behaviors. The results establish the need for a long-term program in the identified school in support of students’ academic success. Families facing disadvantages before COVID-19 will continue to be disproportionately impacted by a lack of access to education. Therefore, such tutoring programs can increase health literacy and improve overall health outcomes.
Descriptive Causes for Decreased Breast and Cervical Screenings in Sikh Populations
Varneet Kaur Brar, B.S.1, Sangeeta Kaur, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan
INTRODUCTION
Prior evaluations of breast and cervical cancer screens have found that immigrant South Asian women have lower compliance rates when compared to non-immigrant, white, or African American women (Shoemaker, 2016). It is widely accepted that early detection of cancers can improve outcomes for patients, and that screenings like mammography and pap smear tests are critical in this process. The aim of this study was to evaluate compliance rates for breast cervical cancer screens in Sikh women in Michigan, as well as to investigate attitudes which may be contributing to any disparities which may exist.
METHODS
Surveys were distributed securely and anonymously to females 21-65 years of age via Qualtrics to Sikh Gurdwaras in the metro-Detroit area. Data collected from Qualtrics was used to identify themes within descriptive causes for noncompliance, rates of compliance, and possible interventions which could better serve this population. Attitudes were quantified using a Likert 1-5 scale.
RESULTS
49 responses were collected, however 11 were removed from analysis due to lack of response. The average age of participants was 41. 94% over 40 reported having a mammogram within the last 3 years. 86.5% of women had pap smears, 10.8% had not and 2.7% could not recall. The top three reasons for not getting a pap smear were feeling they were not at risk of cervical cancer, concern of having a male doctor or nurse, and difficulty of getting an appointment.
CONCLUSIONS
The results of this study show that Sikh women in Michigan have high compliance rates for female cancer screenings. Results showed that attitudes leading to non-compliance mainly stemmed from issues of access, cultural stigma, and lack of education. In line with this, the majority of women without pap smears, reported that it would be most helpful to have women only, culturally sensitive educational/discussion events.
Patient Perceptions of their Health Care Teams and Preferences for Making Decisions regarding Medical Care
Veronica F. Williams, B.S.1, Nelia Afonso, M.D.2,3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
INTRODUCTION
Beaumont Hospital values patient and family-centered care, but a clear understanding of how patients perceive their health care teams and prefer to make decisions regarding their medical treatment have not been well-described. It is necessary to understand patients’ preferences regarding various factors that impact their medical care in order to foster an effective health care environment. The primary goal of this study is to determine how patients’ care teams impact the ways in which they make decisions regarding their medical treatment. A secondary goal is to determine the individuals, both inside and outside of the health care setting, that make up patients’ care teams.
METHODS
Patients of the Internal Medicine resident clinic at Beaumont Hospital, Royal Oak were asked to complete an online survey via their smartphone to answer questions regarding their health care experience. The survey collected data on participants’ demographics and various measures of health status, which were compared to outcomes of perceptions of health care team composition and preferences for making medical decisions.
RESULTS
In the analysis of study participants (n=42) making decisions regarding their medical care with individuals that work in health care and with family members and/or friends, there were no differences found between participants that dependently made decisions compared to participants that independently made decisions, when stratified by various measures of health status (all p-values were > 0.05).
CONCLUSIONS
The results do not support the hypothesis that patients of various health statuses differ in their preferences for making decisions regarding their medical care. Participants’ diverse opinions about the individuals that make up their health care teams and the ways in which they prefer to make decisions about their treatment suggest that an individualized approach is best to provide patients with the optimal patient and family-centered care.
