Global and Community Health Research
This section includes Class of 2024 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.
Autism Spectrum Disorder (ASD) Supplemental Educational and Recreational Programs: a Scoping Review for Best Practices
McKenzie A Allen, B.S.1, Tracey A.H. Taylor, Ph.D.2, Kyeorda Kemp, Ph.D.2,
Kristin L. Rohrbeck, Ed.D.3, Cameron J. Davidson, 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
3School of Education and Human Services, Oakland University, Rochester, Michigan
INTRODUCTION
Supplemental educational and recreational programs are valuable experiences outside of formal educational settings for all children and adolescents. These programs contribute to the development of skills needed to be successful in adulthood, reduce perceived stress, and promote social skills. These types of programs are provided by many different organizations throughout the world; however, best practices for the successful involvement of individuals with autism spectrum disorder (ASD) in these programs are not clearly defined. The goal of this scoping review was to identify best practices for engaging individuals with ASD in supplemental educational and recreational programs that can be applied in self-contained and inclusive settings with neurotypical peers. Secondary goals included determining which best practices were used most frequently, and determining the average number of best practices utilized.
METHODS
Following a preliminary search to identify eleven best practice categories, 4787 articles were identified and screened to ultimately result in 50 articles that met our inclusion criteria.
RESULTS
Of the best practice categories identified in the articles, the two most commonly identified strategies were an organized schedule (78% of studies) and consulting with experts (58% of studies). The median number (IQR) of best practices employed amongst the studies reviewed was four (IQR: 5-2).
CONCLUSIONS
Identification of best practices for recreational and supplemental education programs for individuals with ASD will ultimately result in increased participation and support potentially leading to more positive lifelong outcomes.
Prevalence of traumatic brain injury among the guests at a low-barrier homeless shelter
Nicholas Ang, MPH1, Jason Wasserman, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Traumatic Brain Injury (TBI) is a pressing public health issue, with diverse causes and profound impacts on physical, cognitive, and social functioning. Notably, individuals experiencing homelessness face a disproportionately high risk of TBI compared to the general population. The intricate relationship between TBI and homelessness, including whether TBI contributes to homelessness or vice versa, underscores the need for comprehensive research to guide targeted interventions. The primary goal of this study is aimed at determining the prevalence of TBI’s among guests staying at a low-barrier homeless shelter who represent an especially vulnerable subset of individuals experiencing homelessness.
METHODS
A total of 21 out of 35 shelter guests participated in a survey assessing the prevalence and qualities of TBI among guests at HOPE adult shelter, a low-barrier shelter in Pontiac, Michigan. A single sample difference of proportions test using the binomial distribution was used to compare prevalence of TBI with parameters derived from existing literature on TBI prevalence among both the general population and the general population of individuals experiencing homelessness
RESULTS
Of those surveyed, 17 (81.0%) had experienced at least one TBI in their lifetime and 15 (71.3%) had TBI associated with loss of consciousness. In addition, 7 (33.3%) of the participants had experienced TBIs rated as moderate to severe. Of the participants with head trauma history, 16 (94.1%) experienced their injury before their first onset of homelessness. Compared to both the general population and the broader population of individuals experiencing homelessness, those in this sample were significantly more likely to experience TBI (95% CI 0.0000:0.2857; p < 0.001 and 95% CI 0.3333:0.7619; p < 0.015, respectively) and significantly more likely to experience severe TBI (95% CI 0.0000:0.09524; p < 0.001).
CONCLUSIONS
People experiencing homelessness, especially the most vulnerable among them, require increased attention and support for the associated symptoms and long-term effects of TBI.
The Perception of Needle Exchange Programs among Beaumont Healthcare Providers
Paige Bimberg, B.S.1, Theresa Anasti, Ph.D.2, Stefanie Attardi, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2The Brown School at Washington University, St. Louis, Missouri
INTRODUCTION
An estimated 425,000 people aged 12 and over inject drugs like cocaine, heroin, methamphetamines, prescription opioids, and prescription stimulants in the United States every year. Needle exchange programs (NEPs) have been utilized for years as a way of reducing needle-sharing among people who use drugs (PWUDs) by providing them with unused needles and a place to safely dispose of their used needles. Despite evidence that these facilities are essential for reducing the spread of infectious diseases among PWUDs, NEPs have remained controversial and stigmatized, and their legality is complicated. The primary aim of this project is to qualitatively determine and evaluate the understanding and perception of needle exchange programs among healthcare providers at Beaumont Hospital via virtual interviews.
METHODS
Participants were eligible for this study if they were physicians older than 18 years of age practicing in Southeast Michigan. Study participants were recruited via email and interviews were held via Zoom. Participants were asked the following open-ended questions:
- What is your experience with people who use intravenous substances?
- What do you know about needle exchange programs?
- Describe any professional relationship you have with any harm reduction services.
- How do you perceive the efficacy of needle exchange programs
Responses were recorded and later analyzed for common themes.
RESULTS
Two interviews were conducted which demonstrated themes surrounding positive favorability of NEPs, adequate knowledge about the services they provide, and a lack of a direct affiliation/connection with a specific NEP.
CONCLUSIONS
This study’s limited data reveals decent knowledge and a positive perception of NEPs among physicians, which is a good start towards further investigations of physician attitudes. Further studies with a larger number of participants would reveal a more accurate reflection of the knowledge and attitudes of Southeast Michigan physicians regarding NEPs.
Effect of Housing Intervention on Primary Care Usage Among Individuals Receiving Experiencing Chronic Homelessness
Sarah Chauhdry, M.S.1, Deidre Hurse, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Chronic homelessness presents challenges to accessing healthcare services, often leading individuals to rely on emergency departments (EDs) for medical needs due to an inability to receive preventative services. This study investigates the impact of receiving housing support services on primary care and emergency department utilization.
METHODS
A "health maintenance inventory" was used to evaluate primary care utilization. A survey was conducted to measure healthcare system usage, including self-reported visits to primary care providers (PCPs), usage of preventative services, and ED visits. The participants were divided into two groups based on the duration of homelessness - less than 1 year and greater than 1 year. The Fisher's Exact test was used to compare the data.
RESULTS
We compared individuals who had been experiencing homelessness for less than 1 year (n=7) and greater than 1 year (n=8). The greater than 1 year cohort had significantly higher rates of receiving the hepatitis A vaccine (p=0.0410). Conversely, this group exhibited a lower engagement with colon cancer screening services (p=0.0476). The long-term homeless cohort showed a tendency to favor doctor’s offices as their primary healthcare provider, as opposed to relying on urgent care facilities or emergency rooms, however, this observation did not achieve statistical significance (p=0.0629).
CONCLUSIONS
This study showcases the complex correlation between duration of homelessness with services and healthcare utilization. However, the sample size is small, which could affect the strength and applicability of the findings. Moreover, the data collection method does not determine the duration of housing services received compared to the period of homelessness.
Despite its limitations, this study suggests that longer periods of homelessness with services may lead to increased access to preventive healthcare services, such as vaccinations. Future research must use a larger sample size and more precise methodology that measures duration of housing services and its effect on healthcare behaviors.
The Mental Health of Arab-Americans Living in the United States: A Systematic Review of the Literature
Rania Daboul, B.S.1, Stephanie Swanberg1, Tracey A.H. Taylor, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Arab Americans make up approximately 3.7 million people in the United States.1 This project aimed to focus on how mental health is researched in this population through a systematic review. We provided an analysis of what disorders are being reported and their prevalence. We also looked at how immigration status affects outcomes. Lastly, We looked at perceptions regarding mental health in this community and what factors such as culture and religion play into it.
METHODS
Use our search terms on Pubmed, Embase, PsycINFO, PsycARTICLES, Cochrane Library, Google Scholar, Northern Lights Conference Abstracts, and Dissertations & Theses
Apply our inclusion/ exclusion criteria. Screen the studies by 3 independent reviewers once through and abstract screen then a full text screen
Run a statistical analysis first on the data overall, and then according to whether or not they included refugees
Test categorical variables using Chi-Square tests, and continuous variables using t-tests. All statistical testing was two sided using an alpha of 0.05
RESULTS
Overall, 90 studies met the inclusion criteria. 46 (51.1%) measured depression, 35 (38.9%) studies measured PTSD, and 17 (18.9%) measured anxiety. Other themes included distress, suicide/self-harm, and partner violence. 44 (48.9%) studies included refugees and 46 (51.1%) did not. Of the 44 papers that included refugees, 28 (63.6%) specially measured PTSD as opposed to 7 (15.2%) of the 46 papers whose studies did not include refugees. The Chi-Square Test results in a p-value of <0.0001. Ten (11.1%) included a clinical diagnosis and the remaining studies were self-reported symptoms.
CONCLUSIONS
There is a significant association between studies that included refugees and whether or not PTSD was measured.
Depression was the most commonly studied mental health disorder overall; however, in refugees, PTSD was the most commonly studied disorder followed by depression.
Influence of Trust and Systemic Racism on Community Health in Southeast Michigan
Sneha Dodaballapur, B.S.1, Adina Schneeweis, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, Rochester, Michigan
INTRODUCTION
Marginalized populations often experience worse health outcomes compared to their non-marginalized counterparts, with trust in the medical profession and science playing pivotal roles. Historical mistreatment of marginalized groups has engendered deep-seated mistrust in the medical establishment, particularly among African Americans. This mistrust contributes to various health behaviors, exacerbating healthcare disparities, especially amid the COVID-19 pandemic. This study aims to address the residual impact of discrimination on marginalized communities' health.
METHODS
Snowball sampling was utilized to recruit participants who self-identified as Black or Multi-racial, aged 18 or older, and living in Southeast Michigan. Participants completed a 15-question survey followed by a minute semi-structured interview. The preliminary study included 3 survey participants and 2 interview participants. Textual analysis of coded interview data was conducted to elucidate the intricate relationship between racism, trust, and attitudes towards health.
RESULTS
The average age of participants was 21, all identifying as African American with low/middle-class household earnings. Survey findings revealed unanimous agreement that healthcare providers do not take complaints from their racial/ethnic group seriously, and attitudes towards health have evolved over time. Participants from lower-income backgrounds perceived healthcare resources as less accessible. Views on trusting healthcare workers within one's racial/ethnic group were varied. Although direct experiences of discrimination in healthcare were not reported in semi-structured interview, participants shared instances of perceived neglect affecting family members' healthcare decisions, including vaccine hesitancy in all participants. Family influence and personal research played significant roles in healthcare choices.
CONCLUSIONS
This study underscores the intricate interplay between racism, trust, and healthcare experiences within marginalized communities. Findings highlight the enduring impact of perceived discrimination on healthcare perceptions and attitudes. The challenges of navigating healthcare decisions amidst systemic disparities and misinformation are evident. The role of family influence and personal research in shaping healthcare choices emphasizes the need for culturally sensitive and patient-centered healthcare practices.
Stigmatization of substance abuse in the Chaldean community
Yousif Esho, B.S.1, Deidre Hurse, Ph.D.1, Sarah Lerchenfeldt, Pharm.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Stigma is a set of negative and often unfair beliefs that a society or group has about something. Chaldeans, an ethnic minority group from Iraq who identify as Christian Catholics, offer the same stigmatization regarding substance abuse of any kind. The stigma that is expressed in this community is related to the number of overdoses and lack of treatment for those navigating substance abuse, and this aimed to investigate and understand this relationship.
METHODS
This study utilized an online QualtricsXM survey to explore stigma surrounding substance abuse within the Chaldean community. Demographic information was collected from participants, followed by two validated stigma scale surveys adapted from previous research. One survey assessed personal stigma, while the other targeted public stigma within the Chaldean community. Additionally, a social distance scale measured participants' willingness to associate with individuals experiencing substance abuse. The survey was distributed through various social media outlets and community organizations.
RESULTS
Demographic information was collected from 209 respondents who completed the survey, with a majority of 193 females and 16 males. Approximately, 96% of respondents identified themselves as Catholic. Stigma scores revealed a mean value of 3.0 for personal stigma and 1.6 for perceived stigma, suggesting a significant level of stigma within the Chaldean community. The social distance score, averaging at 2.9, indicated reluctance among respondents to associate with individuals facing substance abuse, further reinforcing the stigma. Statistical analysis revealed a significant difference (<0.05) between drug users and non-drug users.
CONCLUSIONS
The study findings highlight an established stigma within the Chaldean community, evident in responses indicating disapproval of individuals facing substance abuse. Interestingly, respondents displayed contrasting perspectives when considering the community versus their own viewpoint, indicating a potential generational shift in stigma perception. Targeted interventions, particularly focusing on the older generation, may be necessary to address stigma.
Nocturia in Men and Associated Comorbidities; A Southeast Michigan Study
Daniel Fortney, B.S.1, Prasun Sharma, B.S.1, Alexander Geisenhoff, Ph.D.2, Bernadette Zwaans, Ph.D.1,2, Michael Lutz, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health William Beaumont University Hospital, Royal Oak, MI
3Michigan Institute of Urology, Royal Oak, MI
INTRODUCTION
Nocturia is a highly prevalent condition associated with poor quality of life and increased adverse health outcomes. Our study aims to determine the association between nocturia and various comorbidities in a southeast Michigan population.
METHODS
Study data were extracted from self-completed questionnaires from the 2021 Michigan Institute of Urology’s (MIU) Men’s Health Event. A total of 1023 subjects participated, of which 892 completed the nocturia questionnaire. Study participants were divided into three groups based on severity of nocturia: no nocturia, nocturia once per night, and multiple nocturia episodes per night. Pearson’s Chi-square test was used to determine the association between nocturia severity and presence of comorbidities.
RESULTS
The prevalence of hypertension, non-insulin-dependent diabetes, and anxiety were significantly associated with increasing episodes of nocturnal voids. Prevalence of arthritis and colorectal polyps were significantly associated with multiple episodes of nocturia. The prevalence of participants with a family history of hypertension decreased significantly as nocturnal voids increased. The prevalence of participants with a family history of myocardial infarction was significantly associated with nocturia, with the highest prevalence in the nocturia once per night group.
CONCLUSIONS
Nocturia is a common condition among men and is associated with numerous comorbidities. While some mechanisms can be postulated to explain these various associations, further research is needed to delineate the relationship between nocturia and the aforementioned comorbidities.
Metastatic Osteosarcoma Involving the Skin: A Systematic Review of Patient Demographics, Clinical Characteristics, and Treatment Outcomes
Sarah Fried, B.S.1, Ameen Suhrawardy, B.S.1, Rafey Rehman, B.S.1, Malik Aljamal, B.S.2, Drew Moore, M.D.3, Darius Mehregan, M.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Wayne State University, Detroit, MI
3Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, MI
4Department of Dermatology, Wayne State University, Detroit, MI
INTRODUCTION
Skeletal osteosarcomas are common primary bone tumors. They're aggressive and typically spread to the lungs and other bones, and sometimes to the skin. Extraskeletal osteosarcomas, soft tissue tumors, can also metastasize to the skin. Our systematic review aimed to explore demographics, clinical features, and treatment outcomes in patients with skin-involved metastatic osteosarcomas.
METHODS
We conducted a systematic review following PRISMA guidelines, searching PubMed, EMBASE, and Cochrane Library. Papers were reviewed using Rayyan QCRI, with inclusion confirmed by at least two reviewers. From 1239 studies screened, 31 were included, involving 36 patients with skin-involved metastatic osteosarcoma.
RESULTS
Primary osteosarcoma occurred skeletally in 28 cases and extraskeletally in 8. Average age at presentation was 35.9 years, with skin lesions appearing around 3.02 years post-diagnosis, predominantly in males (52.9%). Metastatic skin lesions were firm (22.6%), tender (17%), erythematous (13.2%), and rapidly growing (13.2%). Lesions manifested as nodules (92.6%), cysts (3.7%), or patches (3.7%). Most common skin metastasis sites were head & neck (36.7%), abdomen (15%), and thigh (11.7%). Skin metastasis location often differed from the primary tumor origin; for example, 58.3% of femur osteosarcomas spread to the head & neck. Leading extracutaneous metastasis sites were lung (45.1%), abdomen (9.8%), and head & neck (9.8%). Average follow-up time was 1.36 years, revealing two disease-free patients, 11 with persistent disease, and 13 deceased.
CONCLUSIONS
Unidentifiable skin lesions in osteosarcoma patients require exploration to rule out metastasis. Patient history, including osteosarcoma type and location, influences prognosis and skin metastasis site. Clinicians must thoroughly review symptoms to uncover additional sites of involvement. Given the association between poor prognosis and extracutaneous metastases, comprehensive testing, especially for lung metastasis, is necessary. Future studies should investigate skin and extracutaneous metastasis prevalence and treatment efficacy.
Evaluating Instructor Gender and Racial Diversity in YouTube-based Children’s Yoga Videos
Paige Girdley, B.S.1, Dwayne Baxa, 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
There is positive evidence to support the use of yoga practices for the improvement of depression, anxiety, and general well-being in school-aged populations. There is a wealth of instructional yoga videos intended for children available on YouTube, and physicians may recommend this free, easily-accessible resource to pediatric patients and their families to practice yoga. However, gender and racial inclusivity is an important component of mental health resources, and a quick perusal of YouTube suggests that this resource may not reflect the diversity of the US population.
METHODS
A systematic content analysis of children’s instructional yoga videos available on YouTube was conducted. This study analyzed the gender and race of lead instructors as well as other key video characteristics including view count, set design and audiovisual effects in videos 15-60 minutes in duration.
RESULTS
104 children’s instructional yoga videos were analyzed. 98.1% of instructors were identified as female. 94.2% were identified as White, 3.8% Asian, and 1.9% Black. Proportions of instructor gender and racial identities differed significantly from that of the US population. Conjoint analysis of video characteristics revealed viewers preferred videos of shorter duration (less than 30 minutes) with animation, audio effects, and colorful sets.
CONCLUSIONS
This analysis of 104 videos suggests that the gender and racial identities of YouTube children’s yoga instructors do not reflect that of the general US population, and therefore may not reflect the identities of pediatric patients using these resources. Physicians should consider this disproportionality when recommending YouTube as a resource to their pediatric patients. When creating future instructional videos, creators should consider that viewers prefer videos of shorter duration (less than 30 minutes) with animation, audio effects and colorful sets. This information may be especially beneficial to diverse instructors seeking greater child-viewership.
Undergraduate Student Attitudes toward COVID-19: A Comparison of University Students in Michigan and Arizona
Natalia Gumma, B.S.1, Aimen Vanood, M.D.1, Susan Sajadi, M.S.2, Mark Huerta, Ph.D.2, Victoria Lucia, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Arizona State University, Tempe, AZ
INTRODUCTION
Michigan (MI) became a COVID-19 hotspot in April 2020, while Arizona (AZ) later in January 2021. The states differed in their public health precautions. The objective of this study was to compare university student experiences and attitudes towards the COVID-19 pandemic in MI and AZ.
METHODS
An electronic, anonymous Qualtrics survey with a 5-point Likert scale was used to measure student attitudes. One university was surveyed per state. The survey was distributed by contacting student interest groups and professors. Responses were collected between April 5 and June 25, 2021, during which both universities offered on-campus COVID-19 vaccination.
RESULTS
225 responses were recorded (MI=65, AZ=160). Less of the MI cohort received at least one dose of the COVID-19 vaccine (50.8% vs. 63.3%, p=0.038), though both cohorts indicated the vaccine was an important public health measure (p=0.478). MI students reported more discomfort in attending indoor gatherings (p<0.001). Attitudes towards mask-wearing and effects of social distancing on mental and physical well-being were comparable (p>0.05). However, MI students were more likely to agree that social distancing had negatively impacted their education and their current mood (p<0.05).
CONCLUSIONS
The impact on MI students’ comfort with large social gatherings may result from the earlier first wave of COVID-19 in MI, which allowed for more awareness and exposure to public health messaging regarding such precautions.
Pediatric Upper Cervical Spine Trauma: A 10-year Single Center Retrospective Study
Sazid Hasan, B.S.1, Muhammad Waheed, M.D.2, Ameen K Suhrawardy, M.D.2, Collin Braithwaite, B.A.1, Jad G Khalil, M.D.3, Ehab S Saleh, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2DMC, Detroit, Michigan
3William Beaumont Hospital, Royal Oak, Michigan
INTRODUCTION
The unique anatomy of pediatric cervical spines predisposes them to increased risks for traumatic upper cervical spine injuries (tUCSI), an injury generally associated with high morbidity and mortality rates. As the current literature is limited, the purpose of this study was to analyze pediatric tUCSI epidemiological data, variations in treatment and outcomes, and to evaluate clinically relevant trends.
METHODS
We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a pediatric trauma center (William Beaumont Hospital, Royal Oak, Michigan, USA). Retrospective data was queried using ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups (children under three, between three and seven, and between seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using a variety of statistical analyses.
RESULTS
Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%) with a mean age of 11 ± 4 (range 3-16) (Table 1). Overall, the most common causes of injury were a motor vehicle collision (n=16), sports injury (n=13), a fall (n=6), and idiopathic injury (n=5). The most common mechanism of injury in young children was a fall (n=4, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, p=0.043). The most common associated injuries were lower cervical spine, and head injury (n=35).
CONCLUSIONS
This study found that the majority of pediatric tUCSI patients can be managed nonoperatively with dislocations and spinal instability being the most common indications for operative management. Commonly used external fixation methods include cervical collars and Minerva jackets. Our cohort showed a very low mortality, and morbidity rates, which is different from what previous studies have shown.
Impact of Housing First Supportive Housing Provision on Healthcare Accessibility and Health Status of Individuals who Previously Experienced Homelessness
Aubrey Haughn, B.S.1, Tiffany Loh, B.A.1, Jason Adam Wasserman, Ph.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health East, Southfield, MI
INTRODUCTION
Individuals experiencing homelessness face higher risks of infectious diseases, injuries, mental health issues, substance use, and suicide. The Avalon Hickory Way Supportive Housing program in Ann Arbor, Michigan, provides residence to individuals who previously experienced chronic homelessness. The Housing First Supportive Housing approach prioritizes stable housing without pre-conditions regarding health or substance use status. This report aims to assess the impact of supportive housing on residents' self-reported health status and healthcare accessibility.
METHODS
Data were collected through semi-structured interviews with 24 residents who had been in the housing unit for approximately six months. Interviews lasted about 30 minutes and open-ended questions were used to elicit the subjective experiences of each participant. Probe questions were implemented when needed to elicit further information.
Participant narratives were coded line-by-line, with codes then raised to categories to allow themes to emerge in a process akin to grounded theory.
RESULTS
Many residents reported improved healthcare access facilitated by Hickory Way staff and home health services. They also noted increased focus on health since moving into supportive housing. However, barriers such as cost, transportation, and lack of information persisted.
CONCLUSIONS
Given the rising rates of unhoused individuals in the United States, program evaluations like this are crucial for assessing the efficacy of proposed solutions. This report highlights the benefits of supportive housing on health status and healthcare access, while acknowledging persistent barriers that require further attention.
Motivations, Barriers, and Feelings of Safety of Medical Students Volunteering During the COVID-19 Pandemic
Maryam Hermez, MPH1, Rose Wedemeyer, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
The COVID-19 pandemic posed many new challenges to modern healthcare systems and communities all over the globe. A major response to the COVID-19 crisis has been a call for volunteers. Medical students have risen to the challenge by engaging in various types of volunteering opportunities. The majority of literature published today focuses on the motivations of medical students volunteering in an in-person patient care setting. However, many medical students have also volunteered virtually and in non-patient care settings. In this study, we look to better understand the reasons medical students choose to volunteer in-person or virtually in non-patient care or patient care settings alongside any barriers and safety concerns they face.
METHODS
This cross-sectional study involves the creation and distribution of an anonymous survey using Qualtrics to medical students at Oakland University William Beaumont School of Medicine that volunteered during the pandemic. It assesses students’ motivations, barriers, and feelings of safety while volunteering. Analysis employed descriptive statistics, chi-squared tests, t-tests, and ANOVA.
RESULTS
The study cohort included 116 medical students (34 first-years, 25 second-years, 45 third-years, and 14 fourth-years). 45.7% of students voulunteered in both in person and virtual settings, 41.4% in-person settings only, and 12.9% in virtual settings only. First-year medical students completed more in-person only volunteering (58.8%) compared medical students in other years. The most common type of volunteering done was related to in-person patient care. The most common motivation for volunteering was the desire to help others and the most common barrier was finding volunteering opportunities that fit in the school academic schedule.
CONCLUSIONS
In conclusion, this study illuminates the motivations, barriers, and safety concerns of medical students volunteering during the COVID-19 pandemic, revealing a significant preference for in-person patient care among first-year students and highlighting the challenge of balancing volunteering with academic schedules.
Motivators for Ramadan Intermittent Fasting Among US Muslim Students
Ahmed Hussain, B.S.1, Changiz Mohiyeddini, Ph.D.1, Suzan Kamel-ElSayed, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Muslims who have reached puberty participate in Ramadan Intermittent Fasting (RIF). However, the motives for attending RIF are unknown. There is no previous research conducted in the United States regarding Muslims and RIF. There is very little research into motives for religious practices for Muslims in the United States. This study aimed to establish what motivates Muslim students to participate in RIF and to explore their intrinsic and extrinsic motivators.
METHODS
US Muslim students (age 15-37) were surveyed immediately after the month of Ramadan in May 2022. Students were surveyed through a questionnaire called the Ramadan Motivation Index, developed by the authors of the study that measures both intrinsic and extrinsic motives. The questionnaire consisted of participants ranking motivational factors and answering questions about the number of days fasted and self-ascribed religioisty.
RESULTS
The results show that key intrinsic motivators are personal belief, belief in the 5 pillars of Islam, and feeling guilty. Furthermore, key extrinsic motivators are peer pressure and competition among friends. Intrinsic motivators were ranked higher than extrinsic motivators. On average, students with intrinsic motivation fasted for more days than students with extrinsic motivation. Intrinsic motivation was also correlated with higher levels of self-ascribed religiosity.
CONCLUSIONS
Intrinsic motivators are more important than extrinsic motivators for participation in RIF. Muslim students who have intrinsic motives to participate in Ramadan intermittent fasting have more positive outcomes in adherence to fasting practices and report higher levels of religiosity than those with extrinsic motives. This research is useful for educators and parents to provide a better understanding of the nature of adherence to religious practices among Muslims in the United States.
Physician-Patient Face Masking’s Influence on Post-Intravitreal Injection Endophthalmitis Rates
Conner Liddle, B.S.1, Antonio Capone, M.D.1,2, Matthew Trese, D.O.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Associated Retinal Consultants
INTRODUCTION
Introduction: Intravitreal injections (IVI) are frequently used in ophthalmology practices for various conditions. There are rare complications of the procedure, which includes post-injection endophthalmitis of the targeted eye. It has been theorized that face masking of patients and ophthalmologists could reduce the spread of bacteria during such procedures, and thus reduce endophthalmitis rates. To this end, we sought to determine if universal face mask guidelines implemented during the COVID-19 pandemic significantly influenced the incidence of endophthalmitis following intravitreal injections (IVI).
METHODS
Methods: This retrospective cohort study reviewed the electronic health records from a retina-only practice located in Michigan. The study evaluated patients receiving IVIs over two distinct time periods of April 2019-March 2020, and April 2020-March 2021, which made up our unmasked and masked groups, respectively. We then calculated the incidence of endophthalmitis following IVI. We also evaluated cases of post-injection endophthalmitis for both time periods.
RESULTS
Results: There were a total of 121,384 intravitreal injections performed over the two year period of interest. Of these, there were 63,114 unmasked and 58,270 masked patient encounters. A total of 46 post-injection endophthalmitis cases were identified. Of these, 29 cases were from the unmasked period and 17 were from the masked period. This resulted in an incidence of endophthalmitis of 0.046% and 0.038% in the masked and unmasked groups, respectively. This difference did not rise to the level of statistical significance (p=0.1336).
CONCLUSIONS
Conclusion: This study suggests that the incidence of post-injections endophthalmitis was not influenced by the implementation of ophthalmologist-patient face masking after intravitreal injection during the COVID-19 pandemic.
Perspectives of a permanent supportive housing population on their trust in sources of health information, experiences with health care providers, and navigation of health information amidst the COVID-19 pandemic
Tiffany Loh1, Jason Adam Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
INTRODUCTION
Several studies have found that the unhoused population experience mistreatment in health settings. Additionally, limited research exists on the sources of health information used by those who have experienced homelessness. This project aimed to understand the health care and health information attitudes of individuals who have experienced homelessness.
METHODS
This program evaluation consisted of 24 semi-structured interviews conducted on-site with clients who had been residing at a permanent supportive housing program in a semi-urban area in the mid-western US for approximately 6 months. Data were transcribed, coded line-by-line and categorized to reveal emergent themes.
RESULTS
Respondents rely on the Internet, media outlets, medical professionals, and housing non-profit for health information, while the government, religious leaders, friends and family, or community members are less relied on for health information. While some respondents believed COVID-19 was a danger to their health and trusted the COVID-19 vaccine, some respondents expressed distrust towards the vaccine and often cited misinformation. Some respondents expressed being treated differently in a health care setting due to their history of substance use, mental health disorder, and/or history of homelessness. In contrast, some respondents had positive experiences with health care professionals, such as with the physician that conducted home visits at the housing facility.
CONCLUSIONS
Our program evaluation has implications for future health communication with our study population. Individuals who have experienced homelessness are at risk for absorbing health misinformation, as demonstrated by the COVID-19 misinformation in our interviews. However, health care providers and case managers may be a valuable source in promoting scientific health information to this population.
Investigating the attitudes of Chinese adoptees toward genetic testing and its possible applications
Megan Moore, B.S.1, Dana Zakalik, M.D.2, Deidre Hurse, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
INTRODUCTION
Family history has strong medical implications, but most of the 80,000 children adopted from China by American families in the 1990s and early 2000s have no information about their birth families or health history. Direct to Consumer Genetic Testing (DTC-GT) can be used to gain health and ancestry information which would otherwise be impossible to obtain.
METHODS
A brief online survey was distributed via social media groups to Chinese adoptees. The first part of the survey gathered demographic information, and then the second part of the survey depended on whether or not the participant had utilized DTC-GT. For those who had used it, they were asked about the reasons why they used it and how they used the information they received. For those who hadn’t used genetic testing, they were asked why they hadn’t and whether they would be interested in it in the future. T-tests were used to compare the two groups when applicable.
RESULTS
A total of 110 participants, ranging in age from 18 to 30 years old and mostly female, completed the survey, 72 of whom had used genetic counseling previously. Of those, 64 received ancestry information and 57 received health information. Only five reported discussing their results with their primary care physician, and five reported seeking further testing based on their results. Those who received genetic testing were significantly more likely to search for their biological family (p=0.0065).
CONCLUSIONS
Chinese adoptees express an interest in and are using DTC-GT to learn about their ancestry and health information. However, few have discussed results with their providers or acted upon the results. Future studies investigating how use and attitudes change as the adoptee population ages could be of interest and use to medical professionals.
Understanding the Psychological Impact of Early Diagnosis in Young Adult Patients with Myeloproliferative Neoplasms
Jenny Nguyen1, Angela G. Fleischman, M.D./Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2University of California - Irvine, Irvine, California
INTRODUCTION
Recent studies have shown that more young adult patients and children have been diagnosed with myeloproliferative neoplasms (MPN) and that women and younger patients were reported to have higher odds of anxiety than males and older patients. The primary purpose of this study is to understand more about the psychological distress associated with early diagnosis and what they were often distressed about and a secondary goal of understanding which additional resources may be helpful in improving their mental health.
METHODS
This is a survey-based study conducted through Qualtrics and distributed globally via email through an online support group called Myeloproliferative Neoplasms Quality of Life Study Group. Only patients from age 18 to 39 were included in the study, and all responses were anonymous. Patients were asked about their anxiety and depression and whether having an early diagnosis caused distress in various situations. Patients were also asked whether additional resources would improve their mental health.
RESULTS
There were 78 participants in this survey who were diagnosed before 40 years old. 51% of the respondents stated they have anxiety and 33% responded they feel depressed. Of these respective respondents, 70% stated they experienced anxiety after their MPN diagnosis and 61% experienced depression after their MPN diagnosis. 26% had some level of distress when deciding to become pregnant or have children, and for patients who were pregnant, 71% were distressed about the possible risks associated with pregnancy. 79% and 81% believed being part of a support group and seeing a psychiatrist would improve their mental health, respectively.
CONCLUSIONS
Taken together, these results indicate that physicians who are treating young adult patients should be more mindful of the psychological impact that an early diagnosis of MPN could have on them and may consider giving additional resources to support patients’ mental health.
Promoting Community Engagement and Activism in High School Students
Divyani Patel, M.S.1, Michael Marchiori, B.S.1, Lakshmi Vrittamani, M.S.1, Kaitlin Pataroque, M.D.1, Nicholas Ang, MPH1, Rose Wedemeyer, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Service learning has been shown to positively impact the development of secondary education students. Street Medicine Oakland partnered with Avondale High School to pilot a community engagement workshop series in which medical students fostered discussions surrounding homelessness and collaborated on the development and execution of a service project with a class of high school students. Our goal was to provide a model for collaboration with students in secondary education institutions that would both educate students about homelessness and empower them to actively engage in the community through service.
METHODS
We developed a 3-week workshop series with both educational and service learning components based on the 9 Principles of Community Engagement.
Week 1: Discuss homelessness in Oakland County and street medicine; Brainstorm for supply kit project (theme, items, budget etc.)
Week 2: Small group discussions about homelessness and students’ interests/goals; Make scarves for supply kits
Week 3: Large group discussion about the importance of community engagement; Pack supply kits
A pre- and post- survey was administered to students to evaluate the educational effectiveness of these workshops. The survey included Likert scale and Yes/No format questions. Basic statistical methods were used for analysis.
RESULTS
There was a 59%, 81%, and 50% increase in the number of students who felt they learned about homelessness in Oakland County, street medicine, and how to organize a service project, respectively. Additionally, more students felt comfortable talking to friends or family about homelessness. 95% of participants reported enjoying the workshop.
CONCLUSIONS
Though this study was limited by sample size and survey quality, the workshop series appears to have been effective in educating high school students about homelessness and better equipping them to discuss homelessness with others. A widespread implementation of this program can further empower students to learn about underserved groups and partake in community service learning.
Health and Wellbeing in Black Communities: Evaluating Trust
Chandler J. Ray, B.S.1, Adina Schneeweis, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Communication, Journalism, Public Relations at Oakland University, Rochester, Michigan
INTRODUCTION
Perpetuation of systemic racism contributes to health disparity in Black communities, evident in low COVID-19 vaccination rates. This study aims to understand factors influencing vaccination rates in Michigan's Black population and develop targeted interventions. Medical professionals advocate for acknowledging historical inequities and engaging with local leaders to address systemic issues.
METHODS
Snowball sampling and social media recruited Black participants in Michigan for surveys and interviews. Nine-question surveys preceded 30-50 minute interviews, ensuring comprehensive data collection. Textual analysis of transcripts identified factors influencing trust in the healthcare system.
RESULTS
Textual analysis uncovered four major themes: community experiences shaping individual perspectives, community support when formal systems fail, systemic racism fostering caution, and incongruence between individual and community perspectives. Participants highlighted personal experiences, community experiences, parental influence, and world events as key factors shaping their views. Systemic racism's impact on trust was evident, alongside the role of personal experiences and the COVID-19 pandemic in trust formation.
CONCLUSIONS
The study revealed four key themes that illuminate factors influencing trust in the healthcare system among Michigan's Black population. Community experiences and support networks emerged as crucial influencers, while systemic racism posed significant barriers to trust. Understanding these themes is pivotal for developing targeted interventions to promote health equity and vaccine uptake. Limitations include a small sample size and potential interviewer and participant response biases. Future research should begin to engage community leaders and expand the sample to enhance the generalizability of findings.
Female Presidents in American Gastroenterology Societies: An Upwards Trend
Ali Rida, B.S.1, Meghan Mansour, B.S.1, Eric Denha, M.D.1, Thomas Meram, B.S.1, Yasmine Abushukur, M.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Wayne State University School of Medicine, Detroit, Michigan
INTRODUCTION
Gender disparity in medicine, particularly in gastroenterology, is well-documented. Despite women constituting over 50% of the general population and 36% of physicians, only 19% of practicing gastroenterologists are female. Historically, gastroenterology has attracted fewer female physicians compared to other specialties. While factors influencing female physicians' interest in gastroenterology have been explored, the representation of women in leadership roles remains understudied. This study aims to analyze trends in the presidency of prominent gastroenterology and hepatology societies to assess changes in female representation over time.
METHODS
This study examined data from eight gastroenterology and hepatology organizations from 2000 to 2021. Presidents were identified through official organization websites and administrative contacts. Data on demographics, academic metrics, and leadership roles were collected and analyzed. H-index values were obtained from the Scopus database to measure research productivity. Statistical analysis included chi-square tests and t-tests.
RESULTS
Over the 22 years (2000-2021), a total of 151 unique presidents across the eight societies were identified and included in the analysis. Male presidents constituted 86.1% of the total, while female presidents constituted 13.9% of the total.
Males comprised 100% of societal presidents across all societies in the years 2000-2004, 2007, 2013, 2014, 2016, and 2021. Between 2000-2021, 2017 was the only year in which female presidents outnumbered male presidents, representing 66.7% and 33.3% of the total respectively. However, there was a statistically significant increase in the number of females elected to presidency over time as demonstrated by the Cochran-Armitage Trend Test (P = 0.0136).
CONCLUSIONS
Our study reveals a gradual increase in female representation in gastroenterology leadership from 2000 to 2021. While promising, efforts to encourage women to pursue gastroenterology and leadership roles must continue. Recognizing and addressing barriers to career advancement for women is crucial for achieving diversity and equality in the field.
Pontiac Collective Impact Partnership (PCIP) Data Hub
Benjamin Secor, B.S.1, Dr. Jennifer Lucarelli, Ph.D.2, Mariah Milton-Harrison2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, Rochester, Michigan
INTRODUCTION
The Pontiac Collective Impact Partnership (PCIP) consists of local group leaders and residents in the Pontiac area with a shared vision for the community. This organization is based on a collective impact framework and the idea that addressing complex societal issues in a collective format will lead to a higher level of success. To assess the overall effectiveness and to identify strengths and areas for growth, it is important to provide organizational stakeholders regular opportunities to provide input and feedback. As such, PCIP utilized the Partnership Self-Assessment Tool to determine the strengths and opportunities for growth of their organization. We intend to complete the PSAT every few years to track growth and identify the ongoing needs of the organization.
METHODS
The survey utilized a modified version of the Partnership Self-Assessment Tool (PSAT) originating from Lasker, Weiss, and Miller (2001) which aims to measure synergy within partnerships. Final version: 89 questions, multiple-choice, open-ended. In May 2022: Electronic distribution of the survey and was sent to 95 PCIP-associated individuals where participants spent around 15 minutes on the survey.
RESULTS
The survey showed what the PCIP is doing well and areas of improvement. The strengths: non-financial resources and Data Hub areas performing well, PCIP effectively assembles necessary groups and connects with the target population, and the data hub presents accurate and understandable information. Areas of improvement: decision-making along with administration and management require attention, mixed perceptions of decision involvement, some feel excluded, and communication enhancement is needed with both partners and the community.
CONCLUSIONS
Implementing improvements is vital for enhancing efficiency and achieving community goals. It strengthens connections and engagement within the community while also streamlining decision-making processes and improving meeting dynamics. The proposed changes are poised to elevate PCIP's effectiveness and success addressing weaknesses while capitalizing on strengths for community betterment.
Queer Patients’ Interpretation of Language and Environment in Medical Care
Ramona Stamatin, B.S.1, Elizabeth Taylor, M.S.2, Eric James, M.D.3, Michele Parkhill, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University Department of Psychology, Rochester, Michigan
3The Ohio State University College of Medicine Emergency Medicine/Internal Medicine Residency, Columbus, Ohio
INTRODUCTION
LGBTQ+ individuals encounter healthcare barriers due to provider discrimination, prompting efforts to create more inclusive practices. Many providers feel unequipped to treat queer and trans patients due to a lack of formal LGBTQ+ training. This study examines how the language and environment of medical encounters affect queer patients' likelihood of seeking future care, investigates opinions on primary care providers' (PCP’s) inclusive practices, and compares telehealth perceptions amongst groups.
METHODS
The study’s participants were collected through Amazon’s Mechanical Turk (MTurk). Participants were required to reside in the U.S. and be between the ages of 18-60. A screening survey was used to screen out participants who were ineligible; it further identified LGBTQ+ and straight participants, further categorized as “allies” or “non-allies” of the LGBTQ+ community. Four video modules of a physician-patient interaction were randomly and equally distributed to all participants. The recordings differed in environmental conditions or communication identified as either neutral or positive.
RESULTS
Quantitative results were statistically analyzed using a 2 by 2 ANOVA parametric test. Significant group differences emerged in terms of the importance of having an LGBTQ-trained physician. The majority of participants identified examples of inclusive or assumptive language and recognized inclusive clinical environments. LGBTQ+ and Straight Ally groups provided specific examples in which their PCP has displayed inclusiveness of LGBTQ+ individuals. Among participants with past telehealth experiences, a majority in each group preferred it over in-person visits, with LGBTQ+ participants having the highest preference for telehealth.
CONCLUSIONS
Understanding queer patients’ healthcare perspectives offers providers the insight to improve communication skills and facilitate an inclusive environment for such patients. Simple steps providers can take to do so include asking patients' pronouns and displaying non-discrimination statements or pride flags. Patient preferences in favor of telehealth visits are greater among queer participants, in part due to privacy and comfort.
A Qualitative Study on How "Street Medicine Oakland" Effects the Relationship Between the Local Homeless Population and the Healthcare System
Eli Tukel, B.S.1, Theresa Anasti, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, Rochester, Michigan
INTRODUCTION
The homeless population faces several barriers that influence their ability to receive healthcare. In 2019, students at the Oakland University William Beaumont School of Medicine created an initiative to better serve this population in Oakland County, calling the program “Street Medicine Oakland”. This program sends healthcare professionals on a bi-weekly basis to HOPE shelter in Pontiac, MI, offering free medical care to those who seek it out.
This project sought to partner with the program, and conduct a series of qualitative interviews to better understand how their patient population interacts with the healthcare system. Specific aims included learning more about how a proactive approach to care can effect the relationship that the homeless population has with providers, and how it might alter their healthcare habits. This project also sought to take advantage of a qualitative approach to amplify the voices of said individuals and their healthcare experiences.
METHODS
9 individuals were interviewed following a standardized script focused around the specific aims. Interviews were recorded, transcribed, and coded accordingly. Coded themes were trended and evaluated toward overarching conclusions.
RESULTS
The theme that continued to repeat with the greatest consistency was that individuals had significant physical, mental, and emotional barriers to receiving healthcare. Common examples included not having transportation, stigma due to a previous prison sentence or mental illness, or not understanding the clinical nature of their complaints. This commonality transcended variables including age, race, and education achieved.
CONCLUSIONS
The Street Medicine Oakland program helps individuals cope with these barriers to receiving care before their medical issues become more significant.
