The problem of alcohol in Vietnam is interesting when considering the culture surrounding alcohol throughout the country, particularly amongst men. In 2010, Vietnamese men drank 12.1 liters of pure alcohol per capita, while women drank only 0.2 liters (WHO, 2014). The WHO Global Status Report on Alcohol and Health stated, “Vietnam’s national drinking patterns … are among the most fatal with the highest possible score for alcohol-attributable years of life lost,” a metric which includes liver cirrhosis, road traffic crashes, and the prevalence of alcohol use disorders and alcohol dependence (WHO, 2014). In addition, domestic alcohol production in Vietnam has increased and presumably continues to do so (Ngoc, Thieng, Huong 2012). This poster aims to discuss the culture of alcohol in Vietnam, highlight problems it presents to the health of the Vietnamese people, and propose possible policies designed to help ameliorate the burden of alcohol abuse on the Vietnamese healthcare system.
Information presented here is based on 5-week volunteering experience at Primeros Pasos clinic in the rural Palajunoj Valley outside the city of Quetzaltenango, Guatemala. Almost all of the patient population is rural, indigenous Quiche Maya. Guatemala has a relatively high GDP and patient-doctor ratio (1000:1) compared to its neighboring Latin American countries, but these resources are extremely localized to its capital, Guatemala City, where 70% of the country’s physicians work.
Only the wealthy are able to utilize private clinics and hospitals that are known to provide the highest quality care. At these clinics, patients pay out-of-pocket. Indigenous, rural communities typically rely on under-funded, understaffed, overcrowded government Puestos and Centros de Salud that are often far from their homes and difficult to access.
Theoretically, these public clinics allow for Guatemala’s healthcare system to claim “universal coverage,” but a lack of funding for public hospitals and clinics have left many of them in dire condition.
By 2015, 4 out of the 44 public hospitals were forced to shut down all but emergency services because they could not afford to pay their employees.  Guatemala’s Deputy Prosecutor, Hilda Morales, blames the lack of funding and resources on “structural failures,” such as corruption within the system, debt, delays in payment to suppliers, and the poor maintenance of medical equipment. Many of these issues are rooted in the violence, corruption and prejudice against indigenous cultures during the Civil War.
Anna M. Carleen
In 2009 the Greek government admitted that the numbers it had been reporting to the European Union about its national budget deficit were artificially small. The deficit was actually huge, way larger than what the EU requires of member countries if they want to reap the benefits of being in this financial network. A benefit of being in the EU is that it makes it much easier for governments to take out large loans, because lenders trust that a member country will make good on its debts due to the security it has from being part of the union. This admission by the Greek government came at the tail end of, and was very much linked to, the global financial crisis felt here in the United States in 2008. As a result, lenders started enacting stricter borrowing rules, and Greece had to take out even more loans. By spring of 2010 it was veering towards bankruptcy, and in May of 2010 the first of three bailout agreements with the troika (International Monetary Fund, European Central Bank, and the European Commission) was reached. This bailout came with conditions, or austerity terms, that the Greek government had to agree to. These included deep budget cuts, steep tax increases, and promises to implement anti-corruption strategies and cut down on tax evasion. The second bailout came in 2012 after the recession continued to worsen. The third bailout came in summer of 2015 after a series of failed negotiations between Greece’s newly in power Syriza party and the troika, Greece defaulting on its loans, and a popular vote by the Greek people to reject the latest proposed bailout conditions.
Sara Edwards; Lisa Perriera, MD, MPH; and Rebecca J. Mercier MD MPH
- Are there differences in attitudes and beliefs about IUDs based on age?
- We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.
Emily Knudsen-Strong, MSc; Joseph Flaxer; Rickie Brawer, MPH, PhD; Mudit Gilotra, MD; and James Plumb, MD, MPH
•Selected the CAHPS® with Patient Centered Medical Home question set to administer to patients receiving medical care at SKWC (52 questions)
•Included 2 supplemental questions to assess patients’ likelihood to refer others to SKWC
•Developed an additional survey for patients receiving behavioral health services (16 questions)
Participant recruitment and data collection:
•Calculated a target number of 130 participants based on CAHPS® guidelines of 50 surveys per Full Time Employee
•Observed patient flow and developed recruitment strategy for a convenience sample
•Eligibility criteria: patient ≥18 y/o and had a medical appointment in the last 12 months
•Participants were invited to enter an optional raffle to win a $25 gift card to the Fresh Grocer
•Responses were coded and entered into Microsoft Excel Database
•Average scores and response frequencies for each survey question were calculated
Elizabeth Kuhn, Emily Zhang, Naveed A. Rahman, Rebecca Margolis, and Savannah Coe
JeffHEALTH-Helping East Africa Link to Health is a student-run organization at Thomas Jefferson University dedicated to improving basic medical education and quality of life in Rwanda, which was devastated in 1994 by civil war and genocide. Working in partnership with the Rwanda Village Concept Project, a student organization at the National University of Rwanda, JeffHEALTH seeks to implement sustainable health initiatives in our partner villages. Graduate students from Thomas Jefferson University travel to Rwanda where we taught Community Health Workers from the Villages of Akarambi and Ruli the following topics: Nutrition and Vitamin Deficiencies, Family Planning, Prenatal care, HIV, Sexually Transmitted Illnesses and Hepatitis, Breast and Cervical Cancer, Diabetes, and Fistulas. We also taught two programs to children of the villages (Oral Hygiene and Soil Transmitted Helminths) and talked with young adults about Circumcision and HIV Prevention and Sex Education.
Amanda Lacue and Marshall Miller, MD
A quality improvement study based in a primary care resident-based HIV clinic, the Kendig Clinic, was conducted within Jefferson Family Medicine Associates. The study objectives were to
• Determine the percentage of the clinic patients meeting each quality measure
• Compare these calculated clinic measures to known national averages
• Use the data to determine areas to target for future quality improvement initiatives.
Christina E. Lewis; David Clarke, JD; and Maryam Bigdeli, PhD
Decentralization, defined by the World Bank (2001) as, “the transfer of authority and responsibility for public functions from the central government to intermediate and local governments or quasi-‐independent government organizations and/or the private sector,” is a movement that has gained much traction in recent history. For many countries undergoing decentralization, a major driver has been a desire to increase the role and participation of local governments in the decision-‐making space. In doing this, it is hoped to create governance structures that are more accountable and responsive to the people. For health, decentralization has been touted as a potential way to improve responsiveness to local needs, improve service delivery, and improve equitability. In light of these goals, many countries as part of their political decentralization have also opted to decentralize healthcare.
Lindsay S. McAlpine, MSIII; Christine A. Marschilok, PGY-3; Amber S. Maratas, MD; and Jeremy D. Close, MD
In 2002, and reaffirmed in 2009, The American College of Obstetricians and Gynecologists recommended that healthy pregnant women exercise for at least thirty minutes most days of the week. Exercise during a healthy pregnancy is safe and has many maternal and fetal benefits. Identified benefits include management of weight gain, improvement in mood, and preparation for labor. Previous research has evaluated women’s beliefs and practices of exercise in pregnancy, but it has focused on affluent, ethnic majority populations. This survey study was performed to assess beliefs about exercise in pregnancy in a predominantly low-income, urban minority population.
Lindsay S. McAlpine, MSIII; Juana Medina, MD; Nayoung Kim, BS; and Michael Rivlin, MD
Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.
Kevin Molyneux; Ellen Plumb, MD; and Martha Langley Ankeny, MEd
The Interactive Curricula Experience (iCE) is an educational platform intended for interactive education utilizing multiple forms of media. It is being utilized at Thomas Jefferson University (TJU) in various classes, among them Global Health.
One of the pertinent global-health-at-home topics at TJU relates to Latino immigrant health. Latino immigrants number more than 20,000 in Philadelphia. They are located throughout the city, although the highest concentrations are in North and South Philadelphia. With respect to health care, Latino immigrants are less likely to have a regular health care provider than non-immigrant Latinos.
Education to provide culturally sensitive care to Latino immigrants is vital to establish longer-lasting patient-doctor partnerships and decrease the number of Latino immigrants without a regular health care provider. iCE is an attempt to provide that education by stepping out of the lecture hall and assigned readings, and instead allowing students to engage with the material at their own pace.
Addressing Childhood Obesity in Early Head Start Population in Philadelphia through Early Intervention and Food Buying Clubs
Nishant Pandya; Rickie Brawer, MPH, PhD; and Sarah Roescher
To implement a food buying club model to increase access to fresh and healthy foods for families whose children (ages 2-5) participate in Early Head Start and the Maternity Care Coalition.
Compare four potential food distributors: Philadelphia SHARE, Asociacion Puertorriquenos in Marcha (APM), The Common Market, and JETRO to find the organization that can best implement a feasible food buying club run through Early Head Start to fit the families needs.
Nishad A. Rahman and Dimitrios Papanagnou, MD
An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients?
These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of medical professionals could be critical. If EM residents have great risk aversion, they might practice defensive medicine, thereby incurring crippling costs4. On the other hand, if emergency medicine residents are greatly risk tolerant, they may make decisions that lead to significant morbidity and mortality. It is essential to establish a baseline risk profile before any corrective measures can be advanced. This study attempted to accomplish precisely that using Risk Type CompassTM.
Holly A. Rankin; Alisa LoSasso, MD; and Beth I. Schwartz, MD
Preventative sexual education can reduce the negative health outcomes of sexual behavior in adolescent populations.1 The objective of this pilot study was to determine if sexual education can be delivered as a scripted five-minute module during a routine adolescent office visit in a manner that is non-disruptive of clinic flow and acceptable to both patients and providers.
• 85% of providers reported the intervention did not interrupt clinic flow
• 86% of patients reported the intervention to be appropriate and 92% of providers were satisfied overall with the intervention
These pilot data highlight that the incorporation of brief scripted sexual education into routine adolescent preventative office visits is both feasible and acceptable to patients and providers.
Jordan M. Zaid
• Immediately after the Vietnam War ended in 1975, Vietnam experienced economic turmoil and famine as the roots of industrialization began to grip the nation.
• In 1986, the government declared a rapid transition from a planned to a market economy would take hold. The ensuing change caused further increased industrial development and a subsequent growth of the emerging market economy. 1
• To this day, Vietnam’s GDP is rising yearly at a rapid rate.
• For this reason, much of Vietnam has been developed in a relatively short amount of time (since the end of the war) but much of it has lagged behind, including the infrastructure including water pipes and water sanitation plants. This lag has caused limited access to sanitized water in both rural and urban areas.
• Despite an overall adequate water access for Vietnamese citizens, the sanitation of supplied water has not improved as markedly as the country as a whole.
• Sanitation has increased from 37% in 1990 to 75% in 2011 as defined by the JMP’s sanitation standards. Here, sanitation is defined as the distance between a water supply and human excretion.2
• Although Vietnam’s water has been made safer over the past few decades, it is largely undrinkable.
• A 2009 study done by scientists at the Vietnam Institute of Biotechnology concluded that ammonia levels in Vietnam’s waters range from an average of 6-18 times higher than an acceptable level. 3
Furthermore, arsenic levels range from 2-3 times higher than an acceptable level.
- Empowerment (women, youth, communities)
- Inclusion (age + gender)
- Prevention/Early Detection
- Partner with Rwandan medical students to improve program delivery
- Communicate monthly with local leaders
- Partner with Community Health Center
- Partner with Rwandan medical students to improve program delivery
- Communicate monthly with local leaders
- Partner with Community Health Center
Hepatitis C is a viral infectious disease that is a major cause of liver disease around the world. By the 1970s, it was recognized that many hepatitis cases were not due to the known hepatitis A or hepatitis B viruses. It was not until 1989 when the virus, then known as non--‐A, non--‐B hepatitis, was identified as a new distinct virus, hepatitis C. The virus has seven major genotypes, with genotype 1 causing about 75% of cases in the United States. By 1990, a screening test for the virus was developed, and within a year, the first treatment for the virus was approved.1 Research through the 1990s and into the early 2000s improved treatment options. Before 2011, the standard of care treatment for hepatitis C consisted of pegylated interferon and ribavirin, which successfully cured between 45% and 80% of individuals, depending on the specific genotype of HCV. In recent years, new treatments consisting of a combination of ledpiasivir, sofosbuvir, ribavirin, and pegylated interferon have improved the cure rate to up to 99% in some genotypes.2 These drugs work without the many severe side effects of older classes of drugs, which had a relatively high risk of causing life threatening hemolytic anemia.3 However, the cost of these new treatments can approach $100,000 for a twelve--‐week therapy, making the cost of treatment prohibitively expensive for many Americans. 4
Lost in Legislation: Barriers in Actualization of Post-Apartheid Healthcare Reform in South Africa and American Analogies
Abbie Marie Bender
A nation now defined by the intersection of the Western and Non-Western worlds, South Africa’s evolving healthcare system provides an invaluable reference for the perils that segregation and class control can create for large groups of a population. Under apartheid, the system propagated such separation in the availability and delivery of medicine to its peoples in a caste-like manner. To be of Western descent in South Africa was a ticket that admitted one to the amenities of Western medicine; those without the whiteness of such validating paper found themselves trapped in substandard care. As apartheid was dissolved with the inauguration of the African National Congress, or ANC, in 1994, a set of goals regarding healthcare reform reflected the burdens created by the inefficient and inconsistent paradigms of segregated care in the decades prior. Still, the inequalities and unpardonable restraints on human rights are not so easily ameliorated with legislature and some of the most critical divisions persisted as a division between the private and public sectors of healthcare. The United States often imagines itself as a model system for other nations to imitate, and we rarely assign equivalent value to the tactics of other nations—especially developing nations. It would be prudent to examine the strengths and pitfalls that other systems have in the development of a more recognizable healthcare plan for our own country and its peoples. It stands to reason that there is much to be gained from studying a country as extreme as South Africa—one that has evolved from developing to developed in a short time span—and one that is plagued by a problem with which America is hesitant to admit itself infected—the constraints of a traditionally hierarchal health care system that consistently favors certain racial and ethnic groups, even if we attempt to claim that the stratification is founded in socioeconomic standing alone, thus exempted from the propagation of “separate but equal” undertones in care.
“The tragedy is not that things are broken. The tragedy is that things are not mended again.
- Alan Paton
Kelsey L. Capron and Lara C. Weinstein, MD
Homelessness in the United States
- 630,000 homeless in the US in 2012, thousands in Philadelphia
- Over 3% of the US population has been homeless during the past 5 years
- Homeless = no stable residence
Temporary shelters, unsheltered locations (the street, transit stations, parked cars), etc.
- High rates of legal issues, substance abuse/dependency, & lack of stable employment
Severe mental illness = overrepresented & linked to severe health disparities
- Higher risk for all-cause mortality (primarily due to injuries, overdose, CV disease)
Mortality rates 3-4x higher than the general population
Chronic & acute mental & physical health conditions
HIV, tuberculosis, hypertension, diabetes mellitus, Hepatitis C
Life expectancy: 42-52 years for the chronically homeless
- Disproportionately low numbers / low quality of social supports
- The current “continuum of care” model:
Outreach à treatment à transitional housing à permanent supportive housing
Perceived by the homeless as a series of hurdles, often not possible to overcome
- No empiric support in favor of the practice of requiring individuals to participate in psychiatric treatment or to maintain sobriety before being housed
Poor health is a risk factor for homelessness, and homelessness is a risk factor for increased health needs.
What Are Multidisciplinary Care Rounds (MDR’s)?
MDRs are defined by the unique characteristic of incorporating a multitude of both physician and non-physician specialties into the conversation with the patient for the coordination of their care.
What is Discussed During an MDR?
Activities relating to the care of the patient that may be incorporated into the MDR include summarizing the treatment that the patient has undergone, discussing the treatment approach that is planned for the patient, working through potential issues that may arise from the treatments, and discussing the potential future therapy.
What is Telehealth?
Telehealth is the delivery of Health-care related activities or information via telecommunications technologies (eg. web conferencing). It is differentiated from telemedicine in that the focus is expansive and includes preventative as well as curative aspects.
- The number of participants in high school sports has increased since 1989 (National Federation of State HS Association).
- From 2000-2010 7% of public schools cut athletic programs while less than 1% added them (Sharp Center Univ. Michigan).
- Some estimates predict 27% of public high schools will not offer varsity athletics by 2020 (Sharp Center Univ. Michigan).
- School’s are dropping athletic programs (as well as music and theater programs) due to budget cuts.
- Alternative approaches schools are taking include “pay to play” which increases the financial burden on students and families.
- In 2011, 3 out of 4 school districts in PA planned to decrease the number of extracurricular activities to deal with increasing budget cuts (Hardy).
- Despite increased participation, high school sports programs are threatened by budget cuts.
Emma Howard-Young and Jordan Howard-Young, MA
History of the Pasteur Clinic Đà Lạt
The Pasteur Clinic is associated with the Institut Pasteur, part of the international network of research institutes dedicated to the prevention and treatment of infectious diseases. The Đà Lạt branch of Vietnam’s Institut Pasteur was built between 1930 and 1936 under the direction of Dr. Alexandre Yersin, a physician remembered for identifying Yersinia pestis as the causative agent of Plague and a student of the eponymous French chemist and microbiologist Louis Pasteur. While many overt references to the French colonial tradition have been supplanted in Vietnam by nationalist sentiments, the Institut Pasteur retains its reputation thanks to a history of serving the needs of the Vietnamese population. Yersin, who lived out the final years of his life in Vietnam after overseeing the acclimatization of the quinine-producing Cinchona tree for the treatment of malaria, is remembered as a friend to the Vietnamese people. Since its founding, the Institut Pasteur in Đà Lạt has conducted infectious disease research and served as a major hub for vaccine production in central Vietnam.
Prior to 2014, the Pasteur clinic was located inside the Institut Pasteur complex and focused primarily on the administration of vaccines. The clinic’s medical director, Dr. Nguyễn Thị Thủy, began to explore ways the clinic could serve the significant health needs of the community in a broader way and subsequently received permission to build a free standing clinic within the Institut compound to provide an expanded array of services to the populace. Using loans, grants, and the clinic staff’s own finances, the newly independent clinic opened its current facility and officially began its expanded operations on October 24, 2014. A dedicated staff of physicians, nurse practitioners, nurses, medical assistants, and clerks now oversee the administration of the clinic and its daily provision of health services to patients from Đà Lạt and the surrounding areas.
Marlee Madora and Molly Klores
Philadelphia FIGHT is a comprehensive HIV/AIDS service organization providing primary care, consumer education, advocacy, and research on potential treatments and vaccines. FIGHT was formed as a partnership of individuals living with HIV/ AIDS and clinicians, who joined together to improve the lives of people living with the disease. Today, FIGHT serves an even broader patient population and recently received designation as a Federally Qualified Health Center. FIGHT strives to address not only HIV-infected patients, but all at-risk populations through education, outreach, and preventative medicine.
The annual Bridging the Gaps interns are responsible for several projects, including a client satisfaction survey, a “FIGHT Stories” client portrait project, and this year, projects on smoking cessation and Preexposure Prophylaxis (PrEP) use.
DEMOGRAPHICS OF CRAWFORD COUNTY1,2
- Population – 87,600
- Population density – 86.5 per mi2
- Ratio of patients to PCPs – 1,685:1
- Number of hospitals – 2
- Population 65 and older – 17.4%
- Overweight – 65% Obesity – 32%
- Population with Diabetes – 12%
- Heart disease death rate – 200 deaths per 100,000 people.
The above percentages and rates of disease are either equal to or higher than the averages for the state of Pennsylvania.
Amanda Nemecz, Alexander Rowan, and Talia Stark
Teaching Community Health Workers
In rural Rwandan villages, the communities are linked to healthcare through Community Health Workers (CHW). CHW are appointed based on village election and the requirement that they can read and write. The Rwandan Ministry of Health provides general health training to the CHW so that they can educate and advise the village on health related matters. CHW administer educational sessions at village meetings about prevalent health issues, and advise members of the village when they should go to the Health Center. JeffHEALTH’s teaching aims to supplement the Ministry of Health training. Topics are chosen and approved by the Project Director Andre Munyantanage, village leadership, and head of the local Health Center. The topics are in accordance with the Rwandan government development program Vision 2020.
Education Topics Include:
Family Planning, Teenage Sexual Health, HIV/AIDS Prevention, Dental Hygiene, Breast and Cervical Cancer, Prevention and Detection, Nutrition, Prenatal Care, Soil Helminths,Drug and Alcohol Abuse Prevention