Download Poster Session Abstracts - American Osteopathic Association

16th Annual International Seminar and Poster
Session
“Osteopathic Medicine:
Globally Integrated
Education and
Implementation”
Poster Session Abstracts
AOA Bureau of International Osteopathic Medicine
Saturday, October 25, 2014
8:30 a.m. to 5 p.m.
Washington State Convention Center, Seattle, WA
Rooms 606-607
Posters in room 604
Research Category
1st Place Winner – Research Category
2014 BIOM 1923
Carcinogenic Risk for Carancas Children Exposed to Arsenic through Drinking Water
Primary Author: Elise Craig, OMSII; Additional Authors: Ruben Kenny Briceno, MD; Santiago Benites
Castillo, PhD; Javier Bojorquez Gandarillas, Eng; Shane Sergent, DO, Lorenzo Lim, OMSIV; Katelyn
Wiseman, OMSIV; Gary Willyerd, DO, FACOEP, FAODME, Teresa Colelli, OMSII; Sara Lang, OMSII;
Samantha Ward, OMSII; Jessica Jary, OMSII; ; Suma Marka NGO
Michigan State University College of Osteopathic Medicine, and Cesar Vallejo University, Trujillo, Peru
____________________________________________________________________________________
Background: In developing countries around the world, access to clean water, is often unattainable. Arsenic
is a natural component of the earth’s crust and is widely distributed throughout the air, water, and land. It is
highly toxic in its inorganic form, being known to cause a variety of health problems and cancer. In Peru,
people are exposed to elevated levels of inorganic arsenic through drinking contaminated water. Previous
studies have detected high levels of arsenic in southern Peru, especially in Carancas. In this community, the
only water source for the habitants are local wells where tests for arsenic range between 60-900 parts per
billion. WHO and USEPA guidelines state that under 0.010 mg/L of arsenic consumed per day is safe. In
Carancas, speciation indicated that 90% of the total arsenic was of the trivalent form, which is the most toxic
species to human health. This study evaluated the Primary School of Carancas, where 40 students younger
than 13 years old spend their entire day learning, eating food prepared with, and drinking arsenic
contaminated water.
Methods: To identify arsenic presence, water samples were obtained from the tubular wells of the
Huanucollo Primary School. Urine samples were obtained from 11 students, aged 8-13 years, living in
Carancas. These samples were collected and analyzed in July of 2014. These results, among other collected
data such as, age, height, weight, and daily water ingestion, allowed us to use the ATDS equation to quantify
the carcinogenic risk and probability of developing cancer over a lifetime as a result of daily exposure to
arsenic in drinking water.
Results: The average concentration of arsenic in the water was 0.763 mg As/L and in the urine was 553.91
µg/L. The average age of the 11 children screened was 9.6 years and on average each child is being exposed
to 0.004302 mg of As/kg/day. Given the average weight of these children being 25.36 kg, each child is
exposed to 0.109 mg/L/day. We were then able to calculate the individual carcinogenic risk being 0.0064
and the child population of Carancas’ carcinogenic risk as 2.8912 cases of cancer from 448 children, during
childhood.
Discussion: Data from this study shows that children in Carancas are being exposed to over 10 times the
safety standard limit for arsenic outlined by the WHO and USEPA. Exposure to high arsenic levels during
childhood is associated with increased rates of cancer, especially skin cancer, among many other severe
health effects. Our data suggests that these children have a nearly 3x greater risk of cancer due to their
arsenic exposure. In order to change the exposure that these children have, a filtration system is being
installed. It is projected to remove arsenic with 90% efficiency and this study will be repeated in 6 months to
evaluate the effectiveness of the filtration system and the health of the children.
1
2nd Place Winner – Research Category
2014 BIOM 1896
BMI as an indicator of serum albumin and its role as a prognostic factor for Taiwanese
patients with ESRD on hemodialysis
Primary Author: Anny Ye Xiao, OMSII: Additional Authors: Athena Lin, PhD, YC, Chen, MD,
Taipei, Taiwan
Touro University College of Osteopathic Medicine – California
Background: BMI has been shown to be predictive of mortality risk in ESRD patients on
hemodialysis. Increasing numbers of studies have reported reduced mortality in hemodialysis patients
with a higher BMI, in a phenomenon known as the obesity survival paradox. Additionally, serum
albumin has been a consistent independent predictor of mortality in dialysis patients. Taiwan has the
highest incidence and prevalence of ESRD in the world, likely due to some risk factors that are
unique to Taiwan, and previous studies have shown that the Taiwanese population has a higher body
fat percentage for a given BMI when compared to Caucasians, so in this cross-sectional study we
examined BMI as it relates to serum albumin and its role as a prognostic factor for patients receiving
regular hemodialysis at the TIHTC Taipei Hospital.
Hypothesis: We hypothesize that BMI >25 kg/m2 is correlated with a higher serum albumin than
BMI <25 kg/m2 in ESRD patients on hemodialysis at the TIHTC Taipei Hospital.
Materials and Methods: We obtained the age, BMI, serum albumin, number of comorbidities, and
date of hemodialysis initiation for 131 ESRD patients receiving hemodialysis 3 times per week at the
TIHTC Taipei Hospital Hemodialysis Center. Using serum albumin as a marker for mortality risk, we
compared the serum albumin values of patients with BMI >25 kg/m2to the serum albumin of
patients with BMI <25 kg/m2, matching the 2 patient groups for age, number of comorbidities and
duration of hemodialysis treatment. We then examined serum albumin values after further dividing
the patients into subgroups of underweight BMI <18.5 kg/m2, normal BMI 18.5-24.9 kg/m2,
overweight BMI 25-29.9 kg/m2, and obese BMI >30 kg/m2.
Results: The average albumin was 3.37 ± 0.35 g/dl for patients with BMI <25 kg/m2 and 3.50 ±
0.32 g/dl for patients with BMI >25 kg/m2. The average albumin of patients with BMI <18.5
kg/m2 (N=8) was 3.28 ± 0.44 g/dl, BMI 18.5-24.9 kg/m2(N=73) was 3.38 ± 0.34 g/dl, BMI 25-29.9
kg/m2 (N=44) was 3.53 ± 0.32 g/dl, BMI >30 kg/m2 (N=6) was 3.3 ± 0.26 g/dl. The correlation
coefficient of BMI and serum albumin for patients in the overweight BMI group was r(42) = 0.4, p
<0.05.
Conclusion: BMI in the overweight range was positively correlated with serum albumin levels and
patients in the overweight BMI group had the highest average serum albumin levels. Our results
suggest that Taiwanese patients with ESRD on hemodialysis may benefit from achieving a goal BMI
of 25-29.9 kg/m2.
2
2014 BIOM 1732
The impact of short international medical missions on the professional development of
osteopathic medical students
Primary Author: Caitlin Blaskewicz, OMSII; Additional Authors: Benjamin Switzer, OMSII, MS,
Michael Schmidt, PhD
Lake Erie College of Osteopathic Medicine
Hypothesis: Many medical students choose to go abroad during the summer between their first
and second years to volunteer their time in clinics in the developing world. We hypothesize that
short medical missions have a positive impact on the professional development of preclinical
osteopathic medical students. Identifying and qualifying the most valuable attributes of these
summer experiences will help maximize the educational value of future medical missions.
Materials and Methods: At COM, 80 students traveled in 4 cohorts to different locations
(Honduras, Peru, Tanzania and Uganda) for 1-2 weeks between May and June 2014. Students were
asked to complete brief electronic pre- and post- surveys to gauge their comfort level in a variety of
clinical settings, their future career plans as well as the development of clinical skills and personal
growth while abroad. There were 44 responses to the pre-survey and 25 for the post-survey.
Results: Most of students that responded to the survey were between the ages of 22-24 (75%), and
had never been on an international medical mission trip before (89%). When asked why they chose
this summer experience, 41% reported that they were looking to gain clinical experience, 39%
responded that they wanted to learn more about the developing world, 14% reported that they
enjoy traveling to new places and 7% felt residency programs and future employers would look
favorably on the experience. After their mission, more than 80% students reported that they were
better able to ‘think on their feet’, collaborate with peers in a clinical setting, provide compassionate
care and be more effective leaders. In terms of clinical skills gained, 86% of students reported that
they had more confidence in eliciting a medical history from English speaking patients and 77%
reported that they were more confident obtaining a medical history through an interpreter. The
majority of responding students also reported that they were more comfortable performing a basic
physical examination (68%) and speaking with patients about sensitive topics such as sexual history
(77%) and if they were able to afford the recommended treatment options (55%). Students felt the
most uncomfortable eliciting a medical history without an interpreter and performing physical
examinations on patients in varying degrees of distress. Only one student reported that their
international summer experience definitively changed their field of interest (from specializing to
family medicine), but almost one quarter responded in the post survey that they would be more
likely to practice in an underserved area in their future careers.
Conclusion: These findings highlight the positive impact of international medical mission trips on
both professional development and clinical skill building during the preclinical years of osteopathic
medical education.
3
2014 BIOM 1744
Health Systems-Level and Patient-Level Factors Affecting International Patient Decisions
in Seeking Quality Healthcare in Underserved Communities of South Asia
Primary Author: Jay Modi, OMSII; Additional Authors: Jayal Mehta, OMSII, Howard Teitelbaum,
DO, PhD, MPH
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Introduction: India, with a population of over 1.2 billion people, faces numerous obstacles in
providing quality healthcare to all its citizens. Affordable and comprehensive private health
insurance is not attainable by the middle and lower classes, and high out-of-pocket medical
expenditures lead to millions moving into poverty every year. Poor hospital infrastructure and
inadequate funding creates a health system that fails to provide quality care to its community,
leading to an apparent patient dissatisfaction with cost and resources.
Material and Methods: During a medical outreach trip facilitated by Dr. Interns (a non-profit
organization), an extensive healthcare evaluation on impoverished patients at Shree Prannath
Hospital in Surat, India was conducted by two of the investigators. Interviews of 50 randomly
chosen patients were carried out in the local language using a community and preventive health
survey constructed by the authors. Data provided a quantitative assessment of health systems-level
factors, including financing, structure of care of the healthcare facility, culture, linguistic barriers, as
well patient-level factors, i.e. patient preferences, re of treatment, poor adherence, biological
differences.
Results: Personal factors influence patient decision on quality of healthcare pursued. Concern for
having to pay high healthcare costs was seen in 64% of this patient population, illustrating
affordability to be a significant concern for individuals seeking treatment. Over 77% of patients
were not able to recall the date of their last routine check-up; while 70% of patients believed their
health status to be either “good” or “excellent”. Over 90% of the patient population was
remarkably satisfied with healthcare accessibility and overall apparent quality of healthcare in the
local community.
Conclusion: Patient comments indicate an unawareness of the importance of maintenance
healthcare, causing a false sense of security in their current health status. Physician visits are sought
only on an acute basis, leading to a high occurrence of preventable health problems; e.g. infections
and non-communicable illnesses. An apparent contradiction between the lack of quality care and
patient satisfaction demonstrates patients are unaware of the possibility of a more equitable
healthcare system. The results suggest further investigation of perspectives on structure and
function of local healthcare systems in other international communities is needed.
4
2014 BIOM 1795
Sustainable Agriculture Techniques in Developing Countries: A Multidisciplinary
Nutrition Study
Primary Author: Kristi Ray, OMSII; Additional Author: Cyril Blavo, DO
Nova Southeastern University College of Osteopathic Medicine
Introduction: Indonesia has had many problems providing agricultural products to their country
for an affordable cost in the past fifty years. The tropical rainforest environment leaves the soil
unsuitable for agriculture because of slash and burn farming techniques and poor soil irrigation.
The land suffers from extreme soil erosion leading to heavy reliance on importation of all crops,
mainly fruits and vegetables. Due to the lack of agricultural products and the rise of inexpensive
fast food chains, the population has experienced increased instances of obesity, diabetes, and severe
malnutrition.
Hypothesis: To explore and test farming techniques that will increase community involvement in
agricultural sustainability, which will lead to better nutrition and economic independence for
Indonesia.
Materials and Methods: Three community gardens were established at primary schools, which
integrated agriculture and nutrition education into their science curriculum. Sustainable agriculture
techniques including hydroponics and permaculture were used and healthcare workers gave
nutrition classes. The Indonesian Ministry of Health gave participants surveys before and after the
garden was built to assess knowledge gained.
Results: A hybrid hydroponic farm and compost station were successfully built and implemented
at all three schools. Cucumbers, tomatoes, and spinach were propagated by local primary schools
and community compounds. A pipe structure was created to pump water from a fresh water,
waterfall fed stream with the help of engineers from University of Jakarta. These gardens were
successfully implemented into the science curriculum at Balinese schools. Community impact and
nutrition assessments were completed with the help of the Indonesian Ministry of Health.
Participants propagated their own seedlings and produced their own home grown vegetables.
Conclusion: Community involvement in sustainability and education was achieved through the
creation of community gardens. Alternative farming techniques such as crop stacking and
hydroponics were proposed and a shade house was built. Composting with plants and sea grass to
create fertile soil was successful, and will be used in future endeavors. The Indonesian Ministry of
Health will continue nutrition assessments and also continue to build community gardens within
primary schools. Through this research, local farmers are also open to new agriculture technology
consisting of hydroponic farming methods in order to secure more economic and environmental
sustainability. A united Nations grant is currently underway to make this project nationwide in
order to eradicate malnutrition .
5
2014 BIOM 1879
Beliefs and Educational Access to Safe Drinking Water Practices and Diarrheal Illness in
El Salvador
Primary Author: Meghan E. Greenfield, OMSII; Additional Authors: Kerilyn Woodbridge Kimball,
OMSII, Dalia Meisha, DDS, Dean Sutphin, PHD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine – Virginia Campus
Introduction: According to the World Health Organization (WHO), in 2010, 87% of the
population in El Salvador was using improved drinking water sources. Since data was not available
for the highly underserved areas where the COM conducts medical outreach, an initial study of an
ongoing longitudinal IRB approved study was developed. The purpose of the study was to assess
beliefs regarding access to safe water and the impact of exposure to contaminated water on health
status.
Hypothesis: It was hypothesized that the extent of knowledge of safe water and sanitation
practices of El Salvadorian residents would be limited and vary across COM selected villages.
Materials and Methods: An adapted version of WHO’s Core Questions on Drinking-Water and
Sanitation for Household Survey and a health assessment survey developed by international and US
experts were used to assess these beliefs. In July 2014, the surveys were administered across three
villages in El Salvador, San Salvador, Sonsonate, and Chalatenango. A total of 95 adult residents
attending COM associated clinics made up the convenience sample.
Results: Overall, 60.6% of participants believe that their water is unsafe to drink. Although 25.3%
report using unimproved drinking water, 41.8% report treating their water, by method of choice
being adding bleach/chlorine (55.1%). Additionally, 58.2% believe that intestinal problems due to
parasites can be obtained from unsafe water exposure and 37.9% reported diarrheal illness at least
once in the last year. Overall, 79.1% have received information about safe water use, with the
majority (51.6%) obtaining that information from the local clinic.
Conclusions: The results indicate that rural and medically underserved villages in El Salvador have
lower access to improved drinking water sources than the average population, and limited
education regarding safe drinking water practices thus accepting the research hypothesis. Further,
diarrheal illness, assumed to be the result of parasitic infections, still remains an issue where lack of
public health information is a contributing factor resulting in improper treatment of the water. We
recommend future COM and public health initiatives target improving education regarding safe
drinking water sources for El Salvadorian residents in targeted underserved areas.
6
2014 BIOM 1887
Concepts of disease, treatment and healthcare utilization in Otavalo, Ecuador
Primary Author: Abigail Kress, OMSIV
Philadelphia College of Osteopathic Medicine
Background: In Ecuador, there are two distinct systems of medicine, Western and Andean. My
goal was to learn about Andean medicine and how patients navigate the divergent systems. Jambi
Huasi clinic in Otavalo, Ecuador is an integrated Andean-Western medical center from where I
based my research.
Hypothesis: The Andean medical system would approach health differently, by emphasizing the
energy of illness, healing rituals, and plant based medicine. This differing viewpoint toward illness
would create cultural barriers to Western healthcare in Otavalo.
Materials and Methods: Data was obtained through 31 interviews with patients at Jambi Huasi
medical clinic. The interviews followed a semi-structured line of questioning to address four main
concepts: 1) general belief toward what causes illness 2) common illnesses within the community 3)
preferred treatments for illnesses 4) reasons for choosing a preferred treatment. All interviews
were recorded on a digital recorder and later transcribed.
Results: Patients thought illness resulted for four reasons; malnutrition, an imbalance of energy,
stress, and failing to take care of oneself. When asked to name common sicknesses in their
community, patients named Western illnesses, but after prompted, discussed Andean sicknesses
like mal aire and espanto. To treat illness, 26 out of 31 patients preferred Andean home remedies
first which were seen as more natural, convenient, economic and initially beneficial. These remedies
usually included herbal teas and energetic cleanses to remove the sick energy. Only 5 patients said
they go to the doctor first. This was due to lack of knowledge in medicinal plants and belief that
pharmaceuticals are more effective. When Andean home remedies failed, patients went to either a
Western doctor or Andean medicine practitioner. Which practitioner the patient went to depended
on symptomatology, severity of illness, previous failed attempts at healing, and current finances.
Conclusion: These findings suggest most patients in Otavalo, Ecuador use their own knowledge
of health and wellness to integrate Andean and Western medicine and manage their own
care. Andean medicine takes a spiritual, energetic, and plant based approach to healing, but does
not result in cultural barriers toward Western medicine. Jambi Huasi, where both Western and
Andean practitioners are available, creates a unique, accepting, and convenient environment for
patients to receive the well rounded care they seek.
7
2014 BIOM 1888
Normal Weight Obesity: An Emerging Risk Factor for Hypertensive Hyperlipidemia in
Rural Nepal
Primary Author: Moriah Nicole Marie Eberhard, OMSII; Additional Authors: Amber Jane Heck,
PhD, Qamrul G. Choudhry, PhD
Rocky Vista University College of Osteopathic Medicine
Rural communities in developing nations are disproportionately affected by chronic disease,
compounding pre-existing malnutrition and infectious disease with hypertension and high
cholesterol. This “double burden” of disease threatens to overwhelm the health services of
countries with limited resources. There is a critical need to understand the presentation of
cardiovascular risk factors, such as hypertension and hyperlipidemia, in remote populations in order
to implement an efficacious intervention.
In this study we aim to assess the cardiovascular risk factors within a rural Nepalese population and
examine the possibility that normal weight obesity, a state of normal BMI with increased body fat,
is responsible for increased presentation of cardiovascular risk factors in this population. Survey
data and screening exam results were collected in spring 2014 in Sipaghat and Goganpani, two
central Nepalese villages, from a total of 370 patients.
Data was manually entered and frequency and correlation analyses were performed using IBM
SPSS software. The population was stratified to elucidate sex-specific differences. 2-tailed Pearson
correlation analyses were used to explore correlative relationships. Analysis revealed average blood
pressure in the pre-hypertensive range (130.5/82.2), average cholesterol in the elevated range (200),
and average BMI in the normal range (21.6). Diastolic blood pressure was correlated with
cholesterol levels (0.197 (p < 0.01)) and weight (0.249 (p < 0.01)). Weight was also correlated to
systolic blood pressure (0.238 (p < 0.01)) and cholesterol (0.173 (p < 0.05)). A correlation was seen
between smoking and BMI (0.247 (p < 0.01). Nether smoking nor drinking were correlated to
blood pressure or cholesterol overall. When the data was stratified by sex, the trends remained:
average blood pressure was 130/82 (female) and 133/83.5 (male), average BMI was 22.1 (female)
and 20.9 (male), and mean cholesterol was 199 (female) and 200.2 (male). A positive correlation
between BMI and cholesterol (0.346 (p < 0.01)) was only observed in males. When stratified by sex,
a correlation of (0.197 (p < 0.01)) was observed between smoking and cholesterol in females that
was not seen in males. We assessed the presentation of cardiovascular risk factors in this rural
Nepalese population and found significantly elevated blood pressure and hyperlipidemia to coexist
with normal BMI. Hyperlipidemia was correlated to BMI in males while smoking was correlated to
BMI in females. Weight was correlated in both sexes to hypertension and cholesterol, which
warrants further research investigating adipose distribution and normal weight obesity in this
population. Additional future directions include evaluation of diet and exercise habits in this
population, as well as the prevalence of genetic variants in regulators of lipid metabolism such as
PPARγ, and RBP4.
8
2014 BIOM 1893
A First-Time Look at the Epidemiological Composition of the Underserved Petit-Trou-deNippes Commune
Primary Author: Greg D. Gibbs, OMSIII; Additional Authors: Bradley R. Rimmert, OMSII,
Amber J. Heck, PhD, Brandon P.D. Noyes, OMSIII, Alan Alex, OMSII, Erin E. Hoffman,
OMSII, Monica L. Multani, OMSIII, Bilaf Nazif, OMSIII
Rocky Vista University College of Osteopathic Medicine
Hypothesis and Introduction: Interventional measures based on a rigorous collection of patient
data remains crucial to preventing disease internationally. The focus of this study is the collection
of patient data from the rural community of Petit-Trou-de-Nippes, consisting of approximately
36,000 people and is located 89 miles west of Port-au-Prince, a 2.5 hour trip by car or a 25 hour
trip on foot. The World Health Organization (WHO) bases their collection of patient data on
governmental records and reporting. Because of this, Colorado Haiti Project, a local nongovernmental organization (NGO), has allowed us to assess patient data collection to optimize
healthcare and education in smaller communes. Emphasis of patient data will include details of
education, chief complaints, and prescribed medicines. This study aims to provide novel insight
into disease presence and the provision of healthcare in Petit-Trou, Haiti.
Materials and Methods: Colorado Haiti Project (CHP) healthcare providers conducted
standardized patient data paper surveys by hand in 2009-2010 while performing medical mission
trips in Petit-Trou. The patient base was compiled from two locations: a permanent medical clinic
and an offsite temporary screening clinic. Transference to electronic database was done manually
and frequency analysis was performed using IBM SPSS software.
Results: A total of 1,398 patients were surveyed. First, the more common diseases as tracked by
WHO were compared with diagnoses made by physicians visiting Petit-Trou; these include
intestinal helminths, tuberculosis, and anemia of children under 5 years old. Second, the amount of
patients that complained of abdominal pain, rashes, and dizziness were compared with the amount
of patients diagnosed with intestinal helminths, scabies, and anemia, respectively. Lastly, the most
commonly prescribed medications were elucidated: multivitamin supplements, NSAIDs,
acetaminophen, antacids, and contraceptives.
Conclusion: As compared to studies conducted by WHO, there were less reports of intestinal
helminthes, tuberculosis, and anemia of children under 5 years old in the Petit-Trout-de-Nippes
Commune. Multivitamin supplementation, pain relief, treatment of GERD, oral and barrier
contraceptives, and anti-inflammatories were the most prescribed medications. Illuminating the
differences between the epidemiological data collected by CHP and WHO will be vital in the
development of future medical infrastructure and better allocation of financial resources in the area
of Petit-Trou-de-Nippes. A more effective public health education system can also be established
by elucidating the disparity between perceived health issues by the public and actual diagnoses by
physicians. We plan to continue analysis of this data to help CHP, and other NGO’s, enhance the
delivery of efficient interventional medical care.
9
2014 BIOM 1895
Assessing the Knowledge of the Human Papilloma Virus and Attitudes Towards the HPV
Vaccine Among Women at the James Moody Clinic at the Baxter Institute in Tegucigalpa,
Honduras
Primary Author: Michaela Sue Lamonde, OMSIII; Additional Authors: Clay Matthew Hoerig,
OMSIII, Lauren Anne Lomaka, OMSIII, Cathy Callahan, MD, MPH, FACOG
Edward Via Virginia College of Osteopathic Medicine – Virginia Campus
Background: Cervical cancer is the leading cause of cancer death of women in Honduras,
affecting up to 3.8% of the population. It is estimated that at least 70% of these cases could be
prevented. With routine Pap smears, regular follow up, and use of the human papilloma virus
(HPV) vaccine the rates and death caused from cervical cancer can be reduced significantly. The
James A. Moody (JMA) Clinic in Tegucigalpa, Honduras has both a women’s health and dental
clinic serving the people of Tegucigalpa as well as students at the Baxter Institute. The women’s
clinic serves the women of Tegucigalpa who would not receive care otherwise. The JMA Clinic
provides primary care, gynecological and obstetric services, including, Pap smears, routine pelvic
exams, and prenatal care. The aim of our research project was to assess patients’ knowledge of
HPV, and their interest in receiving the HPV vaccine for themselves or their family members.
Materials and Methods: All women seeking medical attention at the James Moody Clinic the
week of April 6, 2014 to April 10, 2014 were asked if they would like to participate in the
study. Participation was voluntary and no incentive was provided for participation. A nurse
working at the clinic read a consent form and survey in Spanish to each participant. Participants
remained anonymous and responded to questions regarding HPV, the relationship of HPV and
cervical cancer, the HPV vaccine, and acceptance of the HPV vaccine for themselves and family
members. Statistical analysis was completed using SPSS Version 22. The study received approval
through the Internal Review Board at the Edward Via College of Osteopathic Medicine.
Results/Conclusions: Our study identified a strong correlation between age and knowledge of
HPV. Older women, ages 55-65, were more likely to be knowledgeable about HPV and younger
women, ages 18-20, were the least knowledgeable. Interestingly there was no correlation between
higher level of education and knowledge of HPV or the HPV vaccine. Also, the more
knowledgeable a participant was about HPV the more likely they were to be interested in receiving
the vaccine for themselves. Future work will focus upon a culturally relevant educational program
directed towards young women seen at the JMA Clinic. Ultimately this will lead to the biggest
impact in educating JMA Clinic patients about HPV, its relationship to cervical cancer, and cervical
cancer prevention.
10
2014 BIOM 1899
Prevalence and Identification of Type 2 diabetes in Chacraseca, Nicaragua
Primary Author: Ursula Barghouth, OMSI; Additional Authors: Felicia Ekpo, DO, Chelsea Bullard, MS,
Nicole Schlaefli, PHM, Michelle Smith
A.T. Still University-School of Osteopathic Medicine in Arizona
Background: Non-communicable diseases, accounts for 60% of all fatalities globally. The International
Diabetes Foundation Diabetes Atlas estimates that 10.25% of the Nicaraguan population ages 20 to 79
suffers from type II diabetes. While the Nicaraguan Ministry of Health utilizes a special program to
assist in the management of diabetes care by providing free medications to public sector residents, no
program established for diabetes screening currently exists. Proper management of type II diabetes
requires continuous medical care and often, and often, impoverished patients cannot afford follow-up
care.
Hypothesis: We propose conducting a random glucose screening in Chacraseca will detect high blood
sugar levels in people who have been previously diagnosed with diabetes and those who have not.
Materials and methods: This study correlates demographic information, clinical data, and blood
glucose levels obtained through a random finger-stick glucose screening to determine implications for
diabetes management in Chacraseca, Nicaragua. Over four days, research subjects were selected from a
patient pool of 12 clinics within Chacreseca. Although diabetes screening was available to all clinic
patients, the research excluded results from patients under the age of 30, pregnant women, and patients
currently taking medication(s) for diabetes. After consent was obtained, participants completed a brief
survey and a trained volunteer obtained a random finger-stick blood glucose level.
Results: Out of the 161 participants who met criteria for the study, 26.5% presented with a random
blood glucose reading greater than 140mg/dl. Nine participants showed levels equal to or greater than
200 mg/dl, and 6 of the 9 have previously been diagnosed with diabetes in the past. Of the 13
participants previously diagnosed with diabetes, 61.5% presented with blood glucose levels above 140,
and 46.2% had glucose levels above 200.
Conclusion: This study demonstrates that more must be done to educate and care for the Chacrasecan
population with regards to diabetes. During a random screening, over 25% of participants met criteria
for pre-diabetes or diabetes. Additionally, the high number of people with both pre-established diabetes
and uncontrolled blood glucose levels indicate a need for better follow-up care. Despite previous efforts
for diabetes management in Nicaragua, the need remains unmet due to lack of proper clinical
management in diabetes identification and follow-up care.
11
2014 BIOM 1905
The Prevalence of Anemia Among Rural and Urban Pediatric Populations in Peru
Primary Author: Teresa Colelli, OMSII; Additional Authors: Sara Lang, OMSII, Samantha Ward, OMSII,
Jessica Jary, OMSII, Elise Craig, OMSII, Dayna Snyder, OMSII, Dylanb streb, OMSII, Katelyn
Wiseman, OMSIV, Lorenzo Lim, OMSIV, Shane Sergent, DO, Ruben Kenny Briceno, MD, Santiago
Benites Castillo, PhD, Jake Shermetaro, BS candidate, Joe Gorz, DO, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine, and Cesar Vallejo University, Trujillo, Peru
Hypothesis: The COM has been providing healthcare to Peruvian populations through medical
missions since 2010. Anemia was suspected to affect a large portion of the pediatric population to whom
aid was provided; consequently a study was warranted to investigate its prevalence. The Centre for
Disease Control and Prevention (CDC) defines anemia as having a low hemoglobin or hematocrit level.
Iron deficiency anemia is the most common form of anemia worldwide and children are especially
vulnerable. Possible outcomes of iron deficiency anemia include poor growth and mental development,
along with complications due to poor immune status. The prevalence of anemia in two populations of
Peru were analyzed to determine if there is a difference between children living in Iquitos, a medically
underserved city, and in rural villages along the Amazon River.
Materials and Methods: Hemoglobin levels were taken on 76 children aged 2 to 5 years old. Samples
were collected from Iquitos (n=38) and from three villages along the Amazon River (n=38).
Measurements were taken using HemoCue™ Hb 201. Values were analyzed according to CDC
standards, which classifies anemia in this age group as a hemoglobin level of less than 11.1g/dL.
Results: According to CDC standards, 57.9% of the children were found to be anemic. Based on gender,
54.3% (n=46) of males and 63.3% (n=30) of females were anemic. Sampled children from Iquitos
showed 60.5% anemia with 64.3% anemia among females (n=9). Additionally, 18.4% (n=7) had
hemoglobin levels less than 10g/dL. Children from the Amazon River villages showed 55.3% anemia
with 62.5% anemia among females (n=10). Of these children, 10.5% (n=4) had hemoglobin levels less
than 10g/dL.
Conclusions: A significant percentage of children in the analyzed populations met the CDC standards of
anemia. Furthermore, females had a higher frequency of anemia in both the urban and rural populations.
Children sampled from the urban city of Iquitos showed a slightly higher incidence of anemia with a
larger portion of children with a more profound anemia. This may be due to greater reliance on
economical, nutrient-poor foods. Further studies are warranted to investigate the factors resulting in the
development of childhood anemia in these locations. This can also direct future efforts of aid and the
development of sustainable communities.
12
2014 BIOM 1908
BMI and Lipid Analysis of Pediatric Patients from Iquitos, Peru
Primary Author: Teresa Colelli, OMSII; Additional Authors: Samantha Ward, OMSII, Elise Craig,
OMSII, Jessica Jary, OMSII, Sara Lang, OMSII, Dayna Snyder, OMSII, Katelyn Wiseman, OMSIV,
Lorenzo Lim, OMSIV, Shane Sergent, DO, Ruben Kenny Briceno, MD, Santiago Benites Castillo,
PhD, Jake Shermetaro, BS candidate, Joseph Gorz, DO, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine, and Cesar Vallejo University, Trujillo,
Peru
Hypothesis: Obesity is an increasing global concern analyzed through the application of body
mass index (BMI). The COM has been investigating pediatric health in Peruvian populations since
2010 and past studies have demonstrated this concern. Elevated BMI increases the risk of
cardiovascular disease and diabetes. The American Heart Association indicates that atherosclerosis
can begin in childhood and may be associated with elevated cholesterol levels. The American
Academy of Pediatrics (AAP) has also recommended increased cholesterol screening among
adolescents. Thus, lipid analysis was performed to analyze the health risks of children in Iquitos, a
medically underserved city in Peru.
Materials and Methods: Anthropometric measurements were taken on 225 children between 2
and 18 years old. Height was measured using a Field Anthropometer to the nearest 0.01cm. Weight
was taken to the nearest 0.1kg using a Seca scale. Children were classified as normal,
overweight/obese and underweight based on CDC standards. Additionally, a survey about the
children’s eating habits and daily activity level was completed. An analysis of cholesterol,
triglyceride, HDL, LDL and glucose levels were also taken on 14 children aged 9 to 17 after fasting
overnight (6 males, 8 females). Values were analyzed using standards set by the Children’s Hospital
of Michigan.
Results: According to CDC standards, 31.1% of children were overweight/obese. 35.8% of males
(n=123) and 25.5% of females (n=102) were overweight/obese. Among those classified as normal
and overweight/obese, no significant difference was found in survey responses regarding amount
of vegetables/fruits/sweets eaten, exercise level, time spent watching TV, and time spent sleeping.
In the sample of children on whom a lipid panel was preformed, only 1 was considered overweight.
In addition, 85.7% of children had an elevated cholesterol level (>170mg/dL), 57.1% had an
elevated LDL level (>130mg/dL), and 21.4% had a decreased HDL level (<35mg/dL). No
children had both a desirable cholesterol and LDL level. The triglyceride levels and fasting blood
glucose levels of the children analyzed were considered normal (<150mg and <100mg/dL
respectively).
Conclusions: The percentage of obese/overweight children is comparable to results found in
MSUCOM investigations performed in 2012 (37.2%) and 2013 (26.4%). A significant elevation in
cholesterol and LDL levels demonstrates the increased risk these children have of heart disease.
These results support the AAP’s guideline changes and emphasize the importance of cholesterol
screening in children, especially when this risk factor is not as apparent to guardians as an obese
BMI. Further assessments of lipid profiles and examinations of societal influences are warranted.
13
2014 BIOM 1909
Hemoglobin and BMI Assessment of Children in Iquitos, Peru
Primary Author: Samantha Ward, OMSII, Additional Authors: Jake Shermetaro, BS Candidate,
Katelyn Wiseman, OMSIV, Lorenzo Lim, OMSIV, Joseph Gorz, DO, Ruben Kenny Briceno, MD,
Teresa Colelli, OMSII, Sara Lang, OMSII, Elise Craig, OMSII, Jessica Jary, OMSII, Dayna Snyder,
OMSII, Santiago Benites Castillo, PhD, Shane Sergent, DO, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine, and Cesar Vallejo University, Trujillo,
Peru
Hypothesis: Since 2010, COM students have been evaluating the prevalence of obesity in
pediatric populations in Peru on a yearly basis. This year, in an effort to treat each patient as a
whole unit of mind, body, and spirit, hemoglobin tests and health questionnaires were given to
patients to further asses their nutritional health. It was suspected that many children had iron
deficiency anemia. Iron deficiency can have negative long term effects that are often irreversible
and lead to developmental delays. Iquitos, an underprivileged urban city, has few places to get
affordable healthy food. Additionally, with no roads into or out of the city, the Iquiteños must fly
to Lima to receive medical care. This leaves many children without proper care. In the COM clinic,
hemoglobin and BMI of children were analyzed to determine the prevalence of anemia and obesity
in Iquitos.
Materials and Methods: To evaluate the prevalence of obesity in pediatric populations in Iquitos,
anthropometric measurements were taken from pediatric patients, ages 2-17 years. This was done
according to CDC guidelines and compared to CDC normal standards. In addition, an optional
health questionnaire was given to every adult accompanying a child. The questionnaire surveyed the
nutritional content of meals, sleep patterns, average daily activity, education level regarding
nutrition, and overall lifestyle. Anemia was diagnosed in children with a hemoglobin of <11.1g/dl,
consistent with CDC guidelines. For this study only patients who had both anthropometric and
hemoglobin data were included.
Results: The sample (n=38) consisted of 24 males (63.16%) and 14 females (36.84%). The
hemoglobin test resulted in a nearly equal 58.33% (n=24) of males and 64.28% (n=14) of females
being anemic. Of the anemic males, 50.00% had a higher than normal BMI. Of the anemic females,
44.44% had a higher than normal BMI. Of the non-anemic males and non-anemic females,
20.00% had a higher than normal BMI. In other words, 80.00% of children with a normal BMI
were not anemic, whereas 47.82% of those with a high BMI were anemic. Additionally, the
questionnaires reported that the children’s average daily intake of candy was 4 servings and that
93.9% of the children complained of polydipsia and 53.3% of excessive fatigue.
Conclusion: Data from this study shows that as the BMI increases in children, so does the
prevalence of anemia. This suggests that the anemia is linked to poor diet. These results show the
overwhelming need for patient education regarding nutrition and will aid in treatment methods for
Iquitos children. As previously mentioned, anemia and iron deficiency can cause severe harm to
growing children. To determine the role of iron deficiency in the pediatric anemia, it is suggested
that next year’s COM students test ferritin levels in anemic children.
14
2014 BIOM 1910
Pelvic Inflammatory Disease Screening in Iquitos, Peru
Primary Author: Sara Lang, OMSII, Additional Authors: Srikala Yedavally-Yellay, DO, Indira
Reddy, MD, Elise Craig, OMS,II, Samantha Ward, OMSII, Jessica Jary, OMSII, Shane Sergent,
DO, Katelyn Wiseman, OMSIV, Lorenzo Lim, OMSIV, Gary Willyerd, DO, Sarah Shook, DO,
Teresa Colelli, OMSII, Kelin Prokurat, OMSIV, Maithri Reddy, Student, Tori Balogh, Student,
Michigan State University College of Osteopathic Medicine
Introduction: Pelvic inflammatory disease (PID) is an inflammatory issue of a woman’s pelvic
organs, which can lead to reproductive complications.1 Epidemiological studies of PID found that
39% of cases were caused by chlamydial infections.2Chlamydia is a common bacterial infection and
is often asymptomatic, creating an increased risk for PID. A ReproSalud study in rural Peru found
that 70.4% of the women had reproductive tract infections and 1.5% of these women had PID
based on their criterion.3 Since reproductive problems are associated with untreated PID, more
accurate prevalence rates may show the need to improve women’s health care. It was postulated
that the incidence of PID in Iquitos would be similar to those found in the ReproSalud study and
the correlation between chlamydia and PID would be alike to the epidemiological studies.
Methods: In August 2014, Michigan State University College of Osteopathic Medicine provided
medical care in Iquitos, Peru. During examinations, data was collected on the incidence of PID and
chlamydia infections in sexually active women. Bimanual pelvic exams were completed on women
requiring them, noting suprapubic tenderness, cervical motion tenderness, adnexal tenderness,
uterine tenderness, cervical discharge and chandelier sign. Nebula Laboratories STD kits were used to
screen for chlamydial infections. Three of the above findings indicated a positive PID diagnosis. A
survey was distributed to assess general and sexual health demographics of the screened
population.
Results: The mean age of women examined was 34.5 with a range of 16 to 63.No chlamydial
infections were indicated with our screening kits. Of the 57 screened, 1.8% (n=1) met our
diagnostic criteria for PID and 38.6% (n=22) reported a previous pelvic infection. The average age
of the first sexual encounter was 17.7 (n=42, s=2.76) with and average of 1.9 (n=52, s=1.32)
different sexual partners. For contraception, 45.6% (n=26) reported a none/withdraw method and
64.9% (n=37) had no primary care physician.
Discussion: No correlation between chlamydia and PID was observed during this study. The
percentage of women diagnosed PID was similar to those found in the ReproSalud study, along
with the mean age of the first sexual encounter (16.6 -17.7) and number of different partners
(2).3 For contraceptive history, the percentage of women using none/withdraw practices was similar
to other rural parts of Peru (>50%).3 Unlike the ReproSalud study’s high incidence of previous
pelvic infections, our study indicated a lower percentage of past infections. The PID results in
combination with the apparent low access to primary care (<40%) and lack of conceptive practices
suggests a need for better women’s health care initiatives that include sexual health education.
Literature Cited:
1.
2.
3.
"Pelvic Inflammatory Disease (PID) - CDC Fact Sheet." Center for Disease Control and Prevention. CDC, 26 Mar. 2014. Web. 11 Apr.
2014.<http://www.cdc.gov/std/pid/stdfact-pid.htm>.
Simms, I, and J M. Stephenson. "Pelvic inflammatory disease epidemiology: what do we know and what do we need to know?" Sexually
Transmitted Infections 76.2 (2000): 80-87. Web. 2 Apr. 2014.
García, Particia J., Susana Chavez, Barbara Feringa, Marina Chiappe, and Weili Li. "Reproductive tract infections in rural women from the
highlands, jungle, and coastal regions of Peru." SciELO Public Health. World Health Organization, July 2004. Web. 17 Apr. 2014.
15
2014 BIOM 1911
The Epidemiology of Dermatology Complaints in Peru
Primary Author: Jessica Maura Jary, OMSII; Additional Authors: Annette LaCasse, DO, Shane
Sergent, DO, Lorenzo Lim, OMSIV, Katelyn Wiseman, OMSIV, Sumaira Hai, BS candidate, Gary
Willyerd, DO, Elise Craig, OMSII, Teresa Colelli, OMSII, Sara Lang, OMSII, Samantha Ward,
OMSII, Kristi Hawley, DO
Michigan State University College of Osteopathic Medicine
Hypothesis: The purpose of this study was to explore the epidemiology of dermatology
complaints in medically underserved areas of Peru, including the city Iquitos, and villages along the
Amazon River. The current paucity of knowledge on the topic is a disadvantage when attempting
to bring aid to the region. This study hypothesized that dermatologic disease prevalence would be
reflective of the tropical climate and poverty of the region.
Materials and Methods: Over an 8 day period 1800 patients were assessed and treated. 446 of
these patients presented with a dermatology complaint; 9 patients were removed from the sample
due to incomplete data bringing the total to 437. Of the sample 35.9% were male and 64.1%
female. All ages were accepted and ranged from 1 month-86 years old with a mean of 37.4 and
standard deviation of 22.37. Diagnosis was made by clinical observation. Age, sex, diagnosis, and
treatment were recorded by pen and paper.
Results: The most common presenting problems included superficial fungal infections, eczema,
and psoriasis. Superficial fungal infection was the most common problem with a prevalence of
38.2%. This included diagnoses of tinea pedis, t. manus, t. capitis, t. cruris, t. corporis, t. faciei, t.
versicolor, and onychomycoses. 54% of people with superficial fungal infections had tinea pedis.
Eczema was the next most common problem with a prevalence of 12.4%. Psoriasis had a
prevalence of 4.3%. Problems related to sun damage: solar lentigo, basal cell carcinoma, melanoma,
and photoallergy, accounted for 5.3% of diagnoses. Some diagnoses rare in the United States were
made, including leishmaniasis (n=1), chromoblastomycosis (n=1), mycetoma (n=1), and varicella
(n=2).
Conclusions: That superficial fungal infections were the most common dermatologic problem
supported the hypothesis. The region is warm and humid providing an ideal biome for the growth
of fungi. Sun related problems are also consistent with the environment. Likewise, leishmaniasis,
chromoblastomycosis, and mycetoma are indigenous to tropical climates. Varicella is uncommonly
seen in the United States today due to initiation of the vaccine, which is not always available in less
developed areas. That eczema was the second most common diagnosis was less expected. The
environmental and genetic factors that lead to eczema are not fully understood. The knowledge
that superficial fungal infection, eczemas, and psoriasis are the most common dermatology
problems in the region, along with knowledge of the rare tropical disease seen in this sample will be
useful for future treatment of the population.
16
2014 BIOM 1912
Analysis of Anemia in Pediatric Patients in Iquitos, Peru
Primary Author: Samantha Ward, OMSII, Additional Authors: Teresa Colelli, OMSII; Sara Lang,
OMSII, Elise Craig, OMSII, Jessica Jary, OMSII, Dayna Snyder, OMSII, Jake Shermetaro, BS
candidate, Katelyn Wiseman, OMSIV, Lorenzo Lim, OMSIV, Joseph Gorz, DO, Ruben Kenny
Briceno, MD, Santiago Benites Castillo, PhD, Shane Sergent, DO, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine, and Cesar Vallejo University, Trujillo,
Peru
Hypothesis: Anemia is an important health issue that is estimated to affect 39% of children under
the age of 5 in non-industrialized countries (WHO). The causes of anemia include iron deficiency,
chronic disease, persistent bleeding and autoimmune disease. COM students analyzed the
prevalence of anemia in Iquitos, Peru and found that 60.53% of children tested were anemic.
Iquitos is a medically underserved, urban city where fast food is plentiful and healthy food is hard
to find. Due to poor sanitation, many children live with parasites and struggle to afford clean,
bottled water. Instead, they regularly drink products like Coca Cola because it is less expensive than
water. Further blood tests and health questionnaires were offered to children in the clinic to
determine the type of the pediatric anemia.
Materials and Methods: A blood analysis was taken from 14 children (6 males and 8 females)
ages 9 to 13 years. The analysis tested for hemoglobin, hematocrit, mean corpuscular volume, mean
corpuscular hemoglobin and mean corpuscular hemoglobin concentration. These values were
analyzed using standards from the Tropical Medicine and International Health Journal. In addition,
an optional health questionnaire was given to every adult accompanying a child. The questionnaire
surveyed the nutritional content of meals, sleep patterns, average daily activity, education level
regarding nutrition, and overall lifestyle.
Results: Of the 14 children tested, 6 females and 2 males were found to be anemic (<11.5g/dL).
All 8 of the anemic children had normal MCVs (80-100fl). Additionally, all 8 of the anemic children
had low MCHs (<27pg/cell). Therefore, every anemic child had a normocytic, hypochromic
anemia.
BMIs were also calculated and showed that 100% of the children were within normal ranges. Their
surveys however, indicated a poor diet with an average of 3 servings of candy per day. Additionally,
75% of these children reported polydipsia and 87.5% reported excessive fatigue.
Conclusions: Data from this study shows that the children were affected by a normocytic,
hypochromic anemia. Normocytic, hypochromic anemia could imply an anemia of chronic disease.
The poor sanitation in Iquitos and the high prevalence of parasite colonization in children could be
a possible cause of the pediatric anemia. However, Iron deficiency could not be ruled out as a cause
and is strongly suspected due to the children’s poor nutritional state. In order to determine the role
of iron deficiency in pediatric anemia, it is suggested that future studies test for blood ferritin levels.
17
2014 BIOM 1913
Screening for Cervical Cancer in Iquitos, Peru
Primary Author: Sara Lang, OMSII, Additional Authors: Shane Sergent, DO, Katelyn Wiseman,
OMSIV, Lorenzo Lim, OMSIV, Gary Willyerd, DO, Sarah Shook, DO, Srikala Yedavally-Yellay,
DO, Indira Reddy, MD, Elise Craig, OMS,II, Samantha Ward, OMSII, Jessica Jary, OMSII, ,
Teresa Colelli, OMSII, Kelin Prokurat, OMSIV, Maithri Reddy, Student, Tori Balogh, Student,
Michigan State University College of Osteopathic Medicine
Introduction: Due to the lack and availability of medical resources throughout developing
countries, the typical Pap smear cytological screening method for cervical cancer is limited. With
the introduction of visual inspection with acetic acid (VIA), an inexpensive screening tool is now
being utilized and researched. In Peru, cervical cancer remains the number one cause of cancer
among women.1 A study conducted in August 2013 by Bhan and Jelinek used VIA screening in
Iquitos, Peru.2 This study screened 40 women, 14 of whom had positive VIA screens (35%).2 It was
postulated that similar VIA positive rates with lack of primary care would be found during this
study.
Methods: In August 2014, Michigan State College of Osteopathic Medicine provided medical care
in Iquitos, Peru. During this time, the prevalence of cervical precancerous lesions in women
between ages 25 and 50 were determined using the VIA screening method. The method included
applying a 4% solution of acetic acid to the cervical transformation and looking for acetowhite
changes. Acetowhite changes indicated a positive result. A survey was distributed to assess general
and sexual health demographics of the screened population.
Results: The average age of the 47 women screened was 35.7 (s=6.97) and 6 of the women (13%)
had a positive VIA result. Of the 6 women, 50% (n=3) reported no primary care physician. These
women on average had 3.67 different sexual partners (n=6, s=1.97) and 2 recorded a
none/withdraw method of contraception. In comparison, 72.50% (n=29) reported no primary care
physician from the negative VIA screens. An average of 1.76 different sexual partners (n=38,
s=1.08) was found with 50% of these women (n=20) indicating a none/withdraw method of
contraception.
Discussion: Although the same VIA screening methods were used as in the 2013 study, these
results more closely resembled a study conducted in San Martin, Peru, which found 17.9% positive
VIA rates.3 Also, the number of sexual partners and lack of contraceptive practices combined with
positive VIA results indicates a necessity for better sexual health education. Since HPV is the
leading cause of cervical cancer and is transmitted sexually, vaccination against the virus may be a
potential preventative measure. Cervical cancer prevention campaigns involving sexual health
education and HPV vaccines could be the next step in reducing its incidence in Peru.
Literature cited:
1.
2.
3.
WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Center). Human
papillomavirus and related cancers in Peru. Summary report 2010. [5-15-2013].
Web.<www.who.int/hpvcentre>.
Luciani, S, Winkler, J. Cervical cancer prevention in Peru: lessons learned from the TATI demonstration
project. Washington: PAHO; 2006.
Bhan, Chantal, and Kayla Jelinek. "Cervical Cancer Screening in Iquitos, Peru." Diss. Michigan State U
College of Osteopathic Medicine, 2013. Bureau of International Osteopathic Medicine (BIOM) 2013 International
Seminar Poster Session & BIOM/SOMA Student Competition Abstracts. American Osteopathic Association, 2013.
18
2014 BIOM 1914
Adult Health Status in the Impoverished Peruvian Amazon
Primary Author: Katelyn Wiseman, OMSIV; Additional Authors: Lorenzo Lim, OMSIV, Shane
Sergent, DO, Joseph Gorz, DO, Teresa Colelli, OMSII, Elise Craig, OMS,II, Jessica Jary, OMSII,
Sara Lang, OMSII, Samantha Ward, OMSII, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine
As the fourth most populated country in South America, Peru serves as an excellent insight into the
health status of Latin American peoples. For the fifth consecutive year Michigan State University
College of Osteopathic Medicine has hosted a medical mission trip to underserved areas of
Peru. The 2014 mission trip was stationed in Iquitos, Peru where nearly 1800 patients were seen
over an eight-day period. This study was designed to assess the epidemiology of adult patients
visiting the clinic. We hypothesize that the results of the study will yield similar statistics as
published in the national Peruvian health profiles of the Pan American Health Organization
(PAHO) and the Peruvian Ministry of Health.
Adult patients aged 18 and older were included in the study. Patients were categorized by age,
gender, and primary diagnosis consisting of twelve distinct system-based subgroups. Patients were
excluded from the study if any of this data was missing from the patient chart.
In total, 1340 patients were included in the study. Of the sample 63.2% (n=847) were females and
36.8% (n=494) were males. The average age of the patient was 54.3. Most prevalent primary
diagnoses subgroups were dermatology, musculoskeletal, and gastrointestinal/genitourinary with
prevalence rates of 32.6% (n=437), 16% (n=214), and 11.9% (n=159), respectively. Of note, the
most prevalent specific diagnoses were superficial fungal diagnoses (n=167), arthritis (n=101),
headache (n=57), gastroesophageal reflux disease (n=56), podiatric dysfunctions (n=56), and low
back pain (n=52).
In comparison to this study, the Peruvian Ministry of Health reported that the leading causes of
morbidity for Peruvian peoples are respiratory infections, dental infections, and gastrointestinal
infections. Additionally, PAHO reports that the top three causes of mortality in Peru are acute
respiratory infections, ischemic heart disease, and cerebrovascular diseases. The results of this study
do show some similarities to these reports; namely, the high prevalence of gastrointestinal diseases
and infections. However, the overall results of this study reflect a differing prevalence of disease
and infection. Future research is needed to assess the epidemiologic variances in other regions
across Peru. With this information healthcare needs and resources can be better addressed.
19
2014 BIOM 1916
Chronic renal failure in Chacraseca, Nicaragua: addressing the misconception through
education.
Primary Author: Ursula Berghouth, OMSIV; Additional Author: Juliette Drohan, OMSIV
A.T. Still University- School of Osteopathic Medicine in Arizona
Background: Chronic renal insufficiency (CRI) appears to be an epidemic in Central America. In
Nicaragua, mortality rates from CRI increased by 33% from 1996 to 2002. CRI is a progressively
fatal disease that commonly requires either a kidney transplantation or dialysis, and the majority of
CRI patients in Nicaragua who progress to end stage renal disease do not have access to treatment.
Additionally, in 2011, the most commonly reported illness in Chacraseca, Nicaragua was some
variant of kidney disease. Various organizations have supported early detection screening for CRI,
along with health education campaigns. However, there have been no studies to assess the baseline
knowledge of the community.
Hypothesis: We propose obtaining baseline knowledge with regards to renal disease in Chacraseca
will identify “knowledge gaps” that can serve as a guide for creating optimal targeted educational
material on kidney function and disease.
Materials and Methods: Over four days, research subjects were selected from a patient pool of 12
clinics across Chacreseca. Patients were eligible to participate if they were above the age of 18 and
either (a) presented with a chief complaint involving the urinary tract, (b) had clinical indications
for a urinalysis, or (3) had a history of renal disease. Of the 129 patients who fit this criteria, and of
those, 72% participated in the study. After consent was obtained, participants were given a survey
that establishes basic demographic data, pertinent past medical history, and assessed their
knowledge of CRI. Their survey responses were summarized and compared with clinical findings
from the patient encounter in order to identify “knowledge gaps” and common misconceptions
with regards to renal disease.
Results: 47.4% of all adults presenting to the clinic mentioned urinary tract problems in their chief
complaint. Many patients self-diagnosed themselves with “chiasta” or UTI but only 28.4% of
patients who subjectively presented infection actually had a UTI as evidenced by urinalysis; the
majority were in fact due to dehydration or musculoskeletal back pain. Survey results demonstrated
a wide range of knowledge and many misconceptions about CRI, specific to various regions within
Chacraseca.
Conclusion: Targeted educational interventions that address these misconceptions can help to
improve clinical management of renal disease, and can also have implications with regards to
misdiagnosis of UTI’s, overuse of antibiotics, and late diagnosis of CRI.
20
OUTREACH CATEGORY
1st Place Winner - Outreach Category
2014 BIOM 1922
The Use of Empirical Medicine in the Treatment of Syrian Refugees in Turkey
Primary Author: Razan Al-Nahhas, OMSI: Additional Authors: Ahmad Alito, MD, Syria Polyclinic,
Turkey, Maher Azzouz, MD, Syrian American Medical Society, Canfield, OH
Lake Erie College of Osteopathic Medicine-Bradenton Campus
Background: Since the start of the Syrian revolution in 2011, over 1.3 million Syrians have crossed
the border into Turkey after being forcibly displaced from their homes. This has placed an
enormous amount of stress on the Turkish health care system, which has been providing free
medical services to refugees. To help alleviate this burden, Syrian physicians have paired up with
international Non-Governmental Organizations (NGOs) to develop an informal system of medical
centers. These clinics are not formally recognized by the Turkish government, leaving them
incredibly limited in resources, capacity to perform certain procedures, and supply of medications.
These limitations on patient management and care have forced physicians to resort to the use of
empirical medicine.
Description: Through the Syrian American Medical Society mission trip program, I had the
opportunity to volunteer at both the Syria Polyclinic 1(SP1) and the Malteser-International Blue
Crescent (IBC) postoperative center. We performed patient histories and physical examinations,
and provided assessments. Almost all treatment of patients was based solely on the history and the
physical exam. SP1 has no access to a lab, therefore basic diagnostic tools are not available. In fact,
the only form of imaging available at the clinic is an ultrasound reserved for the OB/GYN to
monitor the progress of obstetric patients. Critical or complex cases are referred to the local state
hospital. With over 500 patients seen daily, physicians must make effective assessments within a
limited amount of time, about 7 minutes per patient. Additionally, the medications provided by the
parent NGO, based on the World Health Organization’s Model List of Essential Medicines, are
limited. Every month, the number of patients seen and the medications needed is reassessed.
Despite this, certain drugs are often not provided, while others frequently run out, specifically those
used in the management of chronic conditions such as diabetes, hypertension, and hyperlipidemia.
Discussion: The efficiency of the informal health centers has allowed Turkish officials, who were
initially opposed to the presence of these clinics, to be more accepting and supportive of them.
Empirical treatment requires an experienced physician to make a diagnosis based solely on the
patient's symptoms and physical exam. This form of practice is more difficult and carries a higher
risk of misdiagnosis due to the lack of confirmatory laboratory and imaging studies. However, these
practices have helped mitigate some of the financial strain, and have accommodated some of the
health needs of the Syrian refugees. Therefore, this system has the potential to be a model for
future health crises and critical situations. Syrian physicians have utilized empirical medicine to
provide cost efficient care for the refugees, while alleviating the burden on the Turkish health care
system.
21
2nd Place Winner – Outreach Category
2014 BIOM 1901
“The correlation between maternal nutritional knowledge and growth stunting in
Huehuetenango, Guatemala.”
Primary Author: Charles Nessle, OMSIV
Rocky Vista University College of Osteopathic Medicine
Hypothesis: The authors hypothesize inadequate maternal nutritional knowledge and a negative
correlation to malnutrition and subsequent growth stunting will be observed in this rural region of
Guatemala with a high prevalence.
Materials and methods: A medical missionary team established 20 temporary clinics, each clinic
having 200 patients, at a minimum. Height measurements of children age 2 to 12 were be obtained
using measuring tape and a straight edge. Height-for-age scores (HAZ) were be calculated, and
growth stunting will be defined with a HAZ <-2 SD as dictated by the WHO 2006 Growth
Standards. Then, observed were compared to the current epidemiologic data WHO and UNICEF
currently report for Guatemala. A cross sectional survey was administered orally in Spanish by
bilingual volunteers assessing 3 broad areas of KAP; 16 questions for nutritional contents of food,
11 questions for healthy food decisions, and 5 questions for the benefits of a healthy diet. The
survey instrument utilized was constructed with a combination of questions from two separate and
published surveys assessing nutritional knowledge; a nutritional survey administered to school aged
children by the California State Department of Health sponsored by the United Stated Department
of Agriculture, and a published survey conducted in the United Kingdom by University College
London, funded by a grant from the Biotechnology and Biological Sciences Research Society. The
questions included in the survey were slightly modified from their original content to be pertinent
to our subject population.
Results: There were a total of 353 participants completed the survey instruments. The overall
percentage of correct answers on the survey was 56.02%. The questions for the benefits of a
healthy diet were 80.79% correct. Those assessing ability to make healthy choices were 59.08%,
while the score for the questions pertaining to nutritional contents in food was 46.18%. The
heights of 339 children were recorded during the trip. A total of 50% were found to have HAZ zscore of <-2 SD indicating growth stunting, with 17% of those having HAZ z-score of <-3 SD
indicating wasting. The total percentage of children encountered showing under nutrition was 77%.
In fact, only 20% of those measured were within the recommended HAZ score (95 CI ± 5.81).
Conclusions: Our data supports the initial hypothesis that the region of Huehuetenango would
have a large burden of growth stunting and under nutrition. Additionally, the survey shows that
mothers have suboptimal knowledge pertaining to the nutritional contents of food, recommended
daily servings, and what foods are generally considered to be healthier options. The lack of
maternal nutritional knowledge does have a negative correlation to nutritional health of their
children; however, we also recognize this nutritional knowledge is only one facet of an incredibly
complex health problem.
22
2014 BIOM 1752
Developing Medical Documentation Skills through International Mission Trips - Treasure
Beach, Jamaica
Primary Author: Taylor Kann, OMSII; Additional Authors: Nicholas P. Marburger, OMSII
Lake Erie College of Osteopathic Medicine-Bradenton – Bradenton Campus
Hypothesis: Medical outreach programs offer students an invaluable opportunity to interact with
patients, provide care to a culturally diverse population, and develop competency as future
physicians. However, many mission trips emphasize patient encounters while failing to stress the
importance of writing a coherent medical record. Many schools lack enough opportunity to
sharpen these skills. Consequently, students are ill prepared to enter rotations where these skills are
expected. In Treasure Beach, Jamaica, Lake Erie College of Osteopathic Medicine-Bradenton
medical students documented each patient encounter, including their medical history and physical
findings. Writing accurate health records is a skill necessary for success as an osteopathic physician
and can be afforded to students through medical mission trips.
Materials and Methods: The COM worked with the County Osteopathic Medical Society to send
a group of medical students and physicians to Treasure Beach, Jamaica for a four-day clinical
experience in July 2014. Medical students, under the guidance of a physician, took individual
histories, performed system-focused exams, and provided diagnoses and treatment plans for each
patient. After each exam, students recorded the patient’s history of present illness, medication
dosage, pertinent physical findings, assessment of diagnoses, and plan for treatment. These records
were reviewed by physicians and stored with the local Women’s Club to be used for referral during
future mission trips.
Results: Of the 289 patients seen in Treasure Beach, many suffered from common ailments:
hypertension, diabetes, and obesity. With each patient displaying a unique medical history, students
were challenged to write accurate and precise documentation for the multitude of medical issues
observed. As time was limited, students had to avoid verbosity and remain concise in all relevant
findings. Each patient encountered during the mission trip provided students with the opportunity
to develop their writing skills as medical professionals.
Conclusion: Medical outreach programs are unparalleled learning experiences for students. They
are, also, amazing resources for patients who cannot otherwise afford healthcare. Preparing
accurate, concise medical records is critical to the welfare of patients and physicians; mission trips
offer ample opportunity for students to develop these writing skills. Writing a patient’s subjective
and objective findings, in addition to their health assessment and plan for treatment, helps students
cultivate the skill of patient documentation pivotal to proper care. After seeing patients, performing
physical exams, and writing comprehensive medical records, COM students attending mission trips
are more prepared for competently writing and presenting such records.
23
2014 BIOM 1760
Water and Sanitation Status in Rural Honduras: A Comparison across Honduran Villages
Serviced by COM Continuous Care
Primary Author: Timothy Layng, OMSIII: Additional Authors: Jessica Hovancik, OMSIII, Steven
Murphy, OMSIII, Gina Meletakos, OMSIII, Dalia Meisha, Phd, Dean Sutphin, Phd, Alexis Stoner,
MPH
Edward Via Virginia College of Osteopathic Medicine – Virginia Campus
Introduction: The World Health Organization (WHO) and the United Nations International
Children’s Emergency Fund (UNICEF) established the Joint Monitoring Programme (JMP) for
Water Supply and Sanitation to report and monitor the status of water supplies and sanitation
globally, and at the country level. These goals parallel the COM research and public health
initiatives to establish sustainable communities and continuous healthcare in underserved Latin
American communities.
Hypothesis: The purpose of this study was to describe the current water quality and sanitation
status among five villages surrounding Tegucigalpa, Honduras.
Methods: The research methodology was a case study approach during a COM medical mission
trip in April 2014. The sample included heads of household from residents who presented at COM
medical outreach trips from the villages of Guajire, Campamento, Comayagua, San Juancito, and El
Vino resulting in a convenience sampling of 173 subjects. The research adapted a survey from
WHO’s Core Questions on Drinking-Water and Sanitation for Household Surveys. Additionally, a
panel of experts including US and international representatives established validity of the adapted
survey.
Results: Findings across villages indicate that natives to Comayagua and El Vino traveled the
furthest to obtain water, up to 3 hours in some cases, whereas a majority of those who live in San
Juancito traveled less than 5 minutes. Most residents treated their water before consuming it, but
the methods varied within the villages most frequently adding bleach/chlorine, 86(56.7%) and
boiling, 44(30.6%). While a majority of residents use improved sources of drinking water,
136(78.6%), there are disparities across villages where residents from Comayagua (43.5%) and
Guajire (33.3%) only had access to unimproved drinking water sources. By comparison the village
of San Juancito, which is the most rural, and most sparsely populated, had the highest access to
improved water (100%).
Conclusion: In conclusion, variations amongst villages require different interventions to make
improvements; and similarly within villages, there are differences that require individual attention
by household. We recommend new initiatives by COM in partnership with the Honduran Ministry
of Health to address health disparities associated with current water quality and sanitation and a
longitudinal study to measure progress and sustain improvements.
24
2014 BIOM 1819
Assessing the Water and Sanitation Status of Three Rural Villages in Santa Rosa de Copan,
Honduras: A Comparison to the WHO’s International Assessment
Primary Author: Justin Deptula, OMSIII; Additional Authors: Christopher Hauger, OMSIII,
Alexandra Monteverde, OMSIII, Gregory Capece, OMSIII, Dalia Meisha, PhD, Dean Sutphin,
PHD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine - Carolinas Campus
Introduction: According to the World Health Organization (WHO)/UNICEF Joint Monitoring
Program for Water Supply and Sanitation, one in nine people worldwide lack access to improved
drinking water sources. In rural Honduras, this number is almost doubled. The purpose of this
study is to describe the drinking water sources and sanitation facilities of three rural Honduran
communities and compare the results with the most recent assessment from the WHO/UNICEF
in order to develop public health interventions.
Hypothesis: Based on literature review, two hypotheses are presented: H1 Selected Honduran
village water sources usage will not meet WHO/UNICEF standards; H2 Selected Honduran village
sanitation usage will not meet WHO/UNICEF standards.
Methods: This was an IRB approved case study (IRB#2013/018) using a questionnaire adapted
from the WHO’s Core Questions on Drinking-Water and Sanitation for Household Surveys. A
total of 165 adult residents were sampled in three villages in the province of Santa Rosa de Copan,
Honduras: San Ramon, Monte de la Virgen, and Les Mercedes. Participants were selected via a
convenience sample during a COM medical mission trip in April 2014.
Results: In total, 92.7% of residents participating in the assessment reported an improved drinking
water source usage, compared to the WHO's international assessment of 80% for rural Honduras.
The villages reported an improved sanitation facility usage of 57.1% compared to the WHO’s data
of 74%. Across villages, a pit latrine with slab was the number one source of improved sanitation
(32.5%), while a bush/field or no facility (20.9%) were the most commonly reported unimproved
sanitation facilities. All villages reported similar results for improved drinking water source.
However, Les Mercedes reported a much lower improved toilet facility usage (44%) than San
Ramon (71.7%) and Monte de la Virgen (60.4%).
Conclusion: Overall, the three villages demonstrated a better improved drinking water source
usage, but a worse improved sanitation facility usage than the WHO data. These rates meet the
Millennium Development Goals recommended by WHO/UNICEF for an improved water usage
of 88% (H1 Rejected), but fail to meet the goal for an improved sanitation usage of 75% (H2
Accepted). Recommendations for future research in rural Honduras should focus on the types of
sanitation facilities used and their public health impact in order to facilitate proposals for future
improvements in sanitary conditions.
25
2014 BIOM 1825
International Medical Missions: The Need and Importance of Early Clinical Exposure for
Medical Students
Primary Author: Kristi Ray, OMSII
Nova Southeastern University College of Osteopathic Medicine
Introduction: Joses Hands is a non-profit international medical mission trip organizer that offers
scholarships to first year medical students to gain early clinical exposure. Seven students across the
United States were selected to participate in Joses Hands/ Misioneros del Camino trip to
Sumpango, Guatemala. The five day trip led by both Guatemalan and American physicians
provided medical help to an underserved community.
Hypothesis: To give first year medical students valuable clinical exposure by allowing them to
participate in a international medical mission trip that benefits an underserved Guatemalan
community.
Materials and Methods: Medical supplies and medications were donated through various
community organizations throughout South Florida. Educational materials were also created in
order teach the local Guatemalan community about various health issues including diabetes,
hypertension, and secxually transmitted diseases.
Results: The first year medical students were able to use skills they had learned during their first
year clinical skills exams including taking blood pressure, ear and eye exams, and cardiovascular,
respiratory, and abdominal exams. There was also two Doctors of Osteopathic Medicine so
students were able to diagnose somatic dysfunctions and treat those under physician supervision.
All seven medical students were taught how to differentially diagnose a variety of illnesses as well as
able to learn medical spanish.
Conclusion: Early clinical exposure for medical students is vital in order to create compassionate
physicians. All seven medical students viewed the Joses Hands medical mission trip as a life
changing experience. They were not only able to perfect their clinical skills, but they were also a
integral part in providing medical care and the opportunity for a better life for the people which
they served.
26
2014 BIOM 1857
Water and Sanitation Status in the Dominican Republic: A Comparison across Urban
Villages Serviced by COM Medical Outreach
Primary Author: Rebecca C. Smith; Additional Authors: Matthew Musto, OMSII, Kerry Fincher,
OMSII, Leandra Jelinek, OMSII, Dalia Meisha, PhD, Dean Sutphine, PHD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine – Carolinas Campus
In 2000, the United Nations compiled a set of goals known as the Millennium Development Goals
which specifically included halving the amount of people without sustainable access to safe
drinking water and basic sanitation by 2015. The purpose of this study was to assess the current
water and sanitation status of communities surrounding Punta Cana, Dominican Republic and
compare them to the most recent WHO international assessment. The research hypothesis was that
access to clean water and sanitation in selected Dominican Villages will not meet the WHO
international assessment. This IRB approved study utilized a case study approach during a COM
medical mission trip in July 2014. Adult residents from communities surrounding the Clinic at
Veron, Hoyo de Frusia, La Cristinita Church, Dominigo Maiz, and Pueblo Neuvo, were selected via
a convenience sample of 172 participants. The survey utilized in this study was modified from
WHO’s Core Questions on Drinking Water and Sanitation for Household Surveys with validation
provided from a panel of experts including international and US representatives. Seventy-three
percent of the participants reported unimproved drinking water conditions compared to 18%
reported by the WHO. The highest proportion of people with an unimproved water source was in
Domingo Maiz where most relied on bottled water (83%). The highest proportion of people
utilizing an improved water source was in Pueblo Neuvo where most use a protected dug well
(83%). In addition, only 22% reported treating their water and did so using bleach or chlorine.
Availability of improved sanitation varied across the villages. Overall, 72% reported improved
sanitation facilities as compared to the WHO’s assessment of (86%). Domingo Maiz and Pueblo
Nuevo reported 90-95% while La Cristinita Church reported only 39% using improved sanitation,
with most of the population flushing to an unknown place (58.5%). In conclusion, these
communities have varying access to clean water and sanitation. Future policy and public health
efforts should emphasize access to clean water across the region and improving sanitation facilities
in select locations. There should also be follow up studies to monitor progress, education to inform
the population of health risks, and continuous medical care resulting from poor water and
sanitation.
27
2014 BIOM 1873
Water and Sanitation Status in El Salvador: A Comparison between Urban and Rural
Villages to the WHO International Assessment
Primary Author: Kelli Devecki, OMSII; Additional Authors: Dalia Meisha, PhD, Casey Toomba,
OMSII, Dean Sutphin, PHD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine – Virginia and Carolinas Campuses
Introduction: According to the World Health Organization (WHO) international assessment of El
Salvador, from 1990 to 2012, improved drinking water source utilization increased 31% and
improved sanitation utilization increased 20% indicating progress to meet the Millennium
Development Goals (MDG). This study was conducted to assess the current water and sanitation
sources across urban and rural villages located in El Salvador and compare the results to the most
recent assessment conducted by the WHO and the United Nations Children’s Fund (UNICEF).
Hypothesis: The research hypothesis was that selected villages in El Salvador will not meet the
MDG.
Material and Methods: This Institutional Review Board (IRB) approved study administered a
survey adapted from the WHO’s “Core Questions on Drinking-Water and Sanitation for
Household Surveys” validated by a panel of international and US experts. A convenience sample of
91 adult residents completed surveys during an COM medical mission trip in July 2014. Participants
included residents from two rural villages (El Tremedal in Chalatenagno and Santa Agueda) and
one urban village (Santiago Texacuangos).
Results:Overall, 62.1% of urban El Salvadorians used improved water sources and 97% used
improved sanitation practices as compared to the WHO’s assessment of 95% for water and 80%
for sanitation. In comparison, the rural areas indicated 83.3% used improved water sources and
74% used improved sanitation practices as compared to WHO’s assessment of 81% for water and
53% for sanitation. Most urban residents (51.4%) reported using piped water into dwelling for
drinking water and 35.1% flushed to pipe sewer system for sanitation. Rural residents reported the
greatest use of protected dug wells (40.7%) and pit latrine with slab for sanitation (59.2%). Rural
residents are more likely to treat their water with chlorine/bleach than urban.
Conclusion: In conclusion, while progress is being made to meet the MDG, based on this study
and the WHO assessment, El Salvador still has a great need for improved access to water and
sanitation practices; thus the research hypothesis is accepted. It is recommended future public
health and COM initiatives focus on improved water sources for urban El Salvador villages and
improved sanitation for rural villages.
28
2014 BIOM 1884
Education and Beliefs Regarding Safe Drinking Water and Sanitation Practices Across
Selected Communities in Veron, Dominican Republic
Primary Author: Jennifer E. Kelley, OMII: Additional Authors: Alexis Stoner, MPH, Timothy
Immonen, OMSII, Chandra Jennings, OMSII, Fristy Fincher, OMSII, Dalia Meisha, PhD, Dean
Sutphin, PhD
Edward Via Virginia College of Osteopathic Medicine – Carolinas Campus
The Punta Cana Ecological Foundation is attempting to provide rural village residents with clean
drinking water and improved sanitation through a project called Source of Life. While public health
education on safe water and sanitation could be helpful, there is a lack of information on current
practices and the extent of knowledge the residents possess. This IRB approved study assessed the
status of water and sanitation and the extent of public health education in five Dominican Republic
communities serviced by the COM: Veròn, Hoyo de Fruisa, La Cristinita Church, Christian Church
Domingo Maiz, and Pueblo Nuevo. It was hypothesized that the communities included in the study
lack education and access to safe drinking water and sanitation. During a COM medical outreach
trip in July 2014, a convenience sample of 172 adults completed a survey adapted from the WHO's
Core Questions on Drinking-Water and Sanitation for Household Surveys and a “Health
Assessment Survey” developed by an expert panel of US and international representatives. While
differences were observed across villages, overall, 34% of participants did not believe their drinking
water to be safe. In Domingo Miaz, 63% believed their water to be unsafe, 94% use unimproved
drinking water sources, and 42% reported at least one or more cases of a diarrheal disease this year.
In Pubelo Nuevo, 36% reported their water was unsafe water, 8.3% of residents were using
unimproved drinking water sources, and 82% reported at least one or more cases of a diarrheal
disease this year. Overall, 27% of residents believe diarrheal disease can be transmitted through
unsafe water, yet no respondent at the Veròn Clinic site and Hoyo de Fruisa believe that intestinal
disease or malaria can be transmitted through contaminated water. Over 50% of the respondents
in these two villages also reported no access to education on clean water usage. In conclusion,
access to safe drinking water and sanitation vary by community, but all communities have limited
access to safe drinking water, and limited public health education on safe water practices, thus the
research hypothesis was accepted. Public health education on water and sanitation is recommended
to parallel water and sanitation initiatives by the special project in Domingo Maiz and
improvements needed in other selected villages in Veron Dominican Republic.
29
2014 BIOM 1885
Waterborne Health Status in the Dominican Republic: The Association of Diarrheal
Disease and Water Sanitation.
Primary Author: Anastasia Snelling, OMSII; Additional Authors: Lan-Anh Tran, OMSII, Stephanie
Crawford, OMSII, Dalia Meisha, PhD, Dean Sutphin, PhD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine – Virginia Campus
One child dies every 2.5 minutes from preventable diarrheal diseases due to lack of appropriate
water sanitation. It is estimated that diarrheal illnesses make up 4% of the global burden of disease
and 88% of diarrheal diseases can be prevented by improving water quality, sanitation, and hygiene.
The purpose of this study was to survey water sanitation sources and associated diseases among
selected communities in Veron, Dominican Republic. The research hypothesis was that those using
untreated drinking water and sanitation have a greater prevalence of waterborne disease. This IRB
approved study was conducted during an COM medical mission trip using two surveys that were
language-specific and interviewer-administered. Surveys were given to 172 adults attending a July
2014 clinic serviced by COM in five communities from the Dominican Republic: Clinic at Veron,
Hoyo de Fruisa, La Cristinia Church, Domingo Maiz, Pueblo Nuevo Church. Questions about
water sanitation were adopted from WHO Core questions on drinking-water and sanitation for household
surveys. A second survey was developed by a panel of international and US experts and included 11
questions that focused on assessing waterborne health status. A chi-square test was performed
using Pearson chi-square to compare water access, sanitation, and the prevalence of diarrheal
illnesses. Approximately one-third of participants reported having diarrheal illness in the past
year, with more than 51.0% reporting that they have never taken any parasite medication. While not
statistically significant, 58.0% of participants who reported having at least one case of diarrheal
illness in the past year also reported using untreated drinking water sources. Approximately 55.0%
of residents reported skin or eye infections at least once in the last year. The perceived reasons for
infections varied across villages. In Hoyo de Fruisa, soil was believed to be a very high source for
infection (55.0%). While in Pueblo Nuevo, participants believed that animals (90.0%), being in
contact with others having skin disease (72.2%) and washing with water of poor quality (50.0%)
were the highest sources for infection. In conclusion, the hypothesis was not supported by this
data. The overall trend demonstrates that a majority of people still do not have improved drinking
water and waterborne illnesses are prevalent in these communities. Although there is not a
statistically significant relationship, it is recommended that efforts are still needed to improve water
sanitation. In addition, health education is highly recommended to reduce the health burden as a
result of exposure to poor water and sanitation.
30
2014 BIOM 1886
COM Medical Class of 2017 International Outreach Summary
Primary Author: Kara L. Oliver, OMSII; Additional Authors: Kim Tran, OMSII, Marissa
Sanderson, OMSII, Michael Schmidt, PhD
Lake Erie College of Osteopathic Medicine
Abstract: During the months of May and June (2014), 80 COM students volunteered in four
separate international outreach programs. These 1-2 week trips planned by the student body and
their selected organizations reached destinations in Honduras, Peru, Tanzania, and Uganda. During
these experiences, a great deal of teamwork was necessary in order to optimize the assembly and
execution of each clinic. Some of the major stations involved thorough triage of the patient and
presenting patient symptoms to general consultation, OB/GYN, dental, vision, wound care,
laboratory diagnostics, electronic medical record data entry, pharmacy, and public health
education. In summary, these four groups managed to raise over $20,000 towards medical supplies,
provide medical aid to over 2,500 individuals, educate entire communities on critical topics in
public health, and obtained invaluable medical experience and exposure to medicine in the
developing world.
31
2014 BIOM 1894
The Relationship Between Water Source and Skin and Eye Infections in Selected Rural
and Urban Underserved El Salvadoran Villages
Primary Author: Neha Narwani, OMSII; Additional Authors: Dean Sutphin, PhD, Lauren
Pronman, OMSII, Meghan Corrigan Nelson, OMSII, Myungwood Bae, OMSII, Dalia Meisha,
DDS, MPH, DScD, Alexis Stoner, MPH
Edward Via Virginia College of Osteopathic Medicine – Carolinas Campus
Abstract & Hypothesis: According to the World Health Organization, environmental factors
contribute to 18% of the disease burden within El Salvador. Contaminated water is often the
source of diarrheal disease and can contribute to skin and eye infections; however, there is
insufficient research in the underserved areas of El Salvador to determine the appropriate health
care needs and interventions. The purpose of this study was to assess the prevalence of skin and
eye infections in relation to current water and sanitation status in the following villages of El
Salvador: Shalom Family Medical Center of San Salvador, El Tremedal, Chalatenango and Salinitas,
Sonsonate. The research hypothesis was that lack of access to safe water and sanitation is associated
with increased skin and eye infections.
Materials and Methods:This IRB approved study was conducted on a medical outreach trip
through COM in July of 2014. Participants included a convenience sample of 91 adults attending
COM serviced medical clinics. Two surveys were used; one was adapted from WHO’s Core
Questions on Drinking Water and Sanitation on Household and the other developed by a panel of
International and U.S. Experts assessing health status.
Results: Overall 36% of residents reported having a skin or eye infection within the last year.
Drinking water source was not significantly associated with infections across villages. However,
non-drinking water source was significantly associated with reported skin and eye infections overall
(p<.001). Residents who reported skin and eye infection most commonly reported using a
protected dug well (45.2%). There was a significant statistical difference between the three villages
in the prevalence of skin and eye infections: the rural residents of Sonsanate (53.1%) reported a
greater prevalence of infection than the urban residents of the capital city, San Salvador (25.0%)
and the rural residents of El Tremedal (21.9%) (p<.01).
Conclusion: In conclusion, we accept our hypothesis as this study indicated an association
between non-drinking water sources and increased prevalence of skin and eye infections. In the
future, additional water and public health research should involve community-based public health
education to improve safe water use and prevent skin and eye infections.
32
2014 BIOM 1897
Raising awareness of OPP and OMT: More work to be done
Primary Author: Lorenzo Lim, OMSIV; Additional Authors: Joseph Gorz, DO, Teresa Colelli,
OMSII, Elise Craig, OMSII, Jessica Jary, OMSII, Samantha Ward, OMSII, Travis Gordon, DO,
Shane Sergent, DO, Maddi Massa, OMSIII, Ruben Kenny Briceno, MD, Katelyn Wiseman,
OMSIV, Sara Lang, OMSII, Christopher Wozniak, DO, Gary Willyerd, DO
Michigan State University College of Osteopathic Medicine
This is the third year that COM has done presentations on Osteopathic Principles and Practices
(OPP) and Osteopathic Manipulative Medicine (OMM) in Peru. These have proven to be
successful at educating and raising awareness amongst Peruvian populations1,2. After 2 years of
presentations we hypothesize that attendees of a workshop done in 2014 will enter with a greater
initial understanding of OPP and OMM.
In total 5 presentations have been given by COM students to Peruvian health care professionals.
Two in August 2012 and two in August, 2013. These were previously described in a separate
abstract1,2. This year a workshop was conducted at Universidad Cesar Vallejo in August. A before
and after survey involving open-ended questions and five Likert scale type questions were used to
assess agreement with OPP values and awareness of OMM. The effectiveness of the workshops
was assessed using a paired t-test analysis of the Likert scale questions from the before surveys
from 2012 and 2014. Surveys that were incomplete were omitted from the aggregate study but all
of the surveys with a response to question four were used for its analysis. This question
specifically asked about prior knowledge of OMM.
An aggregate score of the five numerical questions had a mean of 19.53 in 2012 (n=49) and 20.68
in 2014 (n=47). The maximum score was 25. The change in the means was 1.15
(p=0.0217). Analysis of question four demonstrated a mean of 2.80 (n=50) in 2012 and in 2014 of
3.15 (n=47). The change in the means was 0.35 (p=0.1391).
Overall, the Peruvian people appeared to be very receptive to OPP/OMM. The change in
knowledge and acceptance of OPP/OMM concepts as a whole increased over the past two years
and this change is statistically significant. However the change in prior knowledge of OMM
specifically was not statistically significant. We believe this shows that more work is needed in
raising awareness of OMM in Peru. The gains in the aggregate score could be from increased
agreement with Tenets of Osteopathy that the other questions assessed. As we move towards
unification in the United States it is even more important that we continue to increase awareness
and knowledge of OPP and OMM abroad.
1. Lim L, Gordon T, Sergent SR, Hawkins J, Simon J, Bajoka B , Favazza L, Wiseman K, Schrotenboer A,
Cameroamortegui F. Willyerd GL,. OMT: Reducing Pain and Changing International Patient Perception.. Journal
of the American Osteopathic Association.. 2013 Mar; 113(3): 236.
2. Massa M, Lim L, Wiseman K, Sergent SR, D.O., Briceno RK, M.D., Teimorzadeh M, Pitters L, Jelinek K,
Gorz J, D.O., Ludwig A, Castellani K, Bhan C, Kuehne L, Willyerd GL, D.O. Osteopathic Principles and
Practice and Osteopathic Manipulative Medicine Perception in Peruvian Health Care Professionals. Journal of the
American Osteopathic Association.. 2014 Mar; 114(1): 57.
33
2014 BIOM 1902
Evaluation of the different stratums of medical education and care provided to both rural
and urban populations in Gujarat, India
Primary Author: Megha Patel, OMSII; Additional Author: Katherine Wyrick, OMSII
Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Introduction: We traveled to India to understand the determinants of health and disparities of care
in an international setting, and to apply our fundamental knowledge obtained during the first year
of medical school in a clinical setting.
Materials and Methods: Throughout our stay in Gujarat, India, we traveled to various cities and
villages to observe different tiers of medical care at each location. The facilities we attended
included private clinics in a rural setting, an international hospital, and a large government teaching
hospital in the city. All of these places differed in the quantity, quality, and type of care provided
along with a vastly different patient population. We worked with a local doctor, Dr. Prajapati, to
collaborate with various physicians and surgeons in different communities to ensure that we were
exposed to multiple levels of medical access and care in India. We were immersed in a variety of
situations in which we had to think, act, and provide care, just as a third year Indian medical
student would. We were encouraged to independently investigate chief complaints and imaging
studies in order for us to develop our critical thinking skills. We documented the various types of
patients and procedures we saw, their differences to care provided in other clinics we visited, and
questions for us to research after our trip.
Results: The type of care provided at Apollo Hospital, one of the first hospitals in India to receive
international healthcare accreditation by Joint Commission International, was the gold standard of
what we as American Osteopathic medical students perceived as excellent quality of care. They
provided holistic healthcare that focused on prevention, novel treatments, and health education for
patients and their families. In contrast to Apollo, which provided specialty and super-specialty care,
smaller village clinics that we visited were severely limited in the quality of care they could provide
due to their lack of resources, time, and over-population. Also, due to the high rate of illiteracy,
patients were not willing to be compliant with their treatment protocols, and waited to consult their
doctor until their condition had progressed to become life threatening. This presentation of
complicated cases and neglect have made physicians adept at maximizing their knowledge with the
limited tools they have to save their patient; this comes with the price tag of higher volumes of
patients, shortened treatment times, lack of patient education, and overall reduced hygiene.
Conclusions: Our experience in India has taught us that when physicians are faced with limited
resources and overpopulation, as they are in small rural clinics, they focus primarily on being
thorough and efficient. In contrast, if physicians are given sufficient time and provided with the
necessary tools, then the standard of care remains at a level comparable to that in the US.
34
2014 BIOM 1903
Community Health Workers for Health System Strengthening: The Osteopathic Medical
Student Perspective
Primary Author: Stacey Rittmueller, OMSII; Additional Authors: Alexa Celerian, OMSII, Adam
Hoverman, DO, DTMH
Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Hypothesis: Osteopathic medical students can acquire an awareness of the health system
strengthening potential of Community health workers (CHWs) and are uniquely positioned to
champion for their integration.
.
Background: Empowering individuals within communities, and communities within health
systems, is required for health advocacy and improved health outcomes. CHWs are a growing force
for improving healthcare and population health. A.T. Still’s description of the body as a city
highlights that “each laborer or organ must be in perfect health, or some degree of failure, a
beginning of universal shortage in perfect work through the system or city, will be the result.”
(Osteopathy, Research and Practice, 1910). Similarly, evidence supports CHWs as critical for
bolstering health systems and achieving health for all.
Materials and Methods: Two osteopathic medical students spent a month in Cusco, Peru. Their
objectives were: 1) improve language skills 2) better understand the role of culture in health and 3)
observe healthcare and community health promotion in a remote limited resource setting. While
pursuing medical Spanish training, students observed CHWs and volunteered at a private clinic
during a public medical sector strike. They also observed a month of Indigenous community
celebrations with daily displays of traditional dance and musical performance.
Results: Both students spent 45-60 hours in language instruction, and one participated in 30 hours
of private clinic observation. Both students observed daily parades and celebrations involving all
ages. The students participated in a National Day of the CHW celebration in Urcos, Peru. During
this session, the students observed approximately 15 Quechua-speaking CHWs following a 12month training covering domestic violence, pregnancy complications, alcohol misuse, handwashing, and TB case identification.
Conclusions: From these experiences, the most salient lessons involved language learning, the role
of culture in health, and the use of CHWs to engage communities and promote health. Proficiency
in language and local culture requires time and commitment. A sense of responsibility for
community well-being comes with celebrating culture. Health agents from underserved
communities acting without financial compensation reveal a surprising commitment to physical,
social, and mental well-being. This early experience of an empowered community illustrates that
similar to organs needing the body to function, individuals need their community for health.
Working together produces health. These lessons and incorporation of CHWs into healthcare can
be applied in the U.S. where increasing demands on physician time and complex chronic disease
management compete with limited time during office visits.
35
2014BIOM 1906
Elevating the Standard of Care Provided in Resource Poor Settings; EMR Development for
use in the Developing World.
Primary Author: J. Zachary Wright, OMSII
Marian University College of Osteopathic Medicine
Current health care reform efforts and advancements in computer technology have caused a big
push for the use of electronic medical records (EMR), especially in the United States. EMR systems
have also started to be used in resource poor settings throughout the world. International aid
organizations have begun to utilize electronic record systems in order to maximize efficiency and
increase the quality of services provided. The goal of this presentation is to highlight my
involvement in the development of an EMR system, called TimmyCare, which was developed by
Timmy Global Health (TGH). I will also introduce Timmy Global Health as an organization
through a discussion of TGH’s international programming in both Ecuador and the Dominican
Republic.
Timmy Global Health is an Indianapolis based non-profit organization that does international aid
work in Ecuador, Guatemala and the Dominican Republic. Timmy Global Health works with local
partner organizations in each country to provide access to health care to communities that have no
other access to health services. TGH supports the work of the partner organizations and local
physicians by providing financial assistance and medical supplies. In addition to providing such
resources, short-term medical service teams are sent to each programming site every two months.
This allows for TGH to fulfill its dual mission of providing access to health care to communities in
need, while also allowing students to learn and participate in global health issues.
Over the last few years Timmy Global Health has developed its own electronic medical record
system. The system, called TimmyCare, was developed in order to improve in-country
programming and more efficiently care for an incredibly large patient population with relatively
limited resources. The EMR system not only makes medical service trips and community clinics
more efficient, but also allows for data collection that has the potential for the expansion of useful
public health projects and services. Prior to starting medical school at Marian University College of
Osteopathic Medicine, I spent a year in the Amazon Basin of Ecuador as a long-term volunteer of
Timmy Global Health. While in Ecuador I helped to implement and optimize the EMR system.
During the summer of 2014, after finishing my first year at COM, I spent two months as a
consultant for Timmy Global Health helping to launch new medical programming on the north
coast of the Dominican Republic. This work involved training local physicians and community
health workers on the EMR system as well as troubleshooting specific issues.
My participation with the TimmyCare system has given me unique experience in the development
of electronic medical records and medical outreach work in the developing world. The work
Timmy Global Health is doing and the potential that comes with having an electronic medical
records system will no doubt improve health services while providing invaluable learning
opportunities to students, tomorrow’s health care leaders.
36
2014 BIOM 1915
Building Research Experience to Impact the Osteopathic Profession
Primary Author: Maddi Massa, OMSIII; Additional Authors: Victoria Blaogh, BS candidate, Jannet
Jones, BS candidate, Zachary Reilly, BS candidate, Sumaira Hai, BS candidate, Jacob Shermetaro,
BS candidate, Sophia Johnson, DO, Shane Sergent, DO
Michigan State University College of Osteopathic Medicine
Background: Research is one of the six main pillars supporting the advancement of the
Osteopathic profession, according to the 2013 AOA mission statement. Emphasizing this aspect of
the medical profession strengthens the quality and capabilities of Osteopathy, both in the United
States and abroad. BS candidate student involvement at COM has been a part of COM’s medical
missions to Peru from early on. The Osteopathic Medical Scholar Program (OMSP), consisting of
BS candidate students being mentored on the way to becoming medical students, is involved in the
research process from start to finish.
Hypothesis: Experience in international research as an BS candidate student positively impacts the
patients served abroad, the students involved, and the Osteopathic profession through research
education and success.
Methods: Over the past five years of medical missions to Peru, has involved 22 Medical Scholars
in research projects. They have had a hand in study design, data collection, and analysis of results
pertaining to a wide variety of study topics. Recently, these students have been mentored in the
creation of their own research project. Student development and project success were the
educational parameters assessed.
Results: Medical Scholars reported increased knowledge in the research process and the impact
research results have on a community. A sense of teamwork, and the value of Osteopathic
Principles applied in research, were also noted. This BS candidate experience has grown
their commitment to and interest in Osteopathy, as well as building a passion for research and
international medicine. With the help of the Medical Scholars, 25 COM student projects have
successfully been published since 2011 alone.
Conclusion: The OMSP at COM offers a unique opportunity to involve budding Osteopaths in
research experience. Research experience needs to be offered and employed early on in the student
population. Research skills such as forming a study design, conducting data collection, and
processing results are acquired skills that take time to understand and become comfortable with.
The future of Osteopathic research growth depends on exposing students to these roles early on. It
reinforces the importance of research, medical sustainability, and Osteopathic knowledge for all of
those involved.
37
2014 BIOM 1918
Healthcare for Haiti’s Poor: Exploring the Integration of Osteopathic Techniques into a
Current Holistic Healthcare Model
Primary Author: Violet Yeager, OMSIII; Additional Authors: Ebony Raymond, OMSIII, Susan
Wright, OMSIII, Jacob Moulds, OMSIII, Maggie Hopkins, MD, MBA, John Roberts, III, MD,
MPH, Alison Smith, MD, PhD, John M. Jones, DO
William Carey College of Osteopathic Medicine
Background: Rural Haiti contains some of the most impoverished and underserved populations in
the world. Sante Total, a non-profit organization providing healthcare to parts of rural Haiti,
provides public health interventions and access to health clinics three to four times per year. These
clinics are operated by alumni, physicians, and students of the Tulane University School of
Medicine, the Tulane School of Public Health and Tropical Medicine, the Louisiana State
University School of Medicine, and recently, students of the COM.
Sante Total takes a holistic approach by involving the community and its leaders in the operational,
educational, and clinical processes of the organization. Community members are employed as
translators, housing coordinators, and security personnel. Haitian students are provided with
scholarships to pursue secondary and medical education. Community leaders help identify and aid
individuals requiring extra support between health clinic offerings. They also oversee the
maintenance of public health projects such as the community gardens and latrines. In an ongoing
effort for sustainability, a community clinic is being built specifically for the rural population of
Jacsonville, Haiti.
Objective: Integrate osteopathic students into current medical outreach efforts in rural Jacsonville,
Haiti.
Methods: Sante Total requires all applicants to submit a personal statement as part of the selection
process. Only a limited number of participants may be accommodated due to the remote location
of clinics. Due to the ongoing nature of the project, participants are chosen based on their desire to
continue the mission of the organization. The organization’s needs are met solely via donations and
volunteer efforts; all board members are unpaid. Additionally, medical students pursuing a DO
degree are offered a training session and material on osteopathic techniques acceptable under MD
physician guidance.
Results: Sante Total has conducted over 17 trips resulting in the treatment of more than 10,000
patients. Each trip provides continuity of care to a rural population in Jacsonville, Haiti. In
November 2014, osteopathic medical students effectively introduced OMT techniques to Sante
Total’s holistic armamentarium; these techniques were well received, and patients found them to be
helpful additions to their overall treatment plans.
Conclusion: Osteopathic Manipulative Techniques were successfully incorporated into the
healthcare clinic during these outreach efforts. By upholding the mission statement of Sante Total
and coordinating fundraising efforts, we successfully contributed to the holistic healthcare of a rural
community in Haiti.
38
2014 BIOM 1919
Holistic Patient-Centered Care and Osteopathic Manipulative Treatment Enhances
Quality of Life in Peruvians with Somatic Dysfunction
Primary Author: Elise Craig, OMSII; Additional Authors: Travis Gordon, DO; Shane Sergent, DO;
Josh Goethals, OMSII; Lorenzo Lim, OMSIV; Katelyn Wiseman, OMSIV; Teresa Colelli, OMSII;
Sara Lang, OMSII; Samantha Ward, OMSII; Jessica Jary, OMSII; Gary Willyerd, DO, FACOEP,
FAODME
Michigan State University College of Osteopathic Medicine.
Background: As the technology of medicine advances through imaging, laboratory studies, and
electronic medical records, physicians are relying less on their history and physical assessment.
However, studies have shown patient-centered, osteopathic care leads to increased patient
satisfaction, compliance, and follow up care. As osteopathic medical students and doctors, we pride
ourselves on the tradition of treating the mind, body, and spirit of our patients and providing
compassionate healthcare. It is our job to spread the osteopathic message and encourage others to
treat their patients as a whole.
Methods: Through the Michigan State University College of Osteopathic Medicine Peru Medical
Mission, we spent one week rotating with osteopathic physicians in the clinic we set up in Iquitos,
Peru. We worked in hematology/oncology, family medicine, pediatrics, internal medicine,
obstetrics/gynecology, emergency medicine, dermatology, podiatry, and osteopathic manipulative
medicine (OMM). The majority of my time was spent working in the OMM room, where we
received nearly 100 referrals from other specialties.
Results/Conclusions: Without the limitations of insurance and a five-minute appointment
window, we were able to provide patient-centered care to the fullest. In the OMM room we took in
depth history and physicals, performed complete body scans, and talked with our patients about the
many aspects of their lives. We treated bilateral thyroid Chapman’s points on a patient presenting
with extreme discomfort due to a 7 year history of papillary thyroid cancer with metastasis to his
lymph nodes. We treated a young girl with a cranial left side bending rotation; she had been
experiencing terrible headaches since she was thrown from her motorcycle and hit her head on the
pavement two years ago. A patient that was unable to use his right arm for two years due to pain
began crying after we put his significantly posterior right rib back in place; we were relieved when
he flashed us a smile and began lifting his right arm. By correcting our patients’ somatic
dysfunction, we were able to alleviate part of the emotional burden and physical pain that their
dysfunction had caused them. Our goal as osteopaths is to improve the quality of our patients’ lives
holistically. In our study, 98% of patients reported that OMT improved their pain, while 2% said
they noticed no change. Our osteopathic training has given us the knowledge and skill set to treat
in a manner that encourages the body to repair and remodel itself. On our last day, a Peruvian
physician asked one of the authors her thoughts about the Galbreath Maneuver. She was ecstatic,
of course, seeing osteopathy already taking root in Peru.
39
2014 BIOM 1924
Evaluation of perception and knowledge of schistosomiasis, and use of traditional healers
Primary Author: Lauren Ogawa, OMSI; Additional Autors: Yalsmin Nibbe, MS, MD, Ben
Ramsden-Stein, OMSII, Eiman Mahmoud, MPH, MD
Touro University College of Osteopathic Medicine – California
Schistosomiasis infects over 200 million people worldwide, and is one of the major health concerns
in Tanzania. Traditional Healers are an officially sanctioned part of the health care system in
Tanzania, however their working relationship with Western institutions is tenuous at best. Previous
research has shown that the decision by local people to seek health care and advice from
Traditional Healers vs brick-and-mortar medical facilities depends on many factors including the
symptoms they are facing and the personal relationship, or lack thereof, they have with a given
provider. This study was aimed towards determining if local people would seek the help or would
admit to seeking help, from a Traditional Healer for what they felt may be schistosomiasis
symptoms in the Tanzanian villages of Burere and Masonga. In addition, this study evaluated the
efficacy of control measures and the perception of schistosomiasis within the group of people who
utilize traditional healers. Surveys were collected from 313 locals at two government Health
Dispensaries, seeking testing and pharmaceutical treatment (praziquantel) for their symptoms.
History and physical exam were performed, and fecal samples were collected in order to diagnose
schistosomiasis infection by light microscopy. An information session about how schistosomiasis is
contracted and spread was provided.
From this study, it was concluded that villagers do report utilizing both Traditional Healers and
Western medicine, and many sought care from Traditional Healers before seeking historically
Western care. However, there were clear discrepancies in the knowledge about schistosomiasis
infection, spread, and prevention, indicating that several improvements need to be made in the
design of education control programs. For example, many believed that schistosomiasis could be
transmitted and spread via ingestion of contaminated water or spitting into water sources.
Our study demonstrates that villagers in Burere and Masonga, as previous studies have suggested,
utilize both Traditional Healers and historically Western care when seeking treatment. The fact that
local people were willing to self-report having seen a Traditional Healer in a Western care setting
suggests local people are not as subject to apparent Western bias against Traditional Healers as
previously thought. In addition, we conclude that education and prevention programs are lacking
due to the incorrect knowledge villagers possess about how schistosomiasis is spread and
contracted. Given the misunderstanding of the constellation of symptoms and etiology of
schistosomiasis in the community, this represents an opportunity for outreach and collaboration
between Traditional Healers and government funded, historically Western care facilities to increase
awareness and decrease incidence and vector control of the disease.
40
2014 BIOM 1925
Utilization of health dispensaries in screening and health education for schistosomiasis
control
Primary Author: Lauren Ogawa, OMSI; Additional Authors: Yalsmin Nibbe, MS, MD, Eiman
Mahmoud, MPH, MD
Touro University College of Osteopathic Medicine – California
Schistosomiasis is one of the top neglected tropical diseases with an estimate of 249 million people
in need of treatment as of 2012, and 90% of those people living in Africa. In Tanzania, the
prevalence of schistosomiasis and other soil-transmitted helminthes can be as high as 80% in
certain areas. The disease is of particular concern in the Lake Victoria region, since many peoples’
lives involve use of lake water for activities of daily living including farming, fishing, and
washing. Current control measures in place include mass treatment of at risk groups and education
programs about prevention. Control programs have been carried in villages, schools and
hospitals. This study compares the efficacy of carrying these control measures in villages and at
point of health care facilities namely dispensaries versus public locations in villages, and assesses the
impact of the use of medical dispensaries and education programs on the incidence of
schistosomiasis.
Health education, screening and treatment were carried in Masonga village both at public location
and at the local dispensary. History and physical examination were administered followed by stool
examination by light microscopy for ova and parasites. Health education sessions were carried and
participants filled a survey in order to evaluate their current knowledge of schistosomiasis
transmission and prevention. The study design had institutional review board approval. In an
attempt to identify best practice in distribution of control efforts and efficiency of utilization of
existing health dispensaries this study examines the public utilization of control measures, access,
and efficacy of point of health care facilities as platform for community outreach activities.
Our study supports the use of health dispensaries to carry community outreach health educations,
screening and collaborative health workers and public participation in schistosomiasis control
measures in rural Tanzania.
41
Non-Compete Category
2014 BIOM 1740
Cultural Attitudes towards Intubation and Tracheostomy in Taipei Hospital
Primary Author: Megan Lung, OMSII; Additional Authors: Vincent Chou, OMSII, Athena Lin,
PhD, Dr Huang, Taiwan International Healthcare Training Center
Touro University College of Osteopathic Medicine – California
Background: Tracheostomy is one of the most common ICU procedures performed; yet the timing
of the procedure remains controversial. As soon as the need for mechanical ventilation is
determined, tracheostomy should be considered to improve weaning. This evaluation usually can be
made within 7-10 days. However, the timing of tracheostomy is highly subjective depending on
many factors. In this study we would like to look specifically at how cultural attitudes prolong
intubation periods. Patients and physicians in Taipei Hospital reported delaying or refusing
tracheostomies due to beliefs that bodies should remain whole. Cultural views on tracheostomies
and other procedures are seen in countries outside of Asia. Patients in Nigeria were hesitant to
receive tracheostomies due to problems with social integration and family acceptance. Western
countries (US, Germany, Switzerland) do not seem to be as reserved, as seen in the shorter average
duration between initiating mechanical intubation and tracheostomy. The following case control
study measures how long the tracheostomy procedure is delayed in this specific hospital. Possible
confounding factors are reasons other than culture for which doctors and patients delay or outright
deny tracheostomy, which may include contraindications or higher risk for delayed complications.
Hypothesis: Cultural beliefs about invasive procedures prolongs the timing of tracheostomies
beyond the standard 7-10 days evaluation period.
Materials and Methods: We collected data from 19 patients at Taipei hospital. These patients
either had tracheostomies or were permanently intubated due to patient and family wishes. For the
patients who had tracheostomies, we collected data on how long they were intubated before
receiving a tracheostomy. For the patients who were permanently intubated, we noted the date they
were intubated and the date we collected data (7/4/2014).
Results: Out of 19 patients, the average time intubated was 24.88 days before the patient decided to
get a tracheostomy. Of this group, 5 patients are still intubated as of 7/4/14 when the study was
concluded. There are three patients who are intubated at 282, 256, and 238 days.
Conclusion: We conclude that Taiwanese attitudes towards tracheostomies prolong intubation
periods beyond the standard 7-10 days needed for evaluation. Traditional beliefs about keeping
family members whole and minimizing invasive procedures causes them to refuse or delay
tracheostomies.
42
2014 BIOM 1926
Klipple Trenaunay Syndrome “A Case Report"(a social disability in kids)
Primary Author: Saira Shaheen, OMSII; Additional Authors: Karan Lal, OMSIII, Professor M Azam
Bukhari, Pakistan
New York Institute of Technology College of Osteopathic Medicine
Klippel Trenaunay syndrome is diagnosed based on a triad of nevus flammeus extending the full
length of a limb, venous varicosities of the same limb, and hypertrophy of all the tissues within the
limb. However, today the syndrome is named for any case where there is association of nevus
flammeus with increased limb size with or without bony overgrowth and with or without venous
varicosities.
It appears that genetic factors play a role in some families and it has been suggested that this
syndrome exhibits autosomal dominant inheritance or perhaps para-dominant inheritance. The
etiology is unknown but it reflects defective vasculature during embryologic development .In Klippel
Trenaunay syndrome, sometimes nevus flammeus is present at birth but sometimes it appears in
early childhood. It is not uncommon for other types of vascular malformations like angiokeratoma
and granuloma telengiectaticum like lesions develop within these patients. The affected individual is
prone to profuse bleeding after trauma and hip dislocation and scoliosis if a leg length discrepancy
becomes apparent. Varicose veins increase the risk of ulceration, deep venous thrombosis,
pulmonary embolism and recurrent septicemia. As far as the treatment is concerned, most patients
do well with elastic support alone; however, other options include laser therapy and/or vascular
surgery.
Here we report a case of a three year old girl meeting all diagnostic criteria for Klippel Trenaunay
syndrome with congenital nevus flammeus but gradual onset of extremity edema.
Through evaluation of child by all physicians because it was considered a social disability when
patient have skin related physical lesions and as no cure for the syndrome, the only goal is to
improve the kid’s quality of life, so we offered her with the elastic garment along with limb
elevation to help in draining the edema and prevention of trauma to the leg.
43