Poster Day 2021: Abstracts: Population Health

Arianna Lanpher, OMS-IV; Benjamin Duong, OMS-IV; Roshny Vijayakar, OMS-IV; and Raul Magadia, MD 

Globally, studies show that patients with a higher body mass index (BMI) are at increased risk for severe sequelae of SARS-CoV2 infection, increasing the need for hospitalization and mechanical ventilation, ultimately leading to increased risk of mortality. 

This study considers 18 comorbidities and mortality in 229 out of 1082 patients admitted to Northeast Alabama Regional Medical Center for SARS-CoV2 infection between May 2020 and January 2021. All statistical analyses were performed in Microsoft Excel and R Studio.

Using mortality as the primary outcome among five BMI classes (underweight, normal, overweight, obese, and morbidly obese), Fisher’s exact test was significant for goodness of fit (p=0.010) but not significant for independence (p=0.92). Ventilation requirements increased with BMI (p=0.0070) but did not increase mortality across weight classes (p=0.30). Cox proportional hazards adjusted for Age and CKD stage captured 34/41 total deaths and yielded a significant model (p=0.0030, 6df, concordance 0.702). For the same length of stay, every additional year of age corresponds to a 2% increase in mortality (HR 1.019, 95% CI [1.008, 1.029], p=0.00050).

In our sample of community hospital patients, BMI is not a significant predictor of mortality, although higher BMI is associated with increased need for mechanical ventilation. Age is a significant predictor of mortality which has been well established. Limitations include small sample size (n=226 with 41 deaths) and inconsistent documentation of covariables in the medical records. Ongoing data collection may elucidate potential deviation from the globally reported association between obesity and SARS-CoV2 mortality.

Arianna Lanpher, OMS-IV; Benjamin Duong, OMS-IV; Roshny Vijayakar, OMS-IV; and Raul Magadia, MD 

Globally, studies show that patients with a higher body mass index (BMI) are at increased risk for severe sequelae of SARS-CoV2 infection, increasing the need for hospitalization and mechanical ventilation, ultimately leading to increased risk of mortality. 

This study considers 18 comorbidities and mortality in 229 out of 1082 patients admitted to Northeast Alabama Regional Medical Center for SARS-CoV2 infection between May 2020 and January 2021. All statistical analyses were performed in Microsoft Excel and R Studio.

Using mortality as the primary outcome among five BMI classes (underweight, normal, overweight, obese, and morbidly obese), Fisher’s exact test was significant for goodness of fit (p=0.010) but not significant for independence (p=0.92). Ventilation requirements increased with BMI (p=0.0070) but did not increase mortality across weight classes (p=0.30). Cox proportional hazards adjusted for Age and CKD stage captured 34/41 total deaths and yielded a significant model (p=0.0030, 6df, concordance 0.702). For the same length of stay, every additional year of age corresponds to a 2% increase in mortality (HR 1.019, 95% CI [1.008, 1.029], p=0.00050).

In our sample of community hospital patients, BMI is not a significant predictor of mortality, although higher BMI is associated with increased need for mechanical ventilation. Age is a significant predictor of mortality which has been well established. Limitations include small sample size (n=226 with 41 deaths) and inconsistent documentation of covariables in the medical records. Ongoing data collection may elucidate potential deviation from the globally reported association between obesity and SARS-CoV2 mortality.

Sarah J. Adkins-Jablonky, PhD; Christina N. Morra, PhD; Sloan E. Almehmi; Tristan W. Boling; Bianca J. Convers; Michael L. Howell; and Samiksha A. Raut, PhD 

As evidence mounted that existing prevention methods would be insufficient to end the COVID-19 pandemic, it became clear that vaccines would be critical to achieve and maintain lower rates of infection. However, vaccine-hesitant sentiments have become widespread, particularly in populations with lower scientific literacy. Thus, non-science major college students are a critical population of interest for the success of the COVID-19 vaccine campaign. 

University of Alabama at Birmingham students in two concurrent non-major biology courses (n=156) in Spring 2021 completed Likert questionnaires and reflections prior to and after an educational intervention addressing vaccine-related concerns. In the module, experts gave presentations about COVID-19 related to microbiology, epidemiological factors, and personal experiences of COVID-19. One class of students completed a podcast-based service-learning project tasked with countering a vaccine misconception. Eight students agreed to participate in post-semester one-on-one interviews.

We found an increase in student willingness to accept a COVID-19 vaccine as well as increased student perception of the COVID-19 vaccines as both safe and effective (Wilcox Rank Sum Test, p<0.05). Further, students were primarily motivated to get a vaccine by a goal of returning to normalcy and personal and community health, however, vaccine-hesitant students still expressed insufficient research and side effects as leading concerns. Students reported the podcast activity encouraged them to draw their own conclusions by evaluating the information themselves.

We show expert-led modules and service-learning activities centered around student-teaching may be effective in increasing non-major student willingness to accept COVID-19 vaccines.

Cathryn Duchette, Danilo V. Tolusso, Whitley J. Stone, Maire M. Blankenship, and Rachel A. Tinius 

Studies have demonstrated that new and expectant mothers experience increased levels of stress and anxiety during the COVID-19 pandemic. Though prenatal yoga is an effective mode of improving mental health during pregnancy, no research has evaluated its effect on mental health during times of extreme stress, such as a global pandemic. The purpose of this study was to determine the influence of a single session and a 10-week prenatal yoga intervention on the mental health of pregnant women during the COVID-19 pandemic.

Women (n=19; 28.52±3.74 years; 20.94±4.69 weeks gestation; BMI 29.33±9.08) were randomized into a yoga or a non-yoga control group. There were no differences in demographic factors or depression/anxiety scores between groups at baseline.

Baseline levels of anxiety and depression were high, with an average depression score of 8.10±4.85 (scores >8 represent possible depression) and an average anxiety score of 39.26±12.99 (scores >39 represent a clinically significant anxiety). After just one session of yoga, women reported feeling less depressed (p=0.028), tense (p<0.001), and fatigued (p=0.004). After 10 weeks, the yoga group had lower anxiety (p=0.002), depression (p=0.032), and total mood disturbance (p=0.002) scores when compared to the control group.

Yoga appears to benefit the mental health of expectant mothers, even in times of extreme stress. The findings of this study provide clinicians with valuable information regarding alternative exercise options for mental health during pregnancy during the COVID-19 pandemic.

Asad E. Ali, Allison M. Gardner, Herman H. Shugart, and Jonathan A. Walter 

Incidence of Lyme disease, a tick-borne illness prevalent in the US, is increasing in endemic regions and regions with no previous history of the disease, significantly impacting public health.

We examined space-time patterns of Lyme disease incidence and the influence of ecological and social factors on disease synchrony, the correlated fluctuations of spatially separate populations. Specifically, we addressed the following questions: Does Lyme disease incidence exhibit spatial synchrony? If so, what geographic patterns does Lyme disease synchrony exhibit? Are geographic patterns of disease synchrony related to weather, land cover, access to health care, or tick-borne disease awareness? How do the effects of these variables on Lyme disease synchrony differ geographically?

We used network analysis and matrix regression to examine geographical patterns of Lyme disease synchrony and their potential mechanisms in 399 counties in the eastern and midwestern US. We found two distinct regions of synchrony in the Northeast and upper Midwest regions exhibiting opposing temporal fluctuations in incidence. Spatial patterns of Lyme disease synchrony were partly explained by land cover, climate, poverty, and awareness of tick-borne illness, with significant predictive variables changing regionally. However, the two regions may have become more synchronous over time, potentially leading to higher-amplitude nation-wide fluctuations in Lyme disease incidence.

Morgan Arneson, Tyler Martinez, Daniel Ruiz, and Ronda Carter, M.D.  

Anxiety, depression, and stress are more prevalent in medical students than in the general population. With the addition of the COVID-19 pandemic and associated social distancing guidelines, it will be pivotal to see its effects on medical students' mental health during their didactic years.

110 students were enrolled in the study and completed the previously validated Depression Anxiety and Stress Scale (DASS) in May 2021. Participants were instructed to complete the questionnaire to reflect their mental health before March 2020 (pre-COVID) and their current perceptions.  Additional non-DASS questions assessed students' academic performance, self-determined sense of isolation, and fear of harmful effects of the virus during COVID-19. Pre-COVID and May 2021 responses were compared and results were assessed using a t-test.

On average, stress, anxiety, and depression all significantly increased. Stress and depression increased in severity from moderate to severe categorically. Anxiety increased significantly as well. Per DASS, anxiety was categorized as extremely severe before the pandemic. Students endorsed the pandemic as having implications on academic performance, feelings of isolation, and fear of contracting the COVID-19 virus towards group settings or activities. 

Overall, a positive association was identified between the COVID-19 pandemic and increased depression, anxiety, and stress within the medical student population. We anticipate future changes as guidelines such as mask mandates and social distancing continue to evolve. We recommend the results of this survey be interpreted with caution as we could not control for increasing academic rigor advancing through the curriculum, and all survey responses were retrospective.

Maria Kewish, MD; Erica M. Román, MD; Sasha-Kay D’Aguilar, MD; and Amith Skandhan, MD

Colorectal Cancer morbidity and mortality can be decreased with appropriate colon cancer screening. A thorough evaluation on the rates of colon cancer screening around the Wiregrass area can give us an insight in the culture of primary prevention in the area and how this has impacted health outcomes in these patients. The purpose of this project is to assess over a 3-year period the amount of colorectal cancer screening in Medicare patients amongst local medical providers.

Timeline: January 2021 to August 12, 2021

Inclusion criteria: Patients age 50-75 with a visit during the measurement period

Exclusion criterion included but were not limited to patients with a diagnostic history of total colectomy or colorectal cancer, patients age 66 and older residing in SNP or long term care and patients with advanced illness or dementia.

Methodology: Analyzed satisfaction rates, data on total number of patients in a given year and total number of patients that satisfied criteria.

The total number of patients analyzed was 5,918, of which 3,365 satisfied the measure. Satisfaction rate was 56.86% in 2021. When compared to 2019 and 2020, satisfaction rate has been steadily increasing in regards to colon cancer screening.

Colon cancer screening guidelines allow for early detection of colon cancer. Identifying the gap in completing this measure amongst local providers is the first step towards promoting the importance of primary prevention and proposing new ways to improve colon cancer screening in the Wiregrass area.