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... Disparities & Inequalities in Type 1 Diabetes By: Shehr Asghar Marian University College of Osteopathic Medicine MS in Biomedical Sciences Introduction Type 1 Diabetes is an autoimmune condition characterized by a deficiency in insulin due to the destruction of pancreatic -cells. This leads to elevated blood glucose levels. The primary treatment involves daily administration of exogenous insulin, but it falls short in replicating natural insulin secretion of pancreatic -cells, hindering effective glucose homeostasis. Optimal management of Type 1 Diabetes is achieved through insulin pumps and continuous glucose monitors. Unfortunately, the annual out-of-pocket expense for insulin can exceed $10,000, rendering it financially burdensome for individuals in a lower socioeconomic status who are dealing with Type 1 Diabetes. The objective of this poster presentation is to address the issues that people in low SES areas have when trying to obtain insulin for their T1DM and creating solutions for those issues. The Problem Solution #2 Data House -islet cells in daily insulin injections, which would help replace -islet cells long term According to research, the most effective treatment to T1DM is -islet cell Transplantation. This treatment is quite complex, and requires hospital stays, which makes it quite expensive. (Chem et al. 2018). The proposed treatment, which essentially puts -islet cells into at home insulin injections, costs significantly less than the transplantation treatment, as well as the normal insulin cost for uninsured people in a 10-year span. Table 1. This cost analysis shows the cost of insulin injections, -islet cell Transplantation, and the proposed -cell insulin treatment for 10 years. Figure 1. This is data taken from different SES areas in Wales and England in 2018-2019. This data shows the proportion of children and young people (CYP) with T1DM that use insulin pump therapy and continuous glucose monitoring (CGMS). People in deprived socioeconomic areas have less access to insulin pumps and continuous glucose monitoring. The cost of insulin for uninsured people is $300 per vial, while the cost is around $100 per vial for publicly insured people, and that is if your state insurance even covers insulin, most states do not. Conclusion Problem: According to the American Diabetes Association, 1.9 millions people in the United States are diagnosed with Type 1 Diabetes (T1DM). People in low SES are deemed to have less access to treatment for T1DM. Socioeconomic Disparities: Individuals with T1DM in a lower socioeconomic status (SES) face challenges in achieving optimal glycemic control, as indicated by research (Karges et al., 2017; Zuijdwijk et al., 2013). A notable disparity emerges between T1DM patients in low and high SES, with those in the latter category, especially those with annual household incomes exceeding $75,000, being more likely to receive physician recommendations for insulin therapies (Commissariat et al., 2017). Consequently, there exists an average HbA1c discrepancy of 1.3% between T1DM patients in low and high SES. Patients in higher SES exhibit a 39% higher likelihood of utilizing insulin pumps and a 37.3% higher likelihood of employing continuous glucose monitoring (CGM) systems compared to their counterparts in lower SES (Addala et al., 2021). The annual out of pocket cost of insulin can be upwards of $10,000 and $3600 for publicly insured people. Solution #1 Create state-wide nonprofit patient assistance programs for Type 1 Diabetes for low SES people Currently, there are some nonprofit patient assistance programs for Type 1 Diabetes, where people could obtain insulin in emergent situations, however these are not easily accessible. Creating state-funded nonprofit organizations that provide diabetic assistance to uninsured or publicly insured people or people in low SES areas would reduce the inaccessibility of insulin pumps for low SES people. Affordable Insulin Now Act of 2023: Qualifying entities would get reimbursed from the government if they gave diabetic patients a monthly insulin dosage for a copay of $35/month. Steps are being taken to get people insulin but there is still a lot of work that needs to be done. T1DM is an autoimmune condition you do not choose to get it, treatment for it should be a right for everyone. Research has shown that low SES areas in the world have less access to insulin pumps and continuous glucose monitoring. Many solutions exist, including creating government programs and other biomedical engineering techniques. T1DM occurs due to insulin deficiency of pancreatic -cells. Citations Karges B, Schwandt A, Heidtmann B, et al. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA 2017;318:13581366. Zuijdwijk CS, Cuerden M, Mahmud FH. Social determinants of health on glycemic control in pediatric type 1 diabetes. J Pediatr 2013;162:730735. Commissariat PV, Boyl CT, Miller KM, Mantravadi MG, DeSalvo DJ, Anderson BJ, et al. Insulin pump use in young children with type 1 diabetes: Sociodemographic factors and parent-reported barriers. Diabetes Technology & Therapeutics, 19 (6) (2017), pp. 363-369, 10.1089/dia.2016.0375.  ...

... From Crisis to Recovery: Exploring Holistic Solutions for Opioid Addiction Edwards, Titus Introduction In the late 1990s, doctors were told by pharmaceutical companies that opioid pain relievers were not addictive and that they could prescribe them freely to patients in severe pain. As a result, doctors began prescribing opioid pain medications at a much higher rate. People began abusing these medications and the misuse of prescription and non-prescription opioids grew at an alarming rate. In 2017, the United States Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency. Since then, opioid use and opioid related deaths have continued to increase prompting concern from government officials, healthcare providers, and public health advocates (HHS, 2023). Here we explore the current impact of the opioid epidemic and the current intervention strategies as well as explore using exercise as a complementary treatment for recovery. Impact of Opioids The need for an immediate response to the opioid crisis is magnified by the increasing number of lives being lost to overdose. According to the National Institute on Drug Abuse, over 80,000 lives were lost due to opioids in 2021 and the number continues to increase every year. Males are more often impacted, especially once they reach the age of 25. The graphs below outline the impact of opiates on our population, providing insights into the variation among racial demographics and age groups. Overdose Deaths from Synthetic and Prescription Opioids Graph from National Institute on Drug Abuse Opioid Overdose Deaths by Age Graph from the CDC and Spencer, 2022 Opioid Overdose Deaths by Race Graph from the CDC and Spencer, 2022 The Problem with Recovery Sweat it Out! Due to the intensely addictive nature of opioids, cessation has become a new battle facing individuals fighting against substance use disorders. According to NIDA, 40-60% of individuals with substance use disorders experience relapse, often occurring within the first two weeks due to the symptoms of withdrawal. Due to the similarity between opioids and endorphins, studies have shown exogenous drugs reduce the number of endorphins naturally produced in the body. After drug use ceases, low production of endorphins continue for weeks causing and intensifying the painful effects of withdrawal. These withdrawal symptoms have become one of the primary areas targeted by those advocating for opioid use cessation. In the search for improved treatments and recovery services for recovering addicts, the use of exercise has gained some interest. Exercise has been shown to have an array of benefits which include reducing the chance of heart attack, blood cholesterol levels, anxiety, depression, and stress as well as increasing energy, selfesteem, cognitive processing, and resilience (Lynch, 2013). All these benefits would be helpful for drug addicts, as they are for everyone, but further research indicates a greater benefit due to the increased production of endorphins during exercise. To offset the reduced production of endorphins in opioid users, exercise is presented as complementary treatment for the management of symptoms of withdrawal (Ahmadi, 2018; Lynch, 2013). Other research indicates that exercise can also help repair neural connections that are destroyed by opioids (Crist, 2019). Further, the anterior mid-cingulate cortex (aMCC) has been identified as the area in the brain that controls tenacity in an individual (Touroutoglou et al., 2021). Research indicates that the aMCC can be trained to increase an individuals willpower by doing difficult tasks(Colcombe et al., 2006). This indicates that by completing a difficult workout or task, an individual gains the ability to complete other undesirable tasks more easily. Applying these findings to the recovery community, it should be far more common for rehabilitation centers and treatment centers to encourage exercise and strength training. The implementation of a grant for building an exercise center at recovery facilities is one way this could be encouraged. Other methods include employing trainers to work with those in recovery to teach proper technique and build workout programs. Recovery centers could also require a form of exercise as part of their program. Exercise should not be positioned as a singular strategy to replace other established methods in addiction treatment; instead, it should be integrated as a complementary approach, working conjunctively with existing interventions. By incorporating exercise as a cotreatment, individuals undergoing addiction recovery can potentially experience enhanced physical, mental, and emotional well-being. Exercise has the potential to contribute positively to various aspects of recovery and support individuals seeking rehabilitation. Current Solutions 1. Medication-Assisted Treatment (MAT) Focus: Medications are prescribed and used to reduce withdrawal symptoms and cravings. (methadone, buprenorphine, naltrexone) Benefits: Using medications mitigates the effects of withdrawal, reducing pain and cravings. Users are able to gradually reduce their opioid dependence while getting their lives back in order. Drawbacks: The medications used in MAT can also be addictive, simply replacing the drug without mitigating the dependency. Medication use requires a prescription which is not available to all in recovery. 2. Abstinence-Based Approach Focus: This approach advocates for the complete cessation of drug use and promotes total sobriety. It encourages the use of a support group or community and typically follows the 12-step program. Benefits: Abstinence offers a much faster independence from drugs since it does not require a weening period. Individuals gain personal responsibility and autonomy while taking control over their lives. The individual emerges with a healthy community of support to continue through their recovery journey. Many religious groups provide support and transition homes for individuals in the abstinence-based approach. Drawbacks: Withdrawal symptoms must be delt with by the individual. Relapse is more likely especially if they are unable to establish a strong support group. The heavy emphasis on willpower can overlook deeper causes for substance use disorder like trauma or mental health issues. Relapse can cause feelings of shame, guilt or inadequacy in the individual. 3. My Choice Every individual is different, but in most cases, building a support group and choosing abstinence is the better choice. By choosing complete sobriety the individual is empowered and motivated to cease drug use because they want to, not because they have a court order. Furthermore, individuals can grow mentally and spiritually and typically find a deeper meaning to their life. Literature Cited Ahmadi, S., Radahmadi, M., Alaei, H., & Ramshini, E. (2018, April 24). Effect of aerobic exercise on morphine self-administration and pain modulation in rats. Advanced biomedical research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952535/ Colcombe, S. J., Erickson, K. I., Scalf, P. E., Kim, J. S., Prakash, R., McAuley, E., Elavsky, S., Marquez, D. X., Hu, L., & Kramer, A. F. (2006). Aerobic exercise training increases brain volume in aging humans. The journals of gerontology. Series A, Biological sciences and medical sciences, 61(11), 11661170. https://doi.org/10.1093/gerona/61.11.1166 Crist, R., Reiner, B. C., & Berrettini, W. H. (2019, June). A review of Opioid Addiction Genetics. Current opinion in psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368898/ Lynch, W. J., Peterson, A. B., Sanchez, V., Abel, J., & Smith, M. A. (2013, September). Exercise as a novel treatment for drug addiction: A neurobiological and stage-dependent hypothesis. Neuroscience and biobehavioral reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788047/ Sinha, R. (2011, October). New findings on biological factors predicting addiction relapse vulnerability. Current psychiatry reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674771/ Spencer, Merianne R.;Minio, Arialdi M.;Warner, Margaret; Centers for Disease Control and Prevention. (n.d.). Drug overdose deaths in the United States, 20012021. Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/122556 Touroutoglou, A., Andreano, J., Dickerson, B. C., & Barrett, L. F. (2020, February). The tenacious brain: How the anterior mid-cingulate contributes to achieving goals. Cortex; a journal devoted to the study of the nervous system and behavior. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381101/ U.S. Department of Health and Human Services. (2023, September 25). Treatment and recovery. National Institutes of Health. https://nida.nih.gov/publications/drugs-brains-behavior-scienceaddiction/treatment-recovery U.S. Department of Health and Human Services. (2023a, September 25). Drug overdose death rates. National Institutes of Health. https://nida.nih.gov/research-topics/trends-statistics/overdose-deathrates  ...

... 5 4 3 2 1 0 Burnout in Emergency Medicine Physicians Gabriella Ruiz Burnout: A psychological syndrome from emotional exhaustion, depersonalization, and decreased personal accomplishment. Can also include cynicism (Stehman, et al., 2019) Physicians are given no room for mistakes Focus shifted to electronic health records Debt Second victim syndrome About 1 in 2 U.S. physicians have at least one symptom of burnout Consequences of Burnout COVID-19 Effect Physician Burnout New fear of infecting family Lack of resources for family care Massive increase in workload Reliance on less-experienced residents Why Emergency Physicians? Emergency medicine has one of the highest rates of physician burnout 60% of emergency physicians report burnout compared to the 38% in general practices 40% of emergency physicians report high levels of emotional exhaustion and depersonalization This profession includes many sleep disturbances, psychologically demanding situations, and reported low social support at work The average ED physician lifespan is 58.7 years versus the PCP average of 80.3 years Figure. 1 Review Article: Burnout in emergency medicine physicians Solutions Figures 2 and 3. Emergency medicine physician burnout before and during the COVID19 pandemic Effects on Patients Burnout decreases physician empathy Decreased professionalism Higher rates of physician turnover Doubles patient safety incidents Physicians are leaving medicine Untreated clinical depression 40% do not seek help for fear of losing their license 12.9% of male physicians and 21.9% of female physicians suffer with alcohol abuse Up to 18% of physicians treated for substance abuse are emergency physicians 2019 study found 14% considered suicide, and 1% attempted Suicide is the second leading cause of death among residents 1 in 7 emergency physicians report suicidal thoughts Supporting part-time and flexible schedules Do not expect physicians to take work home Hour limits Staff to support in documentation, such as scribes Physician leadership in an ED Teach positive coping strategies Physician small-groups Sources Figure 4. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis  ...

... Closing the Gap in Mental Health Care Candice DeBats Marian University School of Osteopathic Medicine 3200 Cold Spring Road, Indianapolis, IN 46222 Abstract Solution The low accessibility to mental health care in the United States is a major public health problem. This poster reviews the literature on the causes and consequences associated with low accessibility to mental health care, such as the shortage of mental health professionals and health insurance coverage. The consequences are significant and impacts millions due to receiving less-than-optimal or no mental health care. The solution to this issue can be seen through an increase in mental health professionals and psychiatrists nationwide. In order to close the gap in mental health care, the amount of psychiatrists and mental health professionals available throughout the U.S. needs to be increased. By increasing the amount of providers in the country, we could alleviate the potential burden of having out-of-network providers, longer wait times, and minimize the potential that a provider is not accepting new patients. This solution could be implemented by familiarizing medical students to the field of psychiatry, as well as provide them with adequate opportunities to practice in the field. By ensuring students are clinically trained in both under- and over-served communities, they will be prepared for every field of practice and are almost three times as likely to practice in underserved areas (Mongelli et al., 2020). Introduction More than one-third of the U.S. population lives in areas that are underserved by these professionals; about 80% of rural counties lack even a single psychiatrist (Resneck, 2022). Mental health care accessibility has been exceptionally difficult for those of lower socioeconomic status to obtain and has only worsened after the COVID-19 pandemic. Access to mental health care is vital to ones physical health, and should be treated as such by both patients and providers. However, it has been a continuous struggle to provide mental health care for the entire population due to multiple factors on a nationwide level. Whos Affected? - Adolescents and young adults, LGBTQ+ individuals, individuals from historically marginalized racial and ethnic groups, and those in the welfare or juvenile system. (Resneck, 2022) -Racial-ethnic minority groups receive less-than-optimal care due to unconscious bias and stereotypes. (Mongelli et al., 2020) - Rural communities, where more than 1/3 of the population lives in underserved areas. (Resneck, 2022) - Primary care providers are also affected due to the increased integration of behavioral health services into their services, up to 60% of patients with a psychiatric disorder, leading to potential burnout and stress. (Mongelli et al., 2020) Competing Options Since the COVID-19 pandemic, telemedicine has become more popular and accessible, allowing patients to receive care virtually and not have to worry about waiting in-person. However, there is still limited and/or restricted access to innetwork health care providers, long wait times, potential providers not accepting new patients, and other plan coverage limitations. Although telemedicine seems convenient, it poses its disadvantages, especially in regard to mental health, such as difficulties in detecting nonverbal cues, and the lack of physical proximity in the doctor-patient relationship (Collins, 2023). Another competing option that has tried to bridge the gap in mental health care is to provide more federal efforts through the usage of grants and enhancing crisis responses, such as investing $836 million towards 9-8-8, according to SAMHSA. However, there is still an increased number of suicides: 30% for many vulnerable groups since the turn of the millennium (Collins, 2023), so the problem lies more so in the accessibility to citizens directly, not corporations or businesses. Works Cited Collins, S. D. (2023, September 20). Access to mental healthcare difficult for 10.5 million Americans. UPI. https://www.upi.com/Health_News/2023/09/20/mental-health-access/3301695215965/ Dicken, J. E. (n.d.). Mental health care: Access challenges for covered consumers and relevant federal efforts. Mental Health Care: Access Challenges for Covered Consumers and Relevant Federal Efforts | U.S. GAO. https://www.gao.gov/products/gao-22-104597 Lopes, L., Kirzinger, A., Sparks, G., Stokes, M., & Brodie, M. (2022, October 6). KFF/CNN Mental Health in America Survey. KFF. https://www.kff.org/mental-health/report/kff-cnn-mental-health-in-america-survey/ Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020, January 24). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. Focus (American Psychiatric Publishing). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011222/ Ramesh, T., McBain, R. K., & Cantor, J. H. (2023, September 14). Mental health outcomes in US counties lacking broadband access and psychiatrists. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809394 Resneck, J. (2022, November 3). Lack of access to evidence-based mental health care poses grave threat. American Medical Association. https://www.ama-assn.org/about/leadership/lack-access-evidence-based-mental-health-care-poses-grave-threat Samhsa seeks $10.8 billion in fiscal year 2024 to bolster mental health and substance use services across the nation. (2023, March 13). https://www.samhsa.gov/newsroom/press-announcements/20230313/seeking-funding-fy-2024-bolster-mentalhealth-substance-useservices#:~:text=The%20Presidents%20Budget%20for%20Fiscal,agencys%20FY%202023%20enacted%20budget. Study reveals lack of access as root cause for mental health crisis in America. National Council for Mental Wellbeing. (2022, November 17). https://www.thenationalcouncil.org/news/lack-of-access-root-cause-mental-health-crisis-in-america/ The United States Government. (2023, July 25). Fact sheet: Biden-Harris Administration takes action to make it easier to access in-network mental health care. The White House. https://www.whitehouse.gov/briefing-room/statementsreleases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network mentalhealthcare/#:~:text=The%20Administration%20recently%20issued%20proposed,mental%20health%20and%20subst ance%20use  ...

... The Counter-productive Problem of Overmedication in the United States Gupta, Ansh Michael A. Evans Center for Health Sciences, Marian University, Indianapolis 3200 Cold Spring Rd, Indianapolis, IN 46222 Introduction Proton Pump Inhibitors Antidepressants What is Overmedication? Overmedication is a very broad term with many definitions, each centering around the concept of administering too much medication(s). Though not to the point where it may be considered an overdose, it is still considered excessive/unnecessary and can lead to side-effects. In the context of this presentation, I will be referring to the more specific definition of over-prescription, the concept that a patient is prescribed more medication than is necessary to resolve their condition. What are Proton Pump Inhibitors (PPIs)? Proton Pump Inhibitors (PPIs) are a class of drugs which focus on stomach acid production and a variety of diseases/disorders related to it. PPIs typically function to decrease the production of stomach acid. Their mechanism of action (MOA) focuses on the downstream inhibition of neurotransmitters acetylcholine, histamine, and gastrin (all of which regulate H+ ion production). They are used as first-line therapeutic agents for GERD diseases such as NERD, esophagitis, Peptic ulcer disease, Zollinger-Ellison syndrome, etc. [4]. What are Antidepressants? Antidepressants are a broad class of drugs used to treat not only depression, but a variety of medical disorders such as obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD). The MOAs of these drugs typically work to increase concentrations of neurotransmitters such as serotonin and norepinephrine at nerve terminals [24]. Top 5 most overused medications in the US To better understand the problem of overmedication, it may help to focus on some of the top ten most prescribed drug classes in the US. A study in the National Library of Medicine (NLM) focused on drug classes which may warrant closer analyses on their benefits vs. side-effects. It was identified that Proton Pump Inhibitors (PPIs) for indigestion, Levothyroxine for hypothyroidism, Statins, Opioids for chronic pain, and Antidepressants were some of the most frequently prescribed drugs [1]. Long-Term Treatment Concerns & Overprescription One study from 2008 found that 25-70% of patients worldwide take PPIs without proper indication. The same study found that it is common for patients to be prescribed PPIs during an impatient stay to prevent stress ulcers and gastrointestinal bleeding. Following discharge, many patients continue taking their PPIs without indication or planned date for cessation [11]. Many studies have been conducted focusing on the long-term adverse effects of PPIs. Initially, these adverse effects were limited to calcium malabsorption, Vitamin B12 deficiency, and in recent years, long-term PPI usage has been linked to dementia and chronic kidney disease (CKD). A few of these will be focused on below: Calcium is essential to bone health and is primarily derived from the diet and oral supplements. When stomach pH is too high (due to PPI usage), calcium is not absorbed into the blood and is eliminated with waste products. A 2012 survey focused on hip fracture rates in women taking PPIs. The study found a 35% increase in hip fracture rate in women taking PPIs for at least 2 years. The risk was higher in women who took PPIs for longer periods. Finally, women who stopped using PPIs for >2 years had a hip fracture risk comparable to those who never took PPIs [10]. Vitamin B12 has been determined to be essential for proper cognitive function. Like calcium, Vitamin B12 requires a more acidic environment for proper absorption. Data has demonstrated that patients presenting with cognitive decline have been found to have improper myelination lesions specific to B12 deficiency. This link of B12 deficiency to cognitive decline has led to the hypothesis of Dementia development due to excessive PPI usage. In a 2016 study, researchers found patients aged >75 who used PPIs regularly (at least one prescription every 3 months) had a 44% increased risk of dementia incidence [9]. CKD has been estimated to afflict more than 10% of the population in the US. Many studies have found links between PPI usage and acute interstitial nephritis (AIN) and acute kidney injury (AKI) [7,8]. A study using a long-term running cohort found that patients who regularly used PPIs had an increased risk of CKD at 145% and an increased risk of AKI at 172%. Increased dosage found an increased risk of CKD [6]. Long-Term Treatment Concerns & Overprescription Treatment with antidepressants can be short-term, long-term, or both. The short-term is characterized by the acute and continuation phases, while the long-term is characterized by the maintenance phase [26]. Depression is known to occur recurrently and is often managed in primary care, though the results vary in desirability. A review of studies from primary care depression cases found that patients undergoing long-term pharmacological treatment had varying, poor experiences with multiple relapses. On the other side, naturalistic studies found that patients who received non-drug treatment experienced no decline, and in some cases, experienced significant improvement. An article in the American Psychological Association described the issue of patients receiving drug treatments from their primary care providers, without consulting a mental health professional who may direct them to non-drug related treatments better suited to each individual [29]. Antidepressants are known to have several side effects ranging from sexual dysfunction, weight gain, and sleep difficulties to increased risk of osteoporosis, bleeding disorders, and diabetes (Ferguson, 2001). Antidepressant usage has even been linked to increased risk of Parkinsons Disease (PD). A study in the UK found that an increased risk of PD was associated with patients who had undergone antidepressant treatment for at least ~2 years [25, 27]. Figure 1: Use of prescription drugs over a 30-day period in 2015-2016 in the US and Canada [2]. Levothyroxine What is Levothyroxine? Levothyroxine is the primary medication for treatment of primary, secondary, and tertiary hypothyroidism. It works as a synthetic version of the naturally produced thyroid hormone: thyroxine (T4). Natural thyroxine plays a significant role in directly influencing body metabolism. Levothyroxine mimics this role in the absence of sufficient natural T4 [12]. Statins Long-Term Treatment Concerns Levothyroxine is known to have some adverse effects which are usually due to dosing errors or allergies. Its contraindications are renal system and cardiovascular-related (MIs, myocarditis, cardiac arrythmias). There have been some studies attempting to link long-term Levothyroxine to cancers, but there has not been any inclusive evidence to date [13,14,15]. What are Statins? Statins are used for the treatment of a multitude of types of hypercholesterolemia, hyperlipoproteinemia, and hyperglyceridemia. They work to decrease overall cholesterol, specifically lowering LDL while simultaneously raising HDL. Statin have a complicated MOA, but to summarize they focus on the inhibition of HMG-CoA reductase, an enzyme critical for cholesterol synthesis [16]. Overprescription Overprescription problems begin with the treatment of subclinical hypothyroidism, a diagnosis of mildly elevated TSH in the presence of normal thyroxine. Studies suggest that 90% of levothyroxine prescriptions are improper because they are used to treat mild subclinical hypothyroidism or even normal thyroid function, leading to minimal improvement in quality of life. One study found that ~23 million in the US are prescribed Levothyroxine however, ~21 million likely dont need it due to diagnosis errors [19]. A study from the Journal of the Endocrine Society discussed the effects of shifting seasons on the variance of thyroid function in Japanese populations. This study found that TSH peaked in winter months while dipping in the summer [17]. This suggests the possibility of many hypothyroidism misdiagnoses highly alarming when considering adverse effects such as anxiety, diarrhea, and in the worst cases: cardiovascular morbidities and death [18]. The Statin Controversy Statins have widely been regarded as the golden standard for cardiovascular disease (CVD) prevention. However, there is still controversy regarding their overprescription especially statin use as primary preventatives. One study in the BMJ showed no benefit in individuals with a 10-year CVD risk of <20% [21]. This revelation begs to question: Why are so many patients in this risk range still prescribed statins and what are the potential adverse effects? Unfortunately, most studies on statins have been based on industry-based trials aimed at the benefits. These trials tend to exclude large numbers of participants after screening, as revealed from a study by the Heart Protection Study which excluded ~36% of its participants, many of whom may suffer from adverse effects due to statins, before the trial began. Other, community-based studies suggest that more than 60% of patients struggle with compliance with statins due to adverse effects [22]. These studies not only bring into question the credibility of industry studies focused on statin benefits in low-risk groups, but also the bigger problem behind this controversy. Solutions There is no simple solution to this problem with conflicting interests. After all, healthcare is unfortunately a business. Save for the case with Statins, the commonality between the other drugs overprescription ties back to excess workload in primary care. These physicians are, on average, seeing ~20 patients daily amongst many other nonclinical duties such as paperwork [30]. Understandably, one can sympathize with a physician who may turn to prescribing a working medication as a quick means to an end so that they may get to each of their patients. However, even if the goal is to be able to provide care for each patient, quality is more important than quantity. Sadly, the physician workload problem is another problem of its own. Therefore, I propose an experimental solution that is very cost effective. Physicians should turn to the Tenets of Osteopathic Medicine, specifically: the body is a unit; the person is a unit of body, mind, and spirit. Medical practice should emphasize the ability of the body to heal itself. Priority must be placed on non-drug treatment first, though this is easier for some pathologies than others (Some industries will certainly be unhappy with this). Consider the patients lifestyle first and what changes can be made there before jumping to drug therapy. Also, try to educate patients on all the possible benefits and side effects (short-term and long-term, cite studies such as those included in this presentation) to drug treatments - this will allow for a shift in the current attitude towards healthcare (that there is a medicine for most conditions and patients can rely on these drugs without changing their lifestyle). Allow the patient to choose if the long-term side effects are worth the risk or if they would rather change their lifestyle and solve the problem naturally, and for good. Literature Cited  ...

... Prescription for Change: Tackling Indianas Primary Care Physician Shortage Anthony M. Stultz, B.S. Marian University College of Osteopathic Medicine 3200 Cold Spring Rd, Indianapolis, IN 46222 Whats a Primary Care Physician? A primary care physician is a field of doctors that play a very active role in the patients lifestyle and well-being. Primary care doctors are the main point of care for their patients, and they provide care for preventing, treating, and curing for both acute and chronic illnesses. They value the mind, body, and spirit of the patient and look at the patient as a whole, rather than only focusing on one area of patients health. There are five main types of Primary Care Physicians: Family Medicine Physicians Internal Medicine Physicians Obstetrics and Gynecology (OB-GYNs) Pediatricians Geriatrics Todays Findings In Indiana, other specialties dominant the physician workforces. Primary care physicians only take up 34.2% of the workforce. In the Primary Care Physician workforce, 45.2% are Family Medicine Physicians. Of that percentage, less than half see Geriatric patients (patients >65 years old). Obstetrics and Gynecology make up the smallest percentage of practicing Primary Care Physicians. Pediatrics also makes up a significantly small percentage of primary care physicians in the workforce. Introduction In the United States, one of the biggest issues that every state is experiencing is the shortage in doctors. Primary Care Physicians make up a huge percentage of the shortage in doctors. The Midwest took a huge hit by this shortage, especially in rural Indiana. In Indiana today, there are approximately 3,900 primary care physicians. Most primary care physicians are located more towards bigger cities such as Indianapolis, but due to the high demand for primary care physicians, it is difficult to see a primary care doctor. According to pulse today, a primary care physician sees on average more than 25 patients a day and it is believed to increase if this shortage is not addressed in the next decade. Who is Affected? In Indiana today, all parts are struggling with the shortage, especially in the rural parts. Two counties in Indiana are currently experiencing the greatest affected by the shortage in primary care doctors. Union county, located southeast of Indianapolis and on the border of Ohio, are forced to have to go to neighboring counties or go into Ohio for medical services. Another country greatly affected is Benton county, located northwest of Indianapolis and on the border of Illinois. Citizens in this county must resort to neighboring counties in Indiana and Illinois for medical services by a primary care physician. The absence of primary care doctors in Indiana, especially in these counties, lead to an increase in the shortage of primary care physicians in all the Midwest. Solution to the Problem Recently, the medical schools in Indiana are responding to the shortage. Medical schools are adjusting part of their curriculum to emphasize primary care. Adjusting their curriculum allows medical students to get more exposure to primary care. Indiana University School of Medicine have introduced rural health programs, such as in Terre Haute, to help areas that need primary care. Marian University College of Osteopathic Medicine has implemented scholarships that students could receive while being in the D.O. program if they have a strong desire to go into primary care. This resolves medical students' problem with excessive amount of student loan debt. Additional solutions for the shortage in primary care physicians could vary depending on the type of physician: Increase the use of telemedicine Student loan forgiveness Increase physician funding Increase awareness of all the benefits of being the direct point of care for patients References  ...

... Compounding Issues from the Psychiatrist Shortage in the United States Marian University College of Osteopathic Medicine Lily House Background: Increased Need for Psychiatrists Increasing Demands for Mental Health Services Suicide is the 2nd leading cause of death in ages 10 -14 after unintentional injury Pediatric mental health-related emergency department visits have almost doubled in the past 10 years 1 in 5 adults in the U.S. experience mental illness each year Suicide Rates in the United States (2000-2020) Data Courtesy of CDC Age-Adjusted Suicide Rate (per 100,000) 25 20 15 22.822.8 22.422.4 22.422.4 21.921.9 21.321.3 21.021.0 20.720.7 20.320.3 20.220.2 20.020.0 19.819.8 19.219.2 19.019.0 18.518.5 18.518.5 18.218.2 18.118.1 18.118.1 18.118.1 18.118.1 17.717.7 14.214.2 14.014.0 13.913.9 13.513.5 13.413.4 13.313.3 13.013.0 12.612.6 12.512.5 12.312.3 12.112.1 11.811.8 11.611.6 11.311.3 11.011.0 11.011.0 11.011.0 10.910.9 10.810.8 10.710.7 10.410.4 10 5 6.06.06.06.06.16.16.26.26.06.05.55.5 5.05.05.25.25.45.45.55.55.85.8 4.94.9 4.84.8 4.74.7 4.54.5 4.54.5 4.44.4 4.04.04.14.14.24.24.24.2 Compounding Issues from the Shortage Increased Wait times for Psychiatric Care Individuals may wait up to several months for an intake appointment with a psychiatrist In 2022, the median wait time for in-person appointments was 67 days and for telepsychiatry was 43 days Underrepresentation of Minorities in Psychiatrists Black, Hispanic, and American Indian, Alaskan Native, Native Hawaiian, Pacific Islander (AI/AN/NH/PI) psychiatrists are significantly underrepresented in their field as practicing physicians compared to the U.S. population 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Treatment Delays The average delay between onset of mental illness symptoms and treatment is 11 years 47.2% of U.S. adults with mental illness received treatment in 2021 Nearly 60% of patients who receive mental health treatment do so through their primary care physician Shortage Areas 164 million people live in mental health professional shortage areas Total Population Female Male Psychiatrist Shortage More than half of U.S. counties lack a psychiatrist Of 3,135 total counties in the United States, 1,446 had at least one psychiatrist (46.1%). What is being done? Expansion & Addition of Medical Residency Programs Legislation in 2020 added 200 residency slots across all medical specialties The number of residents in psychiatry has increased by 21% 57% of residency programs reported wishes to expand but faced financial barriers What is being done (continued) Telepsychiatry Services 40% of mental health services provided are via telehealth Self-paced modules for cognitive behavioral therapy are offered, which may provide patients with coping tools while they wait for an intake appointment 988 Lifeline Established in 2022 Suicide and crisis lifeline is freely available to anyone 24 hours a day, 7 days a week Trained crisis counselors provide confidential support, crisis counseling, and additional resources via text or phone call What else can be done? Collaboration between Psychiatrists and Primary Care Physicians Nearly 60% of patients who receive mental health treatment do so through their primary care physician Collaboration between PCPs & psychiatrists can aid in ensuring patients are treated appropriately and in a time efficient manner Continued Telepsychiatry & Telehealth Services Telepsychiatry offers individuals access to psychiatric treatment regardless if they are in a shortage area Continued Funding for New Psychiatry Residency Programs and increased number of Residency Slots An increased number of psychiatry residents targets the issue at its core by directly increasing the number of practicing psychiatrists in the future References  ...

... The Importance of Childhood Vaccinations in an Era of Misinformation Claire Kinder Introduction In recent medical history, vaccinations have facilitated the reduction/eradication of many transmissible diseases (Olusanya et al., 2021). Recently, a growing reluctance of parents to vaccinate their children is a pertinent threat to public health and safety (Garett et al., 2021). Non-compliance Non-compliance to routine childhood immunizations increases the likelihood of an outbreak of preventable diseases (Olusanya et al., 2021). This non-compliance is bred by vaccine misinformation which is being spread by many news channels, websites, and social media sites. Nationally, the number of non-medical vaccination exemptions is at 2.5% and it is steadily increasing (Olusanya et al., 2021). While 45 states and Washington D.C. only grant religious vaccine exemptions, 15 states permit philosophical vaccination exemptions based on an individuals personal beliefs (Olusanya et al., 2021). Scientific literature continues to debunk common myths about the dangers of childhood vaccines, however not everyone can access, read, and comprehend these documents. It is necessary to educate the masses on the importance of getting vaccinated and vaccinating their children. Misinformation Home Visits Disingenuous information regarding vaccines is harmful, but very common on the internet. Out of all the U.S. citizens with access to the internet, 55% disclosed that the information they accessed online influenced their health behaviors (Garett et al., 2021). When searching online for vaccinations and immunizations, researchers noted that 43% of the websites that populated were anti-vaccination websites (Garett et al., 2021). These anti-vaccination websites instill fear in their readers by questioning the safety and effectiveness of vaccines, implying that vaccines promote the restriction of freedom, and offering safer alternatives to vaccinations (Garett et al., 2021). In a study examining the HPV vaccine, social media was more impactful to the variance in vaccine coverage as compared to socioeconomic factors and less people were vaccinated in states with higher exposure to vaccine misinformation, conspiracy theories, and safety concerns (Garett et al., 2021). Although misinformation is a factor, the main reason for under-vaccination of children is missed doctors appointments (Blue Cross Blue Shield, 2018). To increase the number of properly vaccinated children, we can implement home visits. Home visits consist of a medical provider visiting a patients residence and assessing the patients vaccination history, educating the patient and/or the patients guardian(s) on the importance and safety of vaccines, and either providing the vaccine at the time of the visit or setting up a follow up appointment to receive the vaccine (Healthy People 2030, 2016). COVID-19 Although in June of 2022 the COVID-19 vaccination was approved for children 6 months old to 11 years old, some parents still chose not to vaccinate their children. As shown in the graph below, as of May 2023, 56% of children in the US have not received the first dose of the vaccine. This powerful quote sums up the origin of this growing vaccination hesitancy: the amount of misinformation online surrounding the vaccine has been labeled as a second pandemic (Garett et al., 2021). Combatting Misinformation Although it is impossible to monitor everything that is posted on the internet, it is necessary to provide factual, data-based health information that is accessible to everyone. By creating a team of dedicated scientists, physicians, and other healthcare workers to patrol the internet and correct misleading information on vaccines, I believe we can combat harmful misinformation. Social media websites can also create algorithms and implement policies that prevent users from fabricating facts about vaccines (Garett et al., 2021). Citations Olusanya, O. A., Bednarczyk, R. A., Davis, R. L., & Shaban-Nejad, A. (2021). Addressing parental vaccine hesitancy and other barriers to Childhood/Adolescent vaccination uptake during the coronavirus (COVID-19) pandemic. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.663074 Vaccination programs: Home visits to increase vaccination rates. Vaccination Programs: Home Visits to Increase Vaccination Rates - Healthy People 2030. (2016, March 24). https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/vaccination-programs-home-visits-increase-vaccinationrates Early childhood vaccination trends in America. Blue Cross Blue Shield. (2018, January 18). https://www.bcbs.com/the-health-of-america/reports/earlychildhood-vaccination-trends-america Garett, R., & Young, S. D. (2021). Online misinformation and vaccine hesitancy. Translational Behavioral Medicine, 11(12), 21942199. https://doi.org/10.1093/tbm/ibab128  ...

... Work-Life Balance of Healthcare Specialists Biomedical Science, Marian University, Indianapolis Basil Mustaklem Background What is Work-Life Balance? Why? Data Why are physicians more prone to work-life imbalance? Age distribution in percentage In total, 530 of the 1,393 physicians and APCs responded to the initial burnout survey. 54% were female; 25.3% were hospital based, 43.9% were office based, and the remaining were both office and hospital based. The Cambridge dictionary defines work-life balance as the amount of time you spend doing your job compared with the amount of time you spend with your family and doing things you enjoy. For physicians, however, defining what work time means is complex in modern medicine. Typical physician duties include patient contact, administrative tasks, charting, teaching, meetings, and community outreach activities. Individual and organizational factors may affect burnout in physicians and advance practice clinicians (APCs), such as the addition of mobile technology which can impede personal time with work. Burnout levels have risen four points from 61% in 2021 to 65% in 2022 of surveyed physicians. Among the associated physicians with burnout, 75% have stated that their work-life balance has deteriorated within the past year (2022). Among the respondents, 60.5% and 32% had symptoms of moderate to high EE and DP, respectively. 28% of the respondents had symptoms of moderate to low personal accomplishment. What contributes to Work-Life Balance? Sleep Exercise Nutrition Interactions with family and friends Pursuits of enjoyment Response Emotional exhaustion score according to specialty. The major factors impacting work life balance included workload, workflow, and scheduling. What are beneficial changes that physicians want? A total of 1393 surveys were sent out. Of these, 530 respondents gave complete baseline data, and 343 responded to the follow-up survey. There were 414 individual comments, which included 663 factors on worklife balance. The major factors impacting worklife balance included workload, workflow, and scheduling, followed by comments on administration and meetings, time/time off, staffing, and self-care. Effect What is the effect of an improper work-life balance? Financing Decreased hospital capacities Privatization of hospitals Pressure for overperformance Increased cynicism in physicians Inclination to leave clinical work Higher medical errors and malpractice risk Lower work ethic Decreased quality of life Direct negative impact to mental and physical wellbeing Alcohol and drug abuse Higher suicide rates for physicians than the general population Due to the overwhelming amount of stimulus in the field of healthcare, it isnt uncommon for even the best caretakers to develop poor work-life balance habits, leading to symptoms of long-term burnout. Packed schedules, demanding pace, time crunches, and emotional intensity are all aspects in a physicians career that may not be seen as significantly impactful in other careers. There is a known stigma within society that physicians and medical providers are supposed to be superhuman and not suffer from the same diseases as others. But research has shown that early signs of poor work-life balance and burnout can be attributed to the educational level, when students are in the process of acquiring their MD or DO degree. Solutions There is a significant level of burnout in physicians and APCs which is directly linked to the lack of work-life balance in their careers. With the ever-increasing need for healthcare providers in our society, it is paramount that communities recognize and respect the importance of proper work-life balance. Although adjustments for work-life balance require foundational changes at the industry level, practicing healthcare professionals can also incorporate individual quality of life alterations to alleviate burnout and improve work-life balance. Potential methods for industry level improvement for work-life balance: Reduced working schedules Fines for pressuring overtime work Flexible contracts for healthcare providers Working towards a culture that values physician health Potential methods for individual improvement for work-life balance: Schedule Personal Time Learn to say No Establish Boundaries References Aymes, Shannon. Work-Life Balance for Physicians: The What, the Why, and the How. Www.medicalnewstoday.com, 22 Sept. 2020, www.medicalnewstoday.com/articles/318087. Hussenoeder, Felix S., et al. Comparing Burnout and Work-Life Balance among Specialists in Internal Medicine: The Role of Inpatient vs. Outpatient Workplace. Journal of Occupational Medicine and Toxicology, vol. 16, no. 1, 9 Feb. 2021, https://doi.org/10.1186/s12995-021-00294-3. Search, Jackson Physician. Improving Physician Work-Life Balance. Jackson Physician Search, 7 Dec. 2022, www.jacksonphysiciansearch.com/insights/improving-physician-worklife-balance/. Accessed 28 Nov. 2023. Thimmapuram, Jayaram R, et al. Factors Influencing WorkLife Balance in Physicians and Advance Practice Clinicians and the Effect of Heartfulness Meditation Conference on Burnout. Global Advances in Health and Medicine, vol. 8, 15 Jan. 2019, p. 216495611882105, https://doi.org/10.1177/2164956118821056.  ...

... Pharmaceutical Prices Over Time & the Effects in the United States Biomedical Science Program, Marian University, Indianapolis Devin Wilham Abstract (Background) The annual increase on price of pharmaceuticals are becoming a growing health concern in the United States for patients, prescribers, and policy makers. Why is this an issue? Prices of newly marketed and pre-existing pharmaceuticals in the United States has exponentially increased each year. The United States has spent more on pharmaceuticals than other countries. (PGPF) Increase in co-payments for pharmaceuticals reduce affordability of prescribed regiments and reduce patient adherence. (Kesselheim et. al.) How did the issue come to be? A series of instances have led to the issue at hand such as: United States healthcare system enables pharmaceutical manufacturers possessing the ability to freely set prices after approval. (Rome et.al.) The United States possesses market forces that enable continuous high pharmaceutical prices: protection from competition and negotiating power. (Kesselheim et. al.) Who is Impacted All citizens, adult and child, of the United States are impacted, but particularly those who do not possess adequate public or private health insurance. As of 2023, approximately 30 million people in the United States are uninsured and approximately 9 million children in the United States lack proper healthcare coverage. Addressing the Issue Evidence Price Trends for Newly Marketed Drugs from 2008-2021 by Drug Characteristic Price Trends overtime, 2008-2021. Reprinted from Trends in prescription drug launch prices, Rome et. al., 2022. Per Capita Spending on Prescription Drugs in 2019 by Country Per Capita Spending on Prescription Driugs, 2019. Reprinted from Peter G. Peterson Foundation, PGPF, 2022. Prices for Newly Marketed Drugs from 2008-2021 Within the recent years, pharmaceutical policy has been a major topic in the United States government. Most recently in 2022, progress within the pharmaceutical drug policy has been made by Congress. The Inflation Reduction Act -2022 Provides authority to Medicare and Medicaid Services to negotiate pharmaceutical prices. Require pharmaceutical companies to pay rebates to Medicare for price increases that outpace inflation. Provide senior citizens with financial protection. In addition, in recent years, the Supreme Court of the United States forced the US Patent and Trademark Office reevaluate previous permissive approach to the patentability to pharmaceuticals. Solutions Price Trends overtime, 2008-2021. Reprinted from Trends in prescription drug launch prices, Rome et. al., 2022. Attention to Issue With the annual growing price in pharmaceuticals in tandem with the number of people without adequate health insurance. Multiple negative impacts arise such as: Increase in copayments reduce pharmaceutical use by 26% among low-income individuals. Increase in pharmaceutical fees led to a 14% reduction in the use of essential medications leading to a 78% increase in emergency room admission rates and 88% increase in adverse event rates. A potential solution is to increase government involvement to reduce pharmaceutical prices via: Creation of a separate governing body or enhancement of a pre-existing governing body within the federal government. Negotiate pharmaceutical prices at their respective launch and continued sale. Enhance to individuals on other healthcare plans beyond Medicare and Medicaid Services. As pharmaceutical price decrease, the potential of increased affordability can transpire, thus: Increase use among low-income individuals. Increase use of essential medications. Decrease emergency room admission rates. Decrease adverse event rates. Literature Cited Assistant Secretary for Public Affairs (ASPA). New HHS Report Shows National Uninsured Rate Reached All-Time Low in 2023 after Record-Breaking ACA Enrollment Period. HHS.Gov, 8 Aug. 2023, www.hhs.gov/about/news/2023/08/03/new-hhs-report-shows-national-uninsured-rate-reached-all-time-low-2023-after-record-breaking-aca-enrollment-period.html. How Many Americans Dont Have Health Insurance in November 2023? Simply InsuranceTM, 8 June 2023, www.simplyinsurance.com/how-many-americans-dont-have-health-insurance/. How Much Does the United States Spend on Prescription Drugs Compared to Other Countries? Peter G. Peterson Foundation, 7 Nov. 2022, www.pgpf.org/blog/2022/11/how-much-does-theunited-states-spend-on-prescription-drugs-compared-to-other-countries. Hwang, Thomas J., et al. New reforms to prescription drug pricing in the US. JAMA, vol. 328, no. 11, 2022, p. 1041, https://doi.org/10.1001/jama.2022.15268. Kesselheim, Aaron S., et al. The high cost of prescription drugs in the United States. JAMA, vol. 316, no. 8, 2016, p. 858, https://doi.org/10.1001/jama.2016.11237. Lexchin, Joel, and Paul Grootendorst. Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: A systematic review of the evidence. International Journal of Health Services, vol. 34, no. 1, 2004, pp. 101122, https://doi.org/10.2190/4m3e-l0yf-w1td-ekg0. Nelson, Arthur A., et al. The effect of a Medicaid drug copayment program on the utilization and cost of prescription services. Medical Care, vol. 22, no. 8, 1984, pp. 724736, https://doi.org/10.1097/00005650-198408000-00004. Rome, Benjamin N., et al. Trends in prescription drug launch prices, 2008-2021. JAMA, vol. 327, no. 21, 2022, p. 2145, https://doi.org/10.1001/jama.2022.5542. Tamblyn, Robyn. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA, vol. 285, no. 4, 2001, p. 421, https://doi.org/10.1001/jama.285.4.421. Wineinger, Nathan E., et al. Trends in prices of popular brand-name prescription drugs in the United States. JAMA Network Open, vol. 2, no. 5, 2019, https://doi.org/10.1001/jamanetworkopen.2019.4791.  ...