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Recent Research: Healthcare 2021-2022

A collection of recent Amish and plain Anabaptist studies research publications in healthcare.

Cory Anderson & Lindsey Potts (2022). Physical health conditions of the Amish and intervening social mechanisms: an exhaustive narrative review. Ethnicity & Health, 27(8): 1952-1978

Abstract: As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers our knowledge of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population. Amish health research, now representing approximately a quarter of all Amish-focused publications, is in need of review, to the end of strengthening this knowledge body’s coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. Herein, we synthesize and discuss Amish physical health conditions research, both the population’s distinctive health profile and mechanisms shaping this profile. Specifically, we summarize research addressing BMI, physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. In reflection, we raise questions about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups’ health, several recurring methodological complications, and public health policy considerations.

Key words: synthesis, rural health, population health, anabaptist, religion and health

Anderson, Cory, and Lindsey Potts (2021). Research Trends in Amish Population Health, a Growing Literature about a Growing Rural Population. Journal of Rural Social Sciences, 36(1): Article 6.

Abstract: The Amish are an endogamous rural population experiencing rapid growth; consequently, they have attracted the attention of population health researchers and service providers. With approximately one quarter of all Amish studies publications now devoted to population health (n=246), the time is ripe to review research trends. Using bibliometric measures, we map the genealogy, influence, and configuration of Amish health publications. Amish population health research has (1) a health culture-focused core with clusters representing social science and health practice, (2) peripheral clusters addressing health conditions–mental, physical, and injury/safety–and (3) several clusters straddling both. We identify fruitful interdisciplinary studies and recommend researchers investigating health culture and conditions seek ways to integrate their research agendas. This article represents a pivot-point for Amish population health research, for it provides a first-ever bibliometric mapping, allowing researchers to more easily locate their work within the literature and identify opportunities for interdisciplinary collaborations.

Key words: bibliometric analysis, citation network analysis, ethnicity and population health, meta-review, religion and population health

Seiler RL, Kallies KJ, Borgert AJ, Reetz SR, Jarman BT. (2022). Postoperative Outcomes in the Plain Community Population of Western Wisconsin. The American Surgeon.

Abstract: Background: Residents of plain communities constitute an underserved minority population that is not reliably captured in contemporary surgical outcomes research. We hypothesized that plain communities (PC) patients would have higher postoperative complication rates than a general surgical population. Methods: A retrospective review of 30-day postoperative outcomes for PC patients compared to a majority (non-PC) matched patient population from September 2014 to March 2020 was performed. The primary outcome measure was any complication within 30 days of surgery. Results: 270 PC patients were matched with 493 non-PC patients. The 30-day complication rate was higher for the PC group (6.3% vs 3.7%, P = .09), though not statistically significant. There was significantly lower utilization of preventive care services, and postoperative follow-up among PC patients. Discussion: Although our regional PC surgical patient population utilized preventive and postoperative health care services less than the non-PC population, there was no statistically significant difference in overall 30-day postoperative morbidity or mortality.

Zoran, S., Anbouba, G., Zhao, Q. et al. (2022). Telemedicine in the Amish and Mennonite communities of Wisconsin. J Community Genet. 13:445–448.

Abstract: The Plain Community (PC) is a medically underserved group found predominantly in the northeastern and midwestern USA. Due to the community’s founder population with few converts and infrequent outside marriage, metabolic and genetic disorders are more prevalent. Individuals in the PC experience geographic, financial, and cultural barriers when accessing healthcare. In Wisconsin, a collaboration between clinicians at a rural community health clinic and the academic medical clinic established an outreach clinic for medical genetics located in a rural location closer to a Wisconsin PC which consists of both Amish and Mennonite communities. However, patients with acute medical concerns requiring more urgent genetics care must travel to the academic center. Telemedicine (TM) is a technology that increases access to healthcare, often reducing financial and travel barriers. Using survey tools, we explored whether TM could be used to provide genetic services to individuals in the Wisconsin PC at an outreach clinic. Results indicated that 36% of survey participants responded favorably to receiving services by TM at a clinic designed for the PC. Members of the Mennonite community are significantly more likely to consider receiving services via TM than those of the Amish community. The results of the surveys indicate potential utility of TM at the outreach clinic as alternative way to improve access to genetic and other subspecialty services for the PC.

Key words: telemedicine, genetic, outreach, plain people

Long S, Lowe R B (2022). Severe Pertussis Infection With Hyperleukocytosis in a 10-Month-Old Unvaccinated Amish Female: A Case Report. Cureus 14(7): e26885.

Abstract: Bordetella pertussis (B. pertussis) commonly infects individuals of all ages. However, pertussis, the disease caused by B. pertussis infection, is most severe in young infants. Severe pertussis, defined by the presence of refractory hypoxemia, pneumonia, cardiogenic shock, and hyperleukocytosis, is associated with significant morbidity and mortality. Both hyperleukocytosis and pulmonary hypertension have been found to be predictive of mortality in young infants. Leukoreductive strategies such as leukapheresis and exchange transfusion have been employed to treat these complications. Pulmonary hypertension is thought to be a result of aggregation of white blood cells in pulmonary vasculature; however, studies have suggested that the mechanism of pulmonary hypertension is multifactorial. We report a case of a 10-month-old unvaccinated Amish female with pertussis complicated by an initial hyperleukocytosis of 204,900 103/uL successfully treated with leukapheresis in our pediatric intensive care unit. This infant never showed signs of pulmonary hypertension, which is often associated with hyperleukocytosis in severe or fatal cases of pertussis in infants and neonates. To our knowledge, this is the most significant degree of hyperleukocytosis reported in pertussis. The findings in this case support the clinical utility of leukoreductive therapy in severe pertussis and provide some evidence that the mechanism of pulmonary hypertension in these patients is multifactorial.

Whitney L, Bonneville K, Morgan M, Perea LL. (2022). Mechanisms of Injury Among the Amish Population in Central Pennsylvania. The American Surgeon. 88(4):608-612.

Abstract: Background: Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population. We hypothesize that there will be an increased incidence of agriculture-related mechanisms of injury. Methods: All Amish trauma patients presenting to our level I trauma center over 20 years (1/2000-4/2020) were retrospectively analyzed. Mechanism and geographic location of injury were collected. Demographic and clinical variables were compared between the age groups. Results: There were 1740 patients included in the study with 36.4% (n = 634) ≤ 14 years. Only 10% (n = 174) were ≥ 65 years. The most common mechanism across all ages was falls. However, when separating out the pediatric population ( ≤ 14 years), 27.8% (n = 60) fell from a height on average > 8-10 feet. The most common geographic location of injury was at home in all age groups, except for the 15-24 year group, which was roadways. Discussion: The Amish population poses a unique set of mechanisms of injury and thus injury patterns to rural trauma centers. We have found the most common injuries to be falls, buggy accidents, animal-related injuries, and farming accidents across all age groups. Future research and collaboration with other rural trauma centers treating large Amish populations would be beneficial to maximize injury prevention in this population.

Winch, A. T., Sunderman, K., & Beidel, D. C. (2022). Working With Medical Personnel in the Aftermath of a Mass Shooting: Lessons Learned From Nickel Mines. In C. Bowers, D. Beidel, M. Marks, K. Horan, & J. Cannon-Bowers (Eds.), Mental Health and Wellness in Healthcare Workers: Identifying Risks, Prevention, and Treatment (pp. 282-294). IGI Global.

Abstract: The rising number of mass casualty incidents in the United States has exposed hospital personnel to more traumatic events on the job than ever before, with research citing a lack of mental health support following such events. It is often assumed that the advanced training of medical professionals serves as a protective factor against PTSD and other mental health disorders resulting from occupational trauma. However, this notion is false, and if left untreated, these mental health issues may extend beyond personal distress and negatively impact patient care. Furthermore, not all hospital personnel who are directly exposed to mass casualty incidents have advanced medical training, and many of these individuals have had no experience with these types of traumas. This chapter outlines planning and implementation measures that hospitals can take prior to a mass casualty incident occurring, followed by steps, strategies, and supports that can be deployed once a hospital has become a treating facility for victims of a mass casualty incident.

Margaret M Dines, LCSW, Margaret Spotts, LCSW, Laura Madsen, RN, Arek J Wiktor, MD FACS (2022). 770 Increasing SOAR Participation in a Burn Center through a Social Work Team Approach, Journal of Burn Care & Research. 43(1):S192.

Abstract: Introduction: Peer support has long been used in Burn Centers through organized support groups and programs like Phoenix Society for Burn Survivor’s SOAR (Survivors Offering Assistance in Recovery) individual peer support, often led by Social Workers (SW). The addition of an ambulatory SW in partnership with an inpatient SW allowed our Burn Center to continue participation in the group and individual peer support offerings despite the simultaneous COVID-19 pandemic. We sought to examine participation in support services using our dual SW model. Methods: Prior to 2020, our ABA verified Burn Center only had an inpatient SW who was able to engage our admitted patient population to support services. With the addition of an ambulatory SW, we have been able to target support group participation in the larger ambulatory population. Our dual SW model allows for continued recruitment to our support services; meeting the patient’s needs at each stage of recovery. This tag team approach, coupled with increased use of technology driven by the pandemic, has shown to increase the average number of participants. We reviewed our support group participation and attendance over the past 2 years. Results: In calendar year 2020 with one SW facilitator, only 14 virtual support groups were held with an attendance average of 4-5 participants and 22 individual peer support visits. In only the first 9 months of calendar year 2021 with the addition of a second SOAR trained SW, 18 support groups were completed virtually with new inpatient, in-person participation. The participation rate of now bi-monthly support groups has increased to 9 participants per support group average. At this continued rate, we expect to serve 216 attendees per year through support group. In this same 9-month span 51 SOAR individual peer support visits (12 in-person and 39 virtual), were conducted. Which is an increase from the 22 total peer support visits facilitated in 2020. Conclusions: An additional SOAR trained SW to our Burn Center has increased participation and availability of support groups and individual peer support visits. Peer support promotes socialization and can provide healing for the burn patients and their families in a meaningful and profound way. Burn centers must continue to prioritize the role of the clinical SW to ensure programs such as SOAR support group and individual peer support can be facilitated to ensure an environment that fosters psychological and emotional healing.

Chweya, Veronicah. (2022). Quality Improvement Project: Implementing Heart Disease Prevention Education Among the Amish Community. Retrieved from Sophia, the St. Catherine University repository website:

Abstract: Problem: There is a 40% prevalence of heart disease among rural residents. In East Central Minnesota, there is scarce data about the Amish cardiovascular knowledge, current heart health status, and how their beliefs and health practices impede or facilitate cardiovascular health. Early identification of cardiovascular disease risk factors is essential in ensuring prompt patient-centered culturally congruent education to prevent cardiovascular adverse events. Purpose: The purpose of this quality improvement project, was to assess the Amish heart disease knowledge, self-efficacy, risk perception, and heart health status, and to develop and implement a culturally congruent heart disease education. Method: The project was implemented in the Amish communities in rural East Central Minnesota with seven staff members who assisted in collecting data and providing direction. Data collection occurred in three phases of the project: assessment, education, and post-education evaluation. Results: 13 out of 33 Amish adults completed the project. Heart disease knowledge increased by 29% whereas cardiac self-efficacy increased by 16% after modifying the questionnaire. 100% alluded to have started behavior changes since the education. Overall Amish satisfaction with the education was good with 92% reporting it was very helpful and 7% stating it was not helpful. Conclusion: The data collected confirmed that the heart disease education was valuable in improving the Amish heart disease knowledge and cardiac self-efficacy. Most indicated they had started behavior changes.

White, Ruth and Kristy Winters. (2021, August 5). Responding to hearing loss in an Amish community. The ASHA Leader.

Summary: What if the barrier to receiving hearing care services isn’t what you’d expect: distance, socio-economic status, or even parent motivation? What if instead it is strongly held religious beliefs about the mechanical make-up of a hearing aid? Our team at Michigan Medicine faced this issue when dispensing hearing aids to a small Amish population with prevalent hearing loss in rural Branch County, Michigan. In early 2019, several Amish families sought treatment from our clinic for ear infections and hearing loss. We first met a few school-age children in one family, then learned that other siblings and cousins had similar hearing issues. Given the distance and cost of providing transportation to Michigan Medicine, we knew they needed a locally held hearing screening clinic.


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