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PubMed1982

Michigan's Medical Service Plan: factors responsible for its success.

Eight years after the implementation of its medical service plan, the University of Michigan Medical School carried out a study to determine the extent to which the plan met its original objectives. An analysis of the plan's revenue and expenses, a review of the impact on medical school programs of education, research, and patient care, and an assessment of the environment influencing chairman and faculty recruitment and retention all support the conclusion that Michigan's medical service plan has been successful. In an effort to determine why the plan has succeeded, 35 individuals were surveyed to identify the factors thought to be responsible. A total of 32 potential factors were named; six were considered to be "key/critical," and another 11 were identified as "important/contributory." It is hoped that a sharing of Michigan's experience and understandings will be of help to the approximately 110 medical service plans that exist within the nation's 126 medical schools.

Faculty, Medical↗
PubMed1993

Retrieval and allocation of organs for transplantation: the Michigan experience.

The Organ Procurement Agency of Michigan (OPAM) is now in its twenty-third year of service to the transplant community in Michigan. From a beginning with one coordinator in 1971, it now employs 53 individuals, including 8 laboratory technologists for its own on-site histocompatibility laboratory, a dozen procurement coordinators stationed throughout the state, 6 organ placement coordinators in the main office, 6 screening coordinators who provide around-the-clock coverage at the office, a tissue recovery section, as well as additional finance, education, and administrative support staff. This chapter outlines the history and growth in organ recoveries of the organization. More importantly, the chapter also analyzes the Michigan experience regarding racial distribution of kidneys. While African-Americans comprise 14% of the general population of the state, they comprise 40% of the waiting kidney recipients and only 26% of the actual recipients. Depending upon blood type, average waiting time for a kidney for African-Americans can be up to 4 months longer than for Whites. The analysis attributes this variance primarily to the allocation methodology for kidney distribution, which is largely driven by antigen matching and secondarily to the generally greater frequency and higher degree of blood sensitization among African-Americans, which causes a substantially higher frequency of positive-crossmatch results between potential donor and recipient. The authors conclude that changes in the present allocation system could be made to achieve greater equity for African-American patients, without removing the advantages inherent in transplanting kidneys with closely matched antigens.

ABO Blood-Group System↗
PubMed1993

The fiscal impact of the Medicaid abortion funding ban in Michigan.

OBJECTIVE: To assess the increased public assistance costs resulting from Michigan's 1988 ban on Medicaid funding of abortions. METHODS: The increased number of births resulting from the Medicaid abortion funding ban was estimated. The costs of this increase in births to the state and federal governments were then calculated. RESULTS: Using low and high estimates for the numbers of additional children born as a result of Michigan's prohibition of Medicaid abortion funding (2120 and 5800), and the likelihood of these children's remaining on welfare, the 1991 cohort of infants will cost the state's taxpayers $23.1-63.2 million--several times the $6-7 million cost of the abortions, had they taken place. Including the federally paid share, total incremental costs are $50.2-137.4 million. CONCLUSION: Those who have advocated banning Medicaid funding of abortions to reduce government spending, as in Michigan in 1988, have ignored the much greater cost of requiring that those pregnancies be carried to term.

Abortion, Induced↗
PubMedDate not supplied

On the decrease in the life expentancy of black males in Michigan.

The 1970 census reported that there were slightly more than 1 million nonwhites among Michigan's 8,875,000 residents. Ninety-five percent of these nonwhites are black, and 75 percent live within the city limits of Detroit, compared with 10 percent of the State's white residents. Between 1959-61 and 1969-71, life expectancy at birth increased about 1 year for black and white females, essentially remained unchanged for white males, and decreased more than 3 years for black males. In 1969-71, life expectancy was 61 years for black males, 68 years for white males, 69 years for black females, and 75 years for white females. Much of this growing disparity noted resulted from a dramatic rise in deaths of black males in the 15-44 year age group. Two-thirds of this increase was caused by a major rise in mortality from two causes--accidents and homicides. While death rates for black males decreased for a number of other leading causes, these generally remained higher than similar figures for each of the other three race-sex groups. Given current rates, one of eight black males in Michigan ultimately will die from an accident or from homicide. This probability is 1 of 17 for white males, 1 of 30 for white females, and 1 of 26 for nonwhite females. Homicides reduced the life expectancy of black males by 2.3 years, compared with 0.2 year for white males, less than 0.005 year for white females, and 0.5 year for black females. More than three-quarters of all homicides of black males in Michigan in 1973 were caused by handguns.

Accidents↗
PubMed1993

Behavioral Risk Factor Surveillance System--Michigan, 1987-1991.

A national health objective for the year 2000 is to implement periodic analysis and publication of each state's progress toward the objectives for each racial/ethnic group that constitutes at least 10% of the state's population (objective 22.5a). In Michigan (1990 population: 9.3 million), blacks represent approximately 12% of the adult population*; prevalence estimates for risk factors for the black population derived from the Behavioral Risk Factor Surveillance System (BRFSS) have varied in consistency because of the limitations of small sample sizes. To improve the precision of risk factor prevalence estimates for blacks in Michigan and to improve measurement of the state's progress toward the national year 2000 objectives for blacks, in 1993, the Michigan Department of Public Health (MDPH) aggregated annual state BRFSS data for 1989-1991. This report summarizes the findings of this analysis and compares them with an analysis of annual state BRFSS data for 1987-1991.

Adult↗
PubMed1996

Michigan Children's Immunization Registry: An important tool in reaching & maintaining 100% rates among two-year-olds.

The support of the Michigan State Medical Society is appreciated as we implement the Michigan Children's Immunization Registry. I look forward to collaborating on the registry and other initiatives to quickly raise Michigan's immunization rate for two-year-olds from 64%, the lowest in the nation, to 100%. This is a responsibility that we all bear, in both the public and private sectors. To say that our national status is a professional embarrassment is to understate the seriousness of this circumstance. We must fulfill our obligation to fully immunize all children by age two.

Child↗
PubMed1997

Surveillance for silicosis, 1993--Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin.

PROBLEM/CONDITION: Silicosis is an occupational respiratory disease caused by the inhalation of respirable dust containing crystalline silica. Public health surveillance programs to identify workers at risk for silicosis and target workplace-specific and other prevention efforts are currently being field-tested in seven U.S. states. REPORTING PERIOD COVERED: Confirmed cases ascertained by state health departments during the period January 1, 1993, through December 31, 1993; the cases and associated workplaces were followed through December 1994. DESCRIPTION OF SYSTEMS: As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program initiated by CDC's National Institute for Occupational Safety and Health (NIOSH), development of state-based surveillance and intervention programs for silicosis was initiated in 1987 in Michigan, New Jersey, Ohio, and Wisconsin and in 1992 in Illinois, North Carolina, and Texas. RESULTS: From January 1, 1993, through December 2, 1994, the SENSOR silicosis programs in Illinois, Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin confirmed 256 cases of silicosis that were initially ascertained in 1993. Overall, 185 (72%) were initially identified through review of hospital discharge data or through hospital reports of silicosis diagnoses; 188 (73%) were associated with silica exposure in manufacturing industries (e.g., foundries; stone, clay, glass, and concrete manufacturers; and industrial and commercial machinery manufacture). Overall, 42 (16%) cases were associated with silica exposure from sandblasting operations. Among the 193 confirmed cases for which information was available about duration of employment in jobs with potential exposure to silica, 37 (19%) were employed < or = 10 years in such jobs and 156 (81%) were employed > or = 11 years. A total of 192 primary workplaces associated with potentially hazardous silica exposures were identified for the 256 confirmed silicosis cases. Of these, nine (5%) workplaces were inspected by state health department (SHD) industrial hygienists, 19 (10%) were referred to the Occupational Safety and Health Administration (OSHA) for follow-up, and seven (4%) were routinely monitored by the Mine Safety and Health Administration. Of the 157 (82%) remaining workplaces, follow-up activities determined that 82 were no longer in operation, eight were no longer using silica, 18 were assigned a lower priority for follow-up, six were associated with building trades and could not be inspected because of the transient nature of work in the construction industry, and 43 workplaces were not inspected for other reasons. Fourteen (7%) of the 192 workplaces were inspected. At 10 of the 14 workplaces, airborne levels of crystalline silica were measured; in nine, silica levels exceeded the NIOSH-recommended exposure level of 0.05 mg/m, and in six, airborne silica levels also exceeded federal permissible exposure limits. ACTIONS TAKEN: Employee-specific and other preventive interventions have been initiated in response to reported cases. In addition, special silicosis prevention projects have been initiated in Michigan, New Jersey, North Carolina, Ohio, Texas, and Wisconsin. To facilitate the implementation of silicosis surveillance by other states, efforts are ongoing to identify and standardize core data needed by surveillance programs to describe cases and the workplaces where exposure occurred. These core variables will be incorporated into a user-friendly software system that states can use for data collection and reporting.

Female↗
PubMed1997

Attitudes of veterinarians, animal control directors, and county prosecutors in Michigan regarding enforcement of state animal cruelty legislation.

OBJECTIVES: To determine attitudes of veterinarians, animal control directors, and country prosecutors in Michigan toward enforcement of state animal cruelty legislation and to identify factors associated with whether veterinarians would report suspected cases of animal cruelty. DESIGN: Survey. SAMPLE POPULATION: Questionnaires were sent to 1,146 Michigan Veterinary Medical Association member veterinarians, 139 animal control directors, and 83 county prosecutors in Michigan. RESULTS: 740 (65%) veterinarians, 70 (50%) animal control directors, and 43 (52%) prosecutors responded. Six hundred forty six of 735 (88%) veterinarians reported having treated an animal that they believed had been a victim of animal cruelty, but only 192 of 719 (27%) had ever reported a case of animal cruelty, and only 217 of 734 (30%) had ever testified in an animal cruelty case. Logistic regression analysis of responses revealed that the only factor associated with whether veterinarians would report cases of suspected animal cruelty was the potential reactions of the involved clients to the accusation of animal cruelty. Veterinarians who rated reaction of the involved client as important, very important, or essential to their decision whether to report a case of animal cruelty were less likely to report such cases than were veterinarians who rated potential client reaction as somewhat important or unimportant. CLINICAL IMPLICATIONS: Concern about potential client reaction was the most important factor in whether veterinarians would report cases of suspected animal cruelty.

Administrative Personnel↗
PubMed1991

The biomagnification of polychlorinated biphenyls, toxaphene, and DDT compounds in a Lake Michigan offshore food web.

The biomagnification of polychlorinated biphenyls (PCB), toxaphene, and the DDT family of metabolites was investigated in the epibenthic Mysis relicta (mysid), the benthic Pontoporeia hoyi (amphipod), plankton, particulate flux, surficial sediments, and Myoxocephalus thompsoni (deepwater sculpin) in southeastern Lake Michigan. DDE was the most strongly biomagnified compound, increasing 28.7 times in average concentration from plankton to fish. PCB increased 12.9 times in average concentration from plankton to fish while toxaphene increased by an average factor of 4.7. Particle flux was comprised of lower chlorinated PCB homologues (average chlorine number = 3.8) than the biota (4.5-5.0) and sediments (4.6), possibly reflecting strong influences from atmospheric deposition and/or zooplankton egestion. The percent of higher chlorinated PCB homologues (5 and 6 chlorine atoms per PCB molecule) increased from 54-56% of the total PCB in plankton and M. relicta, to 61% in P. hoyi, to 74% in sculpins. Amphipods contained greater concentrations than mysids of PCB, DDT residues, and toxaphene, possibly reflecting differences in habitat (benthic vs epibenthic) and diet (detritus vs plankton). Based on estimates of average areal biomass and contaminant concentration, offshore Lake Michigan P. hoyi populations contain approximately 15.0 times as much toxaphene, 9.5 times as much total DDT, and 12.0 times as much PCB as the offshore M. relicta populations. Thus, amphipods may represent a greater reservoir than mysids for contaminant storage and subsequent recycling in offshore Lake Michigan.

Animals↗
PubMed1991

Effects of ultraviolet radiation on the primary production of natural phytoplankton assemblages in Lake Michigan.

Inhibition of primary production of offshore Lake Michigan phytoplankton assemblages by solar ultraviolet radiation (SUVR) was observed from April to October in 1986 during in situ incubations in special Plexiglas chambers. Inhibition of primary production by SUVR was observed to a depth of 6 m and at intensities which were approximately 1% of the UV-B intensity at the lake surface. Significant inhibition of primary production by SUVR was restricted to the top third of the euphotic zone. The order of relative sensitivities of offshore Lake Michigan phytoplankton assemblages during different seasons to inhibition by SUVR were spring ED50 = 17.6 kJ/m2 UV-B) greater than fall (ED50 = 30.5 kJ/m2 UV-B) greater than summer (ED50 = 131.6 kJ/m2 UV-B). A hazard assessment model predicted a significant reduction (13%) in areal (total water column) primary production for offshore Lake Michigan due to current SUVR intensities. Concern about possible increased reduction of primary production in the North American Great Lakes due to depletion of the stratospheric ozone layer appears to be unwarranted.

Bicarbonates↗
PubMed2003

Selecting suspension points and excising the vagina during Michigan four-wall sacrospinous suspension.

OBJECTIVE: To describe the variations in the location of the vaginal apex and the length of vagina excised in women undergoing the Michigan four-wall sacrospinous suspension for posthysterectomy vaginal vault prolapse. METHODS: A prospective observational study of 76 women who had the Michigan modification sacrospinous suspension performed between 1998 and 2001 for posthysterectomy vaginal vault prolapse was carried out. Demographics and preoperative, operative, and postoperative findings were noted, including the pelvic organ prolapse quantification score. The locations of the suspension points relative to the hysterectomy scar were recorded. The amount of vagina excised at surgery and the pre- and postoperative vaginal lengths are reported. RESULTS: The mean length and standard deviation of vagina excised was 4.6 +/- 2.5 cm. The apex created at sacrospinous fixation was at the hysterectomy scar in only seven women (9%). It was most often situated behind the hysterectomy scar, in 58 cases (76%); it was situated in front of it in 11 (14%). In seven women no vagina was excised, and in the remaining 69 women a mean length of 5.1 +/- 2.2 cm was removed. The mean vaginal lengths were 9.7 +/- 1.7 cm preoperatively and 9.4 cm +/- 0.8 postoperatively, a 0.3-cm difference. CONCLUSION: When one performs the Michigan modification sacrospinous suspension, the chosen suspension points are often not at the hysterectomy scar, and in women with large prolapses excess vagina frequently is excised without compromising postoperative vaginal length.

Aged↗
PubMed2001

Volatilization of toxaphene from Lakes Michigan and Superior.

The pesticide toxaphene was used extensively on cotton in the southern United States until its use was restricted in 1982. It was previously reported that the upper Great Lakes have received toxaphene by gas absorption following long-range transport from the south and are currently saturated with respect to toxaphene. However, the rate of loss of toxaphene from Lakes Michigan and Superior had been estimated using sparse or estimated data, and thus, these estimates had high uncertainties. For this investigation, samples were collected to provide extensive data on air, water, and sediment concentrations of toxaphene for the upper Great Lakes for the period 1997-98. These data were used to calculate the annual and seasonal fluxes of toxaphene from water to air and sediment. Lake Superior is 200-1000% saturated with toxaphene, and Lake Michigan is 200-500% saturated. It seems clear that both lakes will outgas toxaphene into the atmosphere for some considerable time in the future, and Lake Superior, because of its generally lower water temperatures and higher toxaphene concentration, will outgas toxaphene even longer than will Lake Michigan.

Environmental Monitoring↗
PubMed2003

Reevaluation of air-water exchange fluxes of PCBs in Green Bay and southern Lake Michigan.

Air-water exchange of persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) is an import process for the delivery of contaminants to water bodies, as well as for their removal, and is thus a pivotal parameter in the construction of mass balances in aquatic systems. Simultaneous measurements of PCB concentrations in the gas and dissolved phases conducted in Green Bay in 1989 and in southern Lake Michigan in 1994-1995 were used to estimate air-water exchange fluxes. In this work, improved Henry's law constants for PCBs and new mass-transfer rates across the air-water interface were used to update the previous calculations. The new model calculations suggest that the net volatilization flux of PCBs out of Green Bay ranges from +170 to +5300 ng m(-2) day(-1), which is 2-20 times larger than previous estimates. The flux of PCBs in southern Lake Michigan exhibits net volatilization of +0.5 to +230 ng m(-2) day(-1) throughout the study period (May and July 1994, January 1995), whereas previous estimates reported that the net flux was seasonally absorptive. Thus, water-to-air fluxes are more important for the removal of PCBs from both Green Bay and Lake Michigan than previously recognized.

Air↗
PubMed2004

Synthetic musk fragrances in Lake Michigan.

Synthetic musk fragrances are added to a wide variety of personal care and household products and are present in treated wastewater effluent. Here we report for the first time ambient air and water measurements of six polycyclic musks (AHTN, HHCB, ATII, ADBI, AHMI, and DPMI) and two nitro musks (musk xylene and musk ketone) in North America. The compounds were measured in the air and water of Lake Michigan and in the air of urban Milwaukee, WI. All of the compounds except DPMI were detected. HHCB and AHTN were found in the highest concentrations in all samples. Airborne concentrations of HHCB and AHTN average 4.6 and 2.9 ng/m3, respectively, in Milwaukee and 1.1 and 0.49 ng/m3 over the lake. The average water concentration of HHCB and AHTN in Lake Michigan was 4.7 and 1.0 ng/L, respectively. A lake-wide annual mass budget shows that wastewater treatment plant discharge is the major source (3470 kg/yr) of the synthetic musks while atmospheric deposition contributes less than 1%. Volatilization and outflow through the Straits of Mackinac are major loss mechanisms (2085 and 516 kg/yr for volatilization and outflow, respectively). Concentrations of HHCB are about one-half the predicted steady-state water concentrations in Lake Michigan.

Air Pollutants↗
PubMed2005

Milwaukee, WI, as a source of atmospheric PCBs to Lake Michigan.

A field study of atmospheric PCBs in Milwaukee, WI, U.S.A. was conducted on the shore of Lake Michigan. We believe this is the first report of atmospheric PCBs in Milwaukee, although PCBs are well-known to contaminate the sediments of the Milwaukee River and Outer Harbor. Concentrations of PCBs collected during the June 2001 study are similar to concentrations in other urban-industrial areas and higher than PCBs in background air. The average sigmaPCB (sum of 88 congener groups) gas-phase concentration in Milwaukee was 1.9 ng m(-3)+/-standard deviation 0.78 ng m(-3). The average and standard deviation for the particulate-associated PCBs are 0.05+/-0.02 ng m(-3). Particulate-phase PCBs account for less than 5% of the total atmospheric concentration. PCBs in Milwaukee air are a source of PCBs to Lake Michigan. Calculated net gas exchange fluxes predicted forthe Milwaukee sampling period ranged from -60 to -400 ng m(-2) d(-1), where net deposition is indicated by the negative sign. Calculated particle-associated PCB deposition ranged from 80 to 500 ng m(-2) d(-1). Most of the particle-phase deposition flux is a result of coarse particle deposition and decreases rapidly with distance from shore. Under typical meteorological conditions, particle-associated PCBs depositional flux to the lake surface decreases by 90% within 40 km. For net gas-exchange, the flux reaches zero at about the same distance. At greater distances, particle-phase PCB deposition is negligible, and PCBs are volatilizing at a higher rate than they are being deposited. We calculated that Milwaukee air contributes about 120 kg of PCBs to Lake Michigan each year. This is about 10 times larger than the discharge of PCBs from the Milwaukee River.

Air Movements↗
PubMed1994

Reflections on the Michigan occlusal splint.

Specific features related to the development, design and use of the Michigan splint have been described. Additional benefits from the Michigan splint beyond what can be expected from conventional stabilization splints and bite planes have been suggested. Important aspects of corrections and maintenance care of the Michigan splint have been stressed.

Acrylic Resins↗
PubMed2006

Microbial communities and fecal indicator bacteria associated with Cladophora mats on beach sites along Lake Michigan shores.

A high biomasses of Cladophora, a filamentous green alga, is found mainly during the summer along the shores of Lake Michigan. In this study, the abundance and persistence of the fecal indicator bacterium Escherichia coli and sulfate-reducing bacteria (SRB) on Cladophora mats collected at Lake Michigan beaches were evaluated using both culture-based and molecular analyses. Additionally, 16S rRNA gene cloning and sequencing were used to examine the bacterial community composition. Overall, E. coli was detected in all 63 samples obtained from 11 sites, and the average levels at most beaches ranged from 2,700 CFU/100 g (wet weight) of Cladophora to 7,500 CFU/100 g of Cladophora. However, three beaches were found to have site average E. coli densities of 12,800, 21,130, and 27,950 CFU/100 g of Cladophora. The E. coli levels in the lake water collected at the same time from these three sites were less than the recommended U.S. Environmental Protection Agency limit, 235 CFU/100 ml. E. coli also persisted on Cladophora mats in microcosms at room temperature for more than 7 days, and in some experiments it persisted for as long as 28 days. The SRB densities on Cladophora mats were relatively high, ranging from 4.4x10(6) cells/g (6.64 log CFU/g) to 5.73x10(6) cells/g (6.76 log CFU/g) and accounting for between 20% and 27% of the total bacterial counts. Partial sequences of the 16S rRNA gene clones revealed a phylogenetically diverse community, in which the Cytophaga-Flavobacterium-Bacteroides cluster and the low-G+C-content gram-positive bacteria were the dominant organisms, accounting for 40% and 12.8%, respectively, of the total clone library. These results further reveal the potential public health and ecological significance of Cladophora mats that are commonly found along the shoreline of Lake Michigan, especially with regard to the potential to harbor microorganisms associated with fecal pollution and odor-causing bacteria.

Bathing Beaches↗
PubMed1992

Athletic trainer availability in interscholastic athletics in michigan.

Between January and March 1989, I surveyed the athletic directors of the 711 high schools of the Michigan High School Athletic Association, in order to determine the level of medical care available for students who participate in various sports. The results were compared to previous studies done in Michigan and in other states, to determine if there had been any increase in the number of athletic trainers working in a high school setting or any improvement in their educational backgrounds. Certification by the National Athletic Trainers' Association (NATA) was the measurement used to determine improvement in educational background. With 57% of the 711 athletic directors responding, 41% reported that they had the services of an athletic trainer for at least one sport during the year. The percentage of athletic trainers varied directly with the size of the school. The more populous schools had the greatest percentage of athletic trainers. Seventy percent of the athletic trainers were reported to be certified by the NATA. These findings were compared to two earlier studies conducted in Michigan and to surveys in other states. It was determined that there was an increase in the availability of athletic trainers, particularly certified athletic trainers, at the post-secondary level.

Journal Article↗