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PubMed1999

A statewide analysis of child safety seat use and misuse in Michigan.

This study was designed to determine frequency of child safety seat use for children under the age of 4 years in Michigan, as well as to determine types of misuse. No state has previously conducted such a statewide survey. A two-stage sampling plan was used with data collected through direct observation at a sample of 88 child-care centers and pediatric clinics throughout the state. Misuse data were collected at a subset of the sites through driver interview and visual and hands-on inspection. The study results indicate that 74.5% of children under 4 years of age in Michigan are in safety seats with use highest in vehicles driven by belted drivers, females, and drivers under 60 years of age. Some degree of seat misuse was found in 88.5% of the inspections. The most common types of misuse were related to snugness of fit (both in installing the seat into the vehicle and in securing the child), use of the safety belt locking clip, and the harness positioning clip. Drivers who had a high occurrence of misuse, as compared with drivers with lower misuse, had lower educational levels, removed the seat frequently from their vehicle, were not the parent of the child, and had children who were both younger and smaller. The results show that efforts to encourage people to use child safety seats have been successful.

Adolescent↗
PubMed2001

Organochlorine insecticides, polychlorinated biphenyls, and metals in water, sediment, and green frogs from southwestern Michigan.

In an attempt to explain the etiology of frog deformities and population declines, many possible causative factors have been examined, including the input of synthetic chemicals into aquatic systems, where frogs spend much of their lives, including their entire developmental stages. Deformities in populations of green frogs in wetlands of southwestern Michigan that are influenced by agricultural, urban, or industrial inputs were assessed in this study. Of the 1445 green frogs (Rana clamitans) examined, only four (0.3%) exhibited morphological deformities. This deformity rate is less than the recognized background level of deformities for this species, which is approximately 1%. Concentrations of organochlorine insecticides, polychlorinated biphenyls (PCBs), and metals were determined in water, sediment, frog eggs, tadpoles, and adult green frog tissues. Concentrations of all individual organochlorine insecticides in tissue were less than 6 ng/g, wet wt. Concentrations of sigmaPCBs in tissue did not exceed 100 ng/g, wet wt. Concentrations of toxic metals were less than the limits of detection. Because no significant numbers of green frog deformities were observed in this region, it can be assumed that at these low concentrations, physical malformations in green frogs should not be observed. Significance of study. This study provides information on the incidence of deformities in green frog populations in southwestern Michigan and offers background data on chemical residues in green frogs and their environment.

Animals↗
PubMed2002

Epidemiology of Mycobacterium bovis in free-ranging white-tailed deer, Michigan, USA, 1995-2000.

An endemic area of bovine tuberculosis (TB) (Mycobacterium bovis) currently affecting wild white-tailed deer (Odocoileus virginianus) in northern lower Michigan, USA, constitutes the first self-sustaining outbreak of the infection in free-ranging North American cervids. Given this precedent, epidemiologic insights gained from the outbreak afford the opportunity to guide not only current surveillance and intervention but also control efforts for future outbreaks involving wildlife reservoirs. Our specific objectives were to evaluate retrospective data from field surveillance conducted from 1995 to 2000 to determine apparent prevalence, trends in apparent prevalence, and the effects of various factors on the odds of being M. bovis positive. Data were gathered from post-mortem examinations of 62,560 wild deer collected from all 83 Michigan counties. Records of survey method, sex, age, geographic area and infection status as determined by mycobacterial culture were subjected to trend analysis and multivariable logistic regression. Apparent prevalence for the period was 0.54% (336/62,560) statewide. Prevalence varied widely with geographic area, but significantly decreased since 1995 in the core area of the outbreak-which coincided with implementation of control strategies. Significant risk factors were geographic area, sex, age, and the sex-by-age interaction. The survey method by which deer were obtained for testing was not a predictor of infection. Our results to date suggest an outbreak characterized by broad areas of very low prevalence surrounding focal areas where prevalence is sometimes orders-of-magnitude higher (e.g., deer originating from the core area were up to 147 times more likely to be TB positive than deer from other areas). Our results also identify older male deer as most likely to be M. bovis positive (OR=11.3, 95% CI 3.2, 40.3 for bucks > or =5 years vs. does < or =1.5 years)-an observation consistent with the biology and behavior of the species. Synthesizing these results with those of other ongoing investigations, we hypothesize a two-stage model of disease transmission where TB is maintained at very low prevalence in matriarchal groups, with primary dissemination of the disease attributable to the dispersal and movements of bucks (as well as to the large aggregations of animals created by human activities).

Animals↗
PubMed2003

A herd-level analysis of risk factors for antibodies to Sarcocystis neurona in Michigan equids.

Equine protozoal myeloencephalitis (EPM) is a neurological disease of horses and ponies caused by infection of the central nervous system with the protozoan parasite Sarcocystis neurona. A herd-level analysis of a cross-sectional study of serum antibodies to S. neurona in Michigan equids was conducted, using data collected in 1997 for study that included 1121 equids from 98 Michigan horse farms. Our objective was to identify specific herd-level risk factors associated with seropositivity. We tested associations between herd seroprevalence and various farm-management practices (including feed-storage methods and wildlife control). Multivariable models were developed for three strata based on relative opossum abundance (opossum districts). Herd seroprevalence ranged from 0 to 100% (median=57%). No risk factor was significantly associated with herd seroprevalence at P< or = 0.05 in all opossum districts. Our results suggest that equids living in areas with large opossum populations might be infected with S. neurona from multiple sources.

Animal Husbandry↗
PubMed1997

Patterns of health maintenance on Michigan equine operations.

Data from two 12 month prospective monitoring programs that followed management, economics and animal health from randomly-sampled equine operations in Michigan were used to determine patterns of health maintenance. Health maintenance measures were grouped, and average uses per year were computed for the most-common measures reported: respiratory, Potomac Horse Fever, neurological and multiple-system vaccinations, deworming, and general farrier work. Factors examined for potential association with health maintenance measure use were numbers of equids and horse-days on the operation, average age of equids, disease prevention management procedures, and operation and individual equine activities. The most-common vaccinations reported were respiratory vaccines (administered an average of 0.9 times per equid per year, of which 61% were for rhinopneumonitis). Multiple-system, Potomac Horse Fever and neurological vaccines were given on average 0.9, 0.9 and 0.7 times per equid per year, respectively. Deworming treatments were administered approximately 2.7 times per equid per year, of which 64% were ivermectin. Overall farrier work was reported 3.3 times per equid per year, trimming was done 2.9 times and shoeing was done 1.5 times per equid per year. In general, operations with active equids engaged in training, breeding or showing showed increased use of health maintenance measures. Overall use of health maintenance measures in the Michigan equine operations monitored did not appear to reach recommended levels, because many operations reported no use of these measures. However, on operations where health maintenance measures were reported, operators were using these measures at or near recommended levels.

Aging↗
PubMed1999

Factors influencing recovery from and duration of lameness in Michigan (USA) horses.

The objective of this study was to identify factors that may affect recovery from and duration of a case of lameness in a stratified random sample of Michigan horses. This was done using data from Phase-II of the Michigan equine monitoring system (MEMS Phase-II), the equine health-monitoring study [Kaneene et al., Prev. Vet. Med. 29 (1997b) 277-292; Ross and Kaneene, Prev. Vet. Med. 28 (1996a) 209-224; Ross and Kaneene, Prev. Vet. Med. 29 (1996b) 59-75; Ross et al., Am. J. Vet. Res. 59 (1997) 23-29]. In this study, statistical modelling was conducted to evaluate risk factors affecting recovery from and duration of lameness using multivariable logistic regression and Cox's proportional hazards regression, respectively. Of 357 incident lameness cases reported during MEMS Phase-II, 280 (78.6%) were reported to have recovered. The median duration of a lameness case was 18 days (1st quartile (Q): 1, maximum (Max): 360). A total of 296 of 357 (82.9%) incident lameness cases received some type of treatment. Of 619 total treatments used, 329 (53.2%) were administered, conducted or applied by a veterinarian. Horses experiencing other types of lameness were less likely to recover than those experiencing hoof lameness (odds ratio (OR) = 0.48; 95% CI: 0.25, 0.93). Horses that had participated in exercise-related activities during the study period and prior to the lameness were more likely to recover (OR = 1.91; 95% CI: 1.05, 3.50). Treatment of the lameness was associated with an increased likelihood of recovery (OR = 1.82; 95% CI: 0.97, 3.45). Cases with a veterinarian involved in the diagnosis were associated with a decreased risk of recovery (OR = 0.48; 95% CI: 0.27, 0.84) and a longer duration lameness (HR = 0.58; 95% CI: 0.45, 0.73)--which might indicate that these cases were more complex or severe. Although cases treated for lameness were more likely to recover (OR = 1.82; 95% CI: 1.05, 3.50), treatment was not associated with lameness duration (HR = 0.58; 95% CI: 0.45, 0.73).

Animals↗
PubMed2000

Parents' predicted transmitting abilities are not associated with culling prior to second lactation of Michigan, USA dairy cows.

The objective of this study was to test the association between parents' predicted transmitting abilities (PTAs) for milk, fat and protein and subsequent culling of heifers during rearing or first lactation. The data from 1992 to 1996 consisted of the culling outcome of 5619 Michigan Holstein heifers during rearing or first lactation, and the heifers' parents' PTAs from the period in which the heifers were born. Fixed-effect probit models (both dichotomous and ordered) estimated the relationships between culling and parents' PTAs. Herd effect was modeled as a fixed-effect. There was no association between PTAs of milk, fat, and protein for each heifer's parents and subsequent culling of the heifer during rearing or first lactation. Weak evidence for the necessity of modeling the herd effect as fixed was present. The lack of association between parents' PTAs and reason-specific culling (voluntary versus involuntary)--coupled with the counter-intuitive effects of parents' PTAs on the probability of being culled for each of the reasons--raised questions about the utility of classifying culling reasons according to the voluntary nature of the culling decision. We concluded that Michigan producers are not using parents' genetics in heifer-culling decisions.

Animal Husbandry↗
PubMed2002

Theileria buffeli infection of a Michigan cow confirmed by small subunit ribosomal RNA gene analysis.

Theileria buffeli, generally a benign parasite of cattle, has been reported in animals from Texas, Missouri and North Carolina. To date, there have been no reports of the parasite in cattle residing in northern portions of the US. An 8-year-old cow (Maine Anjou x Angus cross-bred) in Michigan presented with hemoglobinuria and a packed cell volume of 9. Blood films stained with Giemsa showed numerous intraerythrocytic parasites morphologically consistent with T. buffeli. The parasite was confirmed to be T. buffeli by SSU rRNA gene sequence analysis (SSU rRNA sequence, Type A). This represents the first report of this parasite in an animal in Michigan.

Animals↗
PubMed1994

Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience.

PURPOSE: The purposes of this study were (1) to determine the current population-based mortality rate for the surgical treatment of abdominal aortic aneurysms (AAA) in Michigan, (2) to document changes in mortality rates over 11 years, and (3) to identify risk factors for operative mortality. METHODS: A statewide database provided clinical information on all Michigan hospital admissions with a diagnosis of AAA from 1980 to 1990. The mortality rate analysis included all admissions with a primary diagnosis of AAA that underwent repair. Determination of diagnoses and comorbidities were based on International Classification of Diseases-ninth revision-Clinical Modification codes. RESULTS: Conventional surgical repairs were performed on 8185 intact and 1829 ruptured AAA. Hospital mortality rates accompanying operation for intact AAA decreased from 13.6% in 1980 to 5.6% in 1990 (p < 0.001). Mortality rates over the 11 years averaged 10.7% in women and 6.8% in men (p < 0.001). Mortality rates averaged 10.7% in 4170 admissions of patients 70 years old or older and 4.2% in 4015 admissions of patients 69 years old or younger. Preexistent kidney failure was associated with an average mortality rate of 41.2% compared with 6.2% without this comorbidity. Preexistent dysrhythmia increased mortality rates from 6.6% to 13.6%. Uncomplicated hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, arterial occlusive disease, and ischemic heart disease in recent years were not associated with increased mortality rates. Hospitals with an annual volume of 21 or more intact AAA repairs had a surgical mortality rate of 6.2%, compared with 8.9% in hospitals with lower surgical volume (p < 0.001). Mortality rates for surgical repair of ruptured AAA averaged 49.8% and did not improve significantly over the 11 years studied. CONCLUSION: Despite a dramatic drop in surgical mortality rates, repair of intact AAA remains a formidable undertaking. This population-based series documents a substantially higher mortality rate than most selected series. The unchanged mortality rate for ruptured AAA suggests that development of better algorithms to identify those AAA most apt to rupture and earlier intervention in those instances is likely to improve patient survival rates.

Age Distribution↗
PubMed2001

Who favors legalizing physician-assisted suicide? The vote on Michigan's Proposal B.

At the November 1998 general election, Michigan citizens were given the opportunity to vote on Proposal B, an initiative that would have legalized physician-assisted suicide (PAS). PAS initiatives also have been held in Washington State, California, Oregon, and Maine, with only Oregon's passing. We use exit poll data to analyze the vote on Proposal B. Attributes associated with social liberalism -- Democratic Party identification, less frequent church attendance, more education, and greater household income -- led to increased odds of a "yes" vote. Attributes associated with social conservatism -- Republican Party identification and frequent church attendance -- led to decreased odds of a "yes" vote. Similar to the abortion issue, PAS's supporters strongly value personal autonomy, whereas its opponents strongly value the sanctity of life. Voter alignments like those in Michigan will likely appear in other states with the initiative process if PAS reaches their ballots.

Data Collection↗
PubMed2005

Automated speciated mercury measurements in Michigan.

Automated speciated mercury measurements were made at a rural (Dexter, MI) and an urban (Detroit, MI) site in Michigan during selected times from 1999 to 2002 to assess the concentrations of elemental (Hg0), reactive gaseous (RGM), and particulate mercury (Hgp) in these environments. Here we present the first-ever reported values for RGM in Michigan. Median RGM concentrations were 2.21-2.93 pg m(-3) at Dexter and were 3-11 times higher in Detroit at 6.41-22.0 pg m(-3). Maximum RGM concentrations of 38.7 pg m(-3) and 270 pg m(-3) were observed in Dexter and Detroit, respectively. Measured RGM/Hg0 ratios were in the range of 0.04-11.60% indicating that at times RGM comprises greater than the currently held view of 5% of total gaseous mercury in the air. Well-pronounced diurnal patterns of RGM were observed at the rural site, whereas the urban site exhibited patterns that were influenced by nighttime emissions and regional transport. An analysis of RGM/Hgp ratios at the urban site when combined with trajectory analysis suggests that the site receives mercury inputs from both local and regional sources. Episodes of elevated ozone concentrations which were accompanied by increases in RGM concentrations were observed to occur in the late afternoon and overnight. These may be evidence of advection of ozone and RGM over long distances to the site.

Air Pollutants↗
PubMed2005

Identification of brominated carbazoles in sediment cores from Lake Michigan.

During the analysis of brominated flame retardants in sediment cores taken from Lake Michigan, a group of unknown brominated compounds were observed. To identify their chemical structures, a variety of gas chromatographic mass spectrometric techniques were used. With the help of high-resolution and positive chemical ionization mass spectrometry, the molecular formula of the most abundant congener was established to be C12H5Br4N. On the basis of the electron impact and electron capture negative ionization mass spectra, this chemical was suspected of being a tetrabromocarbazole. The structure was confirmed by comparing the mass spectra and gas chromatographic retention times of an authentic standard of 1,3,6,8-tetrabromocarbazole with those of the most abundant unknown. The other unknown compounds may be other bromocarbazole congeners. The time trend determined by measuring these compounds as a function of depth in the Lake Michigan sediment cores indicated that the concentration of 1,3,6,8-tetrabromocarbazole peaked around 1920-1935. This is the first time that bromocarbazoles have been found in the environment.

Carbazoles↗
PubMed2000

Japanese couples' childbirth experiences in Michigan: implications for care.

BACKGROUND: Subtle cultural differences in the childbirth experience for expatriate Japanese couples living in southeast Michigan can sometimes cause conflicts between them and American health caregivers. The purpose of this study was to examine Japanese couples' perceptions and experiences of prenatal care and childbirth in a region of the United States, and to explore the implications for providing culturally competent care. METHODS: In this qualitative study, in-depth interviews of 11 Japanese couples (n = 22) were conducted at an outpatient primary care clinic in southeast Michigan by a team of researchers fluent in the Japanese language and knowledgeable about the culture. Participants also completed a short questionnaire. RESULTS: The major themes that emerged comprised perceptions related to a language barrier, ultrasonography, prenatal vitamin supplementation, episiotomy, epidural anesthesia, and practitioner-patient relationship. Throughout these six themes it was evident that Japanese health care professionals had difficulty accepting health care that was different from the care provided in their home country. CONCLUSION: The most striking finding of this study was the difficulty for health caregivers to provide culturally competent care. Although the program has strongly invested in health professionals and support staff who were fluent in Japanese and knowledgeable about Japanese culture, conflicts still occurred.

Adult↗
PubMed2003

Physician variability in the management of acute postoperative and cancer pain: a quantitative analysis of the Michigan experience.

BACKGROUND: Little is known about physician attitudes, goals, or satisfaction regarding acute postoperative and cancer pain management. OBJECTIVES: To provide quantitative data regarding the status of acute postoperative and cancer pain management by Michigan physicians. To measure physician confidence, preference, and satisfaction as well as identify their pain care goals for acute postoperative and cancer pain management. To evaluate variability in acute postoperative and cancer pain decision making based upon physician demographic characteristics, knowledge, and attitudes. RESEARCH DESIGN: A cross-sectional survey, which included two cancer and three acute postoperative pain vignettes. SUBJECTS: A randomly-selected sample of three hundred sixty-eight licensed Michigan physicians who provide clinical care for acute postoperative and cancer pain patients. RESULTS: The majority of respondents (>50%) reported providing acute postoperative pain care frequently, while a minority (<20%) reported doing so for cancer pain. The majority of the physicians (>75%) reported goals of at least adequate pain relief without distress for both acute postoperative and cancer pain. Physicians more frequently chose the optimal pain management response for men following prostatectomy (56.2%) than for women following myomectomy (42%). They also chose the optimal response for metastatic prostate cancer more frequently (16.3%) than for metastatic breast cancer pain management (10.7%). CONCLUSION: These data highlight physician variability in acute postoperative and cancer pain management decision making. Further study of the physician variable is necessary to improve the management of acute postoperative and cancer pain.

Acute Disease↗
PubMed2002

Acute myocardial infarction in the young--The University of Michigan experience.

BACKGROUND: The purpose of this study was to assess frequency, risk factors, treatment, and complications of very young patients with acute myocardial infarction (MI) at the University of Michigan Medical Center (UMMC). METHODS: From a database of 976 consecutive patients admitted to the UMMC with acute MI between 1995 and 1998, we compared care and outcomes of patients divided into 3 age categories: <46 years, 46-54 years, and >54 years. Risk factors, presenting symptoms, type of MI, management, complications, and hospital outcomes of the 3 groups were evaluated. RESULTS: Young patients represented >10% of all patients with acute MI, and >25% of these individuals were women, a number considerably higher than seen in previous studies. This group of young patients was more likely to have Q-wave MI and risk factors such as family history and tobacco use and less likely to have a history of angina. Although all 3 groups received similar inpatient treatment, there was more attention paid to risk factor modification such as smoking cessation and referral to cardiac rehabilitation in younger individuals. Young patients had fewer in-hospital complications and a lower mortality rate. CONCLUSIONS: At the University of Michigan, >1 in 10 with acute MI is <46 years old. Data suggest that current management and aggressive risk factor modification are quite good in this particular group, and overall the mortality rate is very low.

Adrenergic beta-Antagonists↗
PubMed2006

The proportion of self-reported asthma associated with work in three States: California, Massachusetts, and Michigan, 2001.

OBJECTIVES: To assess the proportion of adult asthma at the state level that may be related to work. DESIGN: Work-related asthma questions were added to the 2001 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire in California, Massachusetts, and Michigan. RESULTS: Findings indicate 7.4-9.7% of those with current asthma reported that their asthma may be work related. These results estimate that approximately 137,000 adults in California, 39,000 in Massachusetts, and 63,000 in Michigan have asthma that may be work related. CONCLUSIONS: These findings are unique in providing population-based estimates at the state level that illustrate that a substantial portion of adult asthma morbidity is due to exposures in the work environment.

Adolescent↗
PubMed2002

Prevalence of risk factors to coronary heart disease in an Arab-American population in southeast Michigan.

Although significant advances have been made in the area of cardiovascular disease, few studies have targeted ethnic groups. There is a large and growing Arab-American (AA) population living in Southeast Michigan, whose risk of cardiovascular disease may be on the increase. The objective of this study was to evaluate the prevalence of cardiovascular disease risk factors and associated behavioral factors in an AA community with a large population of emigrants, subjected to significant lifestyle changes. Three hundred and fifty-two AA living in Southeast Michigan, mostly from the Middle East, were screened to determine their eating and smoking habits, body mass index (BMI) body fat analysis, blood pressure, and complete lipid profiling. Overweight was defined as a BMI greater than or equal to the 85th percentile value for age- and sex-specific reference data from the third National Health and Nutrition Examination Survey (NHANES III). Correlation analysis was used to examine factors associated with being overweight, with adjustment for age and sex. Blood cholesterol concentrations were compared with published data for Arabs from the Middle Eastern countries. The overall prevalence of being overweight in subjects aged 35 and older was significantly higher than NHANES III reference data (Men, 27.7% (95% confidence interval, 21.8-34.5); women, 33.7% (95% confidence interval, 27.9-40.1)). A mean cholesterol concentration of 210 +/- 4 mg/dl was observed in those over the age of 40. The mean high-density lipoprotein (HDL)-cholesterol levels for men and women were 38 and 48 mg/dl, respectively. Greater than 54.6% of all subjects had a total cholesterol:HDL ratio > 4.5. Although being overweight and obesity were prevalent in this population, the mean BMI for men was 25.7 +/- 0.34, compared with 27 +/- 0.58 for women. Increased BMI was significantly correlated (P < 0.01) with increased blood pressure, increased glucose levels, increased total cholesterol and decreased HDL-cholesterol levels (P < 0.01). Elevation in risk factors to cardiovascular disease is prevalent in this population and indicates a need for programs targeting primary prevention of obesity in men and women. These results, which could be attributed in part to lifestyle changes typical of most emigrant populations, suggest an increase in the risk for developing cardiovascular disease. In addition, this study provides a basis for future intervention to improve the health of this population.

Adult↗
PubMedDate not supplied

Organic-solvent water pollution and low birth weight in Michigan.

This pilot study explored the association between a measure of water pollution caused by benzene or chlorinated solvents and the incidence of low birth weights for white residents of Michigan counties. A positive relationship between water pollution by these contaminants and the per cent of low-weight births (less than 2,500 grams, or about 5.5 pounds) resulted despite controls for the incidence of teenaged childbearing, infrequent prenatal care, and mean household income from wages or salaries. Water pollution showed an association with the incidence of low birth weight that was as strong as that between low birth weight and low prenatal care. While correlation cannot prove causation, the finding suggests that impure water may impair fetal growth in Michigan.

Adolescent↗