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PubMed2001

Substance use, need, and demand for substance user treatment services in patients treated for sexually transmitted diseases in michigan.

The association between substance use and communicable diseases, and the need for substance user treatment services for patients treated for communicable diseases, is well documented. This study builds upon this knowledge in that it quantifies the need and demand for substance user treatment services in a large population of patients treated for communicable diseases, specifically, sexually transmitted diseases (STDs), an area in which there is insufficient research published in the literature, but which is essential for policy development. More than 1700 patients treated for STDs in publicly funded clinics in Michigan between 1994-1995 were interviewed about their substance use, consequences of use and demand for substance user treatment services. Results indicated that the rates of substance use and demand for substance user treatment services were significantly higher among persons encountered in the STD clinics compared to the Michigan general adult population; however, a large proportion of STD patients determined to need substance user treatment services according to DSM-III-R criteria for "substance dependence" and "abuse" did not report ever receiving it. These results are followed by a discussion of possible policy implications for planning for substance user treatment services for patients treated for STDs in publicly funded clinics and suggestions for further research.

Adolescent↗
PubMed2002

A comparison of Campylobacter jejuni enteritis incidence rates in high- and low-poultry-density counties: Michigan 1992-1999.

To compare the incidence of Campylobacter jejuni enteritis in high- and low-poultry-density counties in Michigan between the years 1992 and 1999, an ecological study was conducted in the state of Michigan. A log-linear model was used to compare yearly, seasonal, age, and gender-specific incidence rates between county groupings. Counties with a high poultry density had a higher overall incidence of C. jejuni enteritis, particularly among children and young adults, compared with counties with low poultry density. The findings suggest that living in high-poultry-density counties is associated with higher odds for C. jejuni enteritis. This may be due to occupational exposure among poultry workers in these counties, but the findings in children suggest that indirect or environmental exposures may also play a role. Future studies should be conducted to investigate these issues.

Adolescent↗
PubMed1994

Isolation of Borrelia burgdorferi from two patients in Michigan.

Borrelia burgdorferi was isolated from skin biopsy specimens of erythema chronicum migrans lesions on two individuals residing in Menominee County, Michigan, in 1992. To our knowledge, these are the first two cases of culture-confirmed Lyme disease in Michigan. In spite of prompt treatment and resolution of illness, antibodies to B. burgdorferi were detectable for at least 3 months in both patients. Both specimens were obtained at different rural medical practices, thus demonstrating that with adequate laboratory support it is feasible to confirm a diagnosis of acute Lyme disease by culture in rural health care settings.

Adult↗
PubMed1977

Influenza B-associated Reye's syndrome: incidence in Michigan and potential for prevention.

Prospective surveillance for Reye's syndrome in Michigan revealed the occurrence of 46 cases between December 15, 1973 and June 1, 1974. In an attempt to determine the incidence of influenza B-associated Reye's syndrome, a randomized point-prevalence survey of 1,041 schoolchildren was done in a county in Michigan where there had been simultaneous outbreaks of influenza B and Reye's syndrome. Of the children tested, 20% had titers of hemagglutination-inhibiting antibody to influenza virus B/Hong Kong/5/72 of greater than or equal 1:20. Based upon this countywide survey, the incidence of Reye's syndrome following influenza B was estimated as between 30.8 and 57.8 cases of Reye's syndrome per 100,000 cases of influenza B. A detailed epidemiologic investigation of the patients who developed Reye's syndrome indicated that the syndrome occurred four times more frequently in children living in rural areas than in children in the urban areas of the state. These studies indicate that, in addition to antecedent viral infections such as influenza B, factor(s) that are most likely extrinsic or environmental also play a role in the pathogenesis of Reye's syndrome.

Adolescent↗
PubMed2002

Molecular analysis of vancomycin-resistant Enterococcus faecalis from Michigan hospitals during a 10 year period.

We evaluated the molecular relatedness of 47 clinical isolates of vancomycin-resistant Enterococcus faecalis collected from 15 Michigan hospitals from 1991 to 2000. There were 17 PFGE strain types for the 47 isolates. Ten of 15 hospitals demonstrated interhospital, and three of 15 intrahospital, dissemination of some isolates. Forty-two isolates (89.4%) demonstrated vanB resistance. All vanA isolates comprised unique PFGE groups, suggesting transposon dissemination or the presence of a similar plasmid. The results of this study suggest inter- and intrahospital dissemination of strains of vancomycin-resistant E. faecalis during a 10 year period in Michigan.

Anti-Bacterial Agents↗
PubMed1984

Guillain-Barré syndrome and its relationship to swine influenza vaccination in Michigan, 1976-1977.

Active surveillance to detect all patients with Guillain-Barré syndrome who had had onset of illness from July 1, 1976 through April 30, 1977 was undertaken in Michigan after indications that the syndrome might be associated with the National Influenza Immunization Program of 1976-1977. Hospital record room librarians, neurologists, and neurosurgeons reported the greatest number of cases; coded hospital discharge records were the best means of ascertaining case occurrence. This differed from national surveillance, which relied essentially on reports that neurologists and other clinicians sent to state epidemiologists and then to the Centers for Disease Control; hospital discharge lists were not systemically reviewed nationally. A total of 79 of the Michigan cases were in persons who had not received swine influenza vaccine, while 46 cases were in persons who had received it. For unvaccinated adults, the incidence of Guillain-Barré syndrome during the 10-month surveillance period was 0.36 cases per 10(6) person-weeks; for adults with onset within six weeks of vaccination, it was 2.31 cases per 10(6) person-weeks. After six weeks post-vaccination, the rate decreased to 0.17 cases per 10(6) person-weeks. The attributable risk for acquiring Guillain-Barré syndrome within six weeks after receiving swine influenza vaccine was 11.70 cases per 10(6) persons vaccinated.

Adolescent↗
PubMed1993

Zoonotic Brugia infection in western Michigan.

A case of zoonotic lymphatic filariasis is reported from a resident of Michigan. Numerous sections of a small, nongravid female worm, measuring approximately 65 microns in diameter, were identified in histological preparations of an excised inguinal lymph node. Based on its location, small size, thin cuticle, small number of muscle cells, and paired uterine tubes, the worm was identified as a Brugia species, undoubtedly of zoonotic origin from the local animal population. The pathological response of the host to the parasite was one of hyperplastic lymph nodes with a focal granulomatous reaction. This is the first such case to be reported from Michigan and further expands the geographical range of states in which zoonotic Brugia infection have been reported.

Adult↗
PubMed2003

Ethics, professionalism, and humanities at Michigan State University College of Human Medicine.

This article describes the variety of approaches used at Michigan State University's College of Human Medicine for teaching ethics, professionalism, and humanities to undergraduate medical students: courses in ethics and health policy; mentoring programs; selectives in history, literature, and spirituality; structured patient care experiences; and discussions with students in their clinical years on the ethical and professional challenges confronting them in their clinical experiences. Some of these approaches, such as the structured patient-care experience, may be unique to Michigan State. The authors place special emphasis on discussing the challenges that confront this curriculum, including struggles to keep up with the pace of change in the health care system, preserving and highlighting the linkages between the "ethics" and the "professionalism" strands of the curriculum, making optimal use of Web technologies, successfully communicating to students the ultimately practical importance of the medical humanities other than ethics, and solving the problems of geography created by a widely dispersed community campus system.

Bioethics↗
PubMed2004

The Department of Medical Education at the University of Michigan Medical School: a case study in medical education research productivity.

The Department of Medical Education (DME) at the University of Michigan Medical School has a strong and sustained history of contributing to medical education research. The author identifies several dimensions that contribute to this productivity: (1) the quality of department faculty and the complementary areas of expertise they possess; (2) a critical mass of educational scholars, both within and outside the DME; (3) extensive collaborations of DME faculty with colleagues in other departments on educational innovation; (4) the departmental status of the DME; (5) the separation of the DME from the administration of the curriculum; (6) the need to balance the missions of research and educational support of the medical school; (7) the research-intensive nature of the larger University of Michigan environment; (8) the complex challenge of funding the educational scholarship mission; and (9) the importance of maintaining visibility within the institution. Factors that will affect the health of future educational scholarship include (1) the response to the Accreditation Council for Graduate Medical Education's definition of resident competencies and similar initiatives; (2) the growth of opportunities for advanced training in educational scholarship and the corresponding expansion of medical school faculty with greater interest and skills in educational research; (3) an emerging emphasis on the importance of behavioral science in medical care; (4) demands on the clinical productivity of collaborating faculty; and (5) the paucity of funding for medical education research.

Accreditation↗
PubMed1990

Spend-down of assets before Medicaid eligibility among elderly nursing-home recipients in Michigan.

Many elderly persons enter nursing homes as private pay clients, spend their available life savings, and then apply for medical assistance under Medicaid after their assets are depleted. However, reliable data on the size and characteristics of this "spend-down" population have been lacking. This study used Medicaid claims and enrollment data to identify the proportion of elderly Medicaid nursing-home users who originally entered nursing homes as private pay clients versus those eligible for Medicaid before or concurrent with, their nursing-home admission. The study population consisted of all elderly nursing-home users receiving Medicaid in Michigan in 1984, a total of 36,898 unduplicated recipients. Findings indicated that "spend-downers" comprised 27.2% of all elderly users. Once on Medicaid, spend downers exhibited similar nursing-home utilization patterns as other groups, but incurred lower Medicaid claims because they contributed more to the cost of their nursing-home care. In aggregate, the State of Michigan Medicaid program spent $75.4 million on nursing-home services in 1984 for elderly persons who spent down to eligibility in a nursing home. These data are relevant to state policy initiatives to reduce Medicaid spending for nursing-home care by encouraging potential spend downers to purchase long-term care insurance.

Aged↗
PubMed1995

Proportionate mortality study of Vietnam-era veterans of Michigan.

This study examines the proportion of deaths from major diseases among Michigan Vietnam veterans. The distribution of deaths among Michigan Vietnam veterans was compared to deaths among veterans serving elsewhere for 1974-1989 to generate a proportionate mortality ratio (PMR). PMRs were estimated overall and for Black versus non-Black veterans. Overall, Vietnam veterans had significantly elevated PMRs for infectious and parasitic diseases and endocrine disease and lower PMRs for all malignant neoplasms combined. Vietnam veterans overall and non-Black specifically had elevated PMRs for non-Hodgkin's lymphoma. Black Vietnam veterans had elevated PMRs for cancer of the digestive organs, peritoneum, and pancreas. The elevated PMR for non-Hodgkin's lymphoma is consistent with results of individuals exposed to phenoxy herbicides. Results suggest that future studies should examine risks among racial groups separately.

Adult↗
PubMed1995

Herbicide regulation: a case study of Michigan.

Lawn-care herbicides are a type of pesticide regulated under federal and state pesticide legislation. The Michigan Department of Agriculture implements herbicide regulation to protect the public's health and welfare. Yet, due to gaps that exist in all levels of government in the regulation of lawn-care herbicide application, the public is placed at risk. The federal pesticide legislation (Federal Insecticide, Fungicide, and Rodenticide Act) provides for a lower standard of safety in the classification of herbicides applied in the residential context as opposed to the agricultural context. Michigan legislation (The Pesticide Control Act) exempts from the law persons applying general herbicides on their own premises. The state does not require public notification of risks or safety precautions prior to commercial application of these herbicides. Furthermore, on-site inspections are not performed for residential application of herbicides and the state applicator certification program is not assessed for effectiveness.

2,4-Dichlorophenoxyacetic Acid↗
PubMed1997

The challenge of developing community profiles for use in community health assessment: lessons from Michigan's experience.

In Michigan, a number of steps have been undertaken to revitalize a key public health function--community health assessment. This article reports on the activities of these initiatives, focusing on the beginning stage of the community health assessment process--the development of community health profiles. The findings and lessons learned from Michigan's experience, although state specific, appear to have broad applicability to the entire local public health community. It is hoped their publication will stimulate replication of this process among this community in other states.

Community Health Planning↗
PubMed1999

Anglers' attitudes, beliefs, and behaviors as impacted by the Michigan Fish Consumption Advisory.

This study examines the relationship between a person's knowledge that a current ego-involving behavior may include health risks and the undertaking of a subsequent behavior change to reduce this risk. Specifically, 396 licensed anglers were surveyed concerning their beliefs about the health risks of consuming sport-caught fish, their knowledge of the risk information contained in the Michigan Fish Consumption Advisory, and their personal fish consumption behavior. Sixty-five percent of the anglers surveyed reported reading part or all of the Michigan Fish Consumption Advisory; however, as a group, they perceived the risks from eating sport-caught fish as small.

Adult↗
PubMedDate not supplied

Southeast Michigan Diabetes Outreach Network: quality improvement project for diabetes care.

This article describes the development and process measures with related outcomes of the Southeast Michigan Diabetes Outreach Network (SEMDON), one of six Diabetes Outreach Networks in Michigan. SEMDON's mission is to strengthen diabetes prevention, detection, and treatment. Education in diabetes management is provided to participating agencies. The agency staff collect baseline data on patients with diabetes including demographics and physiologic measures. Education is given to the patients by the staff nurses. The collection of information on several care process measures and intermediate outcomes is repeated at 6 months. A report of matched data of these agencies from 404 individuals with diabetes is presented. The outcomes of blood glucose, hemoglobin A1c, blood pressure, and annual foot and eye exams will be analyzed. The SEMDON model may be an effective approach in improving the quality of diabetes care.

Community Networks↗
PubMed2006

Teaching medical education principles and methods to faculty using an active learning approach: the University of Michigan Medical Education Scholars Program.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School was established in 1998 to develop educational leadership, improve teaching skills, and promote educational scholarship among medical school faculty. The Department of Medical Education designed and implemented the program. Eighty-one scholars have completed the MESP, with 15 more currently enrolled. While most scholars have been clinical faculty, some have been basic science faculty or from other allied health fields. The selection process emphasizes potential for contributing to the educational mission of the medical school. Each cohort is limited to two participants per department. The curriculum of the MESP is designed to provide an overview of a wide range of topics in education. It is divided into five broad domains: principles and theories of education, teaching methods, educational research methods, assessment and evaluation, and educational leadership. During the sessions, active learning of content is expected and encouraged. For instance, scholars share responsibility with the session presenters for planning and evaluating individual program sessions. To graduate, scholars are expected to attend the sessions regularly, and to make a final presentation of their project, which demonstrates near-completion or substantial progress toward that goal. Over its eight years, the MESP has evolved in response to environmental changes and ongoing evaluation of the program. Overall, the Medical Education Scholars Program has proven effective in developing faculty skills and educational leadership locally at the University of Michigan Medical School and nationally.

Adult↗
PubMed2000

Hydrodynamic image formation by the peripheral lateral line system of the Lake Michigan mottled sculpin, Cottus bairdi.

Lake Michigan mottled sculpin (Cottus bairdi) have a lateral-line-mediated prey-capture behaviour that consists of an initial orientation towards the prey, a sequence of approach movements, and a final strike at the prey. This unconditioned behaviour can be elicited from blinded sculpin in the laboratory by both real and artificial (vibrating sphere) prey. In order to visualize what Lake Michigan mottled sculpin might perceive through their lateral line when approaching prey, we have combined anatomical, neurophysiological, behavioural and computational modelling techniques to produce three-dimensional maps of how excitation patterns along the lateral line sensory surface change as sculpin approach a vibrating sphere. Changes in the excitation patterns and the information they contain about source location are consistent with behavioural performance, including the approach pathways taken by sculpin to the sphere, the maximum distances at which approaches can be elicited, distances from which strikes are launched, and strike success. Information content is generally higher for laterally located sources than for frontally located sources and this may explain exceptional performance (e.g. successful strikes from unusually long distances) in response to lateral sources and poor performance (e.g. unsuccessful strikes) to frontal sources.

Animals↗
PubMed2004

Emergency department use among Michigan children with special health care needs: an introductory study.

OBJECTIVE: To describe patterns of emergency department (ED) use among children dual-enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS). DATA SOURCES: Individual claims and enrollment data from Michigan's Medicaid and CSHCS programs for the period January 1, 1998, to June 30, 1999. Claims data were linked with eligibility data and then used to develop a 100 percent sample of claims for individuals enrolled in both Medicaid and CSHCS. STUDY DESIGN: Poisson regression analysis was used to examine the rate of ED use for dual-enrolled children. A time-varying hazard analysis was also used to examine the impact of changes over time. The key variables were gender, age, race, county of residence, Medicaid eligibility category, and qualifying diagnosis. PRINCIPAL FINDINGS: Dual-enrolled children under one year of age, and those with qualifying diagnoses of anemia, hemophilia, asthma, epilepsy, and juvenile diabetes displayed especially high rates of ED use. Significant geographic variation in ED use remained after controlling for qualifying diagnoses, race/ethnicity, and other factors. African Americans displayed higher rates of ED utilization than non-Hispanic whites. Supplemental Security Income (SSI) recipients demonstrated higher utilization than other groups. CONCLUSIONS: Children dually enrolled in CSHCS and Medicaid face diverse challenges of both poverty and chronic illness. Differences in patterns of use highlight the importance, but also the difficulty, of developing systems of care to manage complex chronic conditions in low-income populations.

Adolescent↗