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PubMed2005

Survival strategies for Michigan's health care safety net providers.

OBJECTIVE: To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. DATA SOURCES/STUDY SETTING: Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. RESEARCH DESIGN: In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. PRINCIPAL FINDINGS: Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. CONCLUSIONS: Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity.

Administrative Personnel↗
PubMed1984

Michigan School Health Association celebrates golden anniversary.

The Michigan School Health Association celebrated its Golden Anniversary Nov. 10, 1983. As a group dedicated to the promotion of comprehensive school health programs, MSHA has provided members with publications and conferences, and it has encouraged American School Health Association membership. Its members are health educators, college professors, school nurses, affiliated organizations, and voluntary health agency representatives. With 50 years of experience, the Michigan School Health Association is continuing in its leadership role of promoting comprehensive school health programs.

Michigan↗
PubMed2002

Bovine tuberculosis in Michigan wildlife.

White-tailed deer in Michigan are now recognized as a reservoir host of bovine tuberculosis (TB). It has been determined that the most likely cause of bovine TB infection in the deer is from congregating in artificially high numbers at feed sites. The presence of a wildlife reservoir of TB in Michigan poses a serious threat to the control and eradication programs that are now in their final stages in the United States.

Animals↗
PubMed1984

Oral health of children of migrant farm workers in northwest Michigan.

A considerable number of Hispanic agricultural workers come to Northwest Michigan during the summer every year to harvest fruit and vegetable crops. The Department of Community Dentistry of The University of Michigan School of Dentistry helps provide dental services for these migrant workers and their families. Some 203 five-to-14-year-old children of migrant farm workers were examined for caries and periodontal condition and the results compared with recent national surveys. Traditional indicators of dental caries experience (DMFT/dft and DMFS/dfs indices), periodontal disease (PI), and oral cleanliness (OHI-S) were used by one examiner. These migrant children presented higher numbers of decayed teeth and lower numbers of restored teeth than United States schoolchildren generally. Migrant children also presented less caries-free teeth and higher PI and OHI-S scores than United States children generally.

Adolescent↗
PubMed2005

Comparison of Tn1546-like elements in vancomycin-resistant Staphylococcus aureus isolates from Michigan and Pennsylvania.

In 2002, the first two clinical isolates of vancomycin-resistant Staphylococcus aureus (VRSA) containing vanA were recovered in Michigan and Pennsylvania. Tn1546, a mobile genetic element that encodes high-level vancomycin resistance in enterococci, was present in both isolates. With PCR and DNA sequence analysis, we compared the Tn1546 elements from each isolate to the prototype Tn1546 element. The Michigan VRSA element was identical to the prototype Tn1546 element. The Pennsylvania VRSA element showed three distinct modifications: a deletion of nucleotides 1 to 3098 at the 5' end, which eliminated the orf1 region; an 809-bp IS1216V-like element inserted before nucleotide 3099 of Tn1546; and an inverted 1,499-bp IS1251-like element inserted into the vanSH intergenic region. These differences in the Tn1546-like elements indicate that the first two VRSA isolates were the result of independent genetic events.

DNA Transposable Elements↗
PubMed1968

Possible origin of the high incidence of Clostridium botulinum type E in an inland bay (Green Bay of Lake Michigan).

Bottom and shoreline sediments of Green Bay, northern Lake Michigan, and rivers of the Green Bay drainage basin, as well as soils of the surrounding land mass, were examined for Clostridium botulinum type E. Detection was based on identification of type E toxin in enrichment cultures and was influenced by many factors. Testing smaller amounts of sample in multiple cultures was more productive than examining large inocula in fewer cultures. Incubation at 30 C was unsatisfactory, but 14 days at 20 C or 7 days at 25 C gave good results. Mild heating (60 C for 30 min) of specimens reduced the incidence of positive findings. Freezing enrichment cultures prior to testing for toxicity eliminated many nonbotulinal toxic substances that killed mice. A control culture inoculated with type E spores was employed to show whether a specimen contained factors which could mask the presence of type E. Samples from 708 stations were tested in 2,446 cultures. Type E was found in nearly all underwater specimens of Green Bay and northern Lake Michigan but was present less frequently in samples taken along their shores. The incidence was still lower in the rivers emptying into Green Bay with the organism being rare on the shores of these rivers and in the soils of the land mass proper. Samples from the upper reaches of the rivers practically never contained type E. Runoff could deposit type E spores in Green Bay, but this is not considered to be the major factor in the high incidence of the organism. Multiplication in the bay itself is indicated.

Animals↗
PubMed1998

Molecular analysis of glycopeptide-resistant Enterococcus faecium isolates collected from Michigan hospitals over a 6-year period.

The purpose of this study was to evaluate the molecular relatedness of clinical isolates of glycopeptide-resistant Enterococcus faecium isolates collected from hospitals in Michigan. A total of 379 isolates used in this study were all vancomycin-resistant E. faecium isolates collected from 28 hospitals and three extended-care facilities over a 6-year period from 1991 to 1996. For the 379 isolates, there were 73 pulsed-field gel electrophoresis (PFGE) strain types. Within strain types, there were as many as six restriction fragment differences. Most isolates (70%) belonged to six strain types, which were designated M1 (36%), M2 (3%), M3 (18%), M4 (6%), M10 (4%), and M11 (3%). PFGE strain M1 was cultured from 135 patients in 13 hospitals during the period 1993 to 1996. Strain type M2 was cultured from 11 patients in two hospitals during the period 1991 to 1992 and was not observed after 1992. Strain type M3 was cultured from 70 patients in 10 hospitals during the period of 1994 to 1996. Both M4 and M10 were cultured from 23 patients in three hospitals and from 15 patients in two hospitals, respectively, during 1995 to 1996. M11 was cultured from 13 patients in four hospitals during 1996. A total of 23 of 28 hospitals had evidence of clonal dissemination of some isolates. Plasmid content and hybridization analysis done on 103 isolates from one hospital and two affiliated extended-care facilities indicated that the strains contained from one to eight plasmids. Mating experiments indicated transfer of vancomycin resistance from 94 of these isolates into plasmid-free E. faecium GE-1 at transfer frequencies of <10(-9) to 10(-4). Gentamicin resistance and erythromycin resistance were cotransferred at various frequencies. A probe for the vanA gene hybridized to the plasmids of 23 isolates and to the chromosomes of 72 isolates. A probe for the vanB gene hybridized to the chromosomes of 8 isolates. The results of this study suggest inter- and intrahospital dissemination of vancomycin-resistant E. faecium strains over a 6-year period in southeastern Michigan. The majority of isolates studied belonged to the same few PFGE strains, indicating that clonal dissemination was responsible for most of the spread of resistance that occurred.

Anti-Bacterial Agents↗
PubMed2006

Low vision rehabilitation services in Michigan viewed against the national backdrop.

The diagnosis and treatment (including low vision rehabilitation) of permanent vision impairment due to ocular disease and trauma are gaining increased emphasis around the world. In the United States, this emphasis is due to both changing demographics and emerging policies issued by the US Centers for Medicare and Medicaid Services (CMS). In this de facto report, we trace the evolution of low vision rehabilitation service in Michigan, highlighting the role of public appropriations initiated in the mid 1960s and continuing today. An array of state, private, nonprofit, and clinical services for vision rehabilitation in Michigan are described in the context of the historical roots, current roles, and future trends related to emerging policies and systems of care.

Delivery of Health Care↗
PubMed1992

Deployment and utilization of MR imaging in Michigan: observations of a statewide data base.

Patterns of deployment and utilization of magnetic resonance (MR) imaging were studied with a Michigan Department of Public Health data base containing data regarding more than 218,000 patient visits. Michigan currently has 16 hospital-based fixed MR systems (magnets), 14 (13 operational) freestanding fixed magnets, and 11 (10 operational) mobile magnets operating at 45 host sites. The imaging volume for 1991 was approximately 127,000 procedures, with associated charges of $126,500,000. Central nervous system imaging accounted for 82.6% of procedure volume, with extremities accounting for another 12.9%. The average total charge per procedure ranged from $844 to $1,076, and the average professional charge per procedure ranged from $178 to $226. The annual throughput ranged from 1,356 to 7,480 procedures per magnet. Wide variation in many measures was observed both within and among hospital-based, freestanding, and mobile facility types. The use of computed tomography (CT) before MR imaging for the same diagnostic problem continues to be substantial (average, 44% for MR imaging of the head). Patterns of inpatient imaging and prior use of CT indicate that the technical benefit of mobile MR imaging should be investigated further.

Ambulatory Care↗
PubMed1985

Examining the application of the guilty but mentally ill verdict in Michigan.

The insanity defense has come under increased criticism after the highly publicized acquittal of John Hinckley, Jr. A variety of proposals have been suggested to rectify the perceived injustices of an insanity acquittal. In 1975 Michigan passed a guilty but mentally ill statute that allowed for individuals to be found mentally ill at the time of the offense but still criminally responsible for their actions. The authors review the history of the Michigan statute, scrutinize an empirical study of the statute's effectiveness, and debate a number of controversial issues. They suggest that guilty but mentally ill may be a misleading verdict established because of purely political motives.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Physician care for interscholastic athletes in Michigan.

Between January 1989 and March 1989 the athletic directors of the 711 high schools in the Michigan High School Athletic Association were surveyed as to what sports and levels of competition each school offered and what level of medical care was available. Fifty-seven percent of the surveyed schools returned properly completed forms. Sixty-one percent of the schools responding reported having a physician available for at least one team at some time during the year. This was almost universally the football team; with 59% of the schools with varsity football reporting a physician present at either a practice or a contest at least once during the year. Only 13% of the schools reported having a physician available for a team other than varsity football. Seventy-four percent of all varsity teams had neither a physician nor an athletic trainer present at any time during the year. Comparison of the results of this study with similar studies performed in Michigan in 1975 and 1979, as well as studies in other states, demonstrates that despite the increased awareness and popularity of sports medicine, there has been no appreciable change in the amount of access interscholastic athletes have to physician care.

Adolescent↗
PubMed2003

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children.

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.

Adolescent↗
PubMed2006

Chronic disease - related behaviors and health among African Americans and Hispanics in the REACH Detroit 2010 communities, Michigan, and the United States.

OBJECTIVES: To compare chronic disease risk factors and their correlates for African American and Hispanic residents of REACH Detroit, Michigan, and the United States. METHOD: Behavioral Risk Factor Survey data from 2001-2003 were used for comparisons and regression models. RESULTS: Several chronic disease risk factors were more prevalent among REACH Detroit residents than their Michigan and U.S. counterparts. In REACH Detroit, greater fruit and vegetable consumption was associated with more than high school education and older age among Hispanics, and meeting exercise guidelines and older age among African Americans. Less than high school education, smoking, and male gender were associated with lower consumption among African Americans. Greater physical activity was associated with younger age, male gender, and more fruit and vegetable consumption among African Americans, and unemployment among Hispanics. CONCLUSIONS: Surveillance of health behaviors in high-risk communities contributes to planning interventions and policies for reducing racial and ethnic disparities.

Adolescent↗
PubMed2004

Maternal concentration of polychlorinated biphenyls and dichlorodiphenyl dichlorethylene and birth weight in Michigan fish eaters: a cohort study.

BACKGROUND: Studies on maternal exposure to polychlorinated biphenyls (PCBs) reported inconsistent findings regarding birth weight: some studies showed no effect, some reported decreased birth weight, and one study found an increase in weights. These studies used different markers of exposure, such as measurement of PCBs in maternal serum or questionnaire data on fish consumption. Additionally maternal exposures, such as dichlorodiphenyl-dichloroethylene (DDE), which are related to PCB exposure and may interfere with the PCB effect, were rarely taken into account. METHODS: Between 1973 and 1991, the Michigan Department of Community Health conducted three surveys to assess PCB and DDE serum concentrations in Michigan anglers. Through telephone interviews with parents, we gathered information on the birth characteristics of their offspring, focusing on deliveries that occurred after 1968. We used the maternal organochlorine (OC) measurement closest to the date of delivery as the exposure. Although one mother may have contributed more than one child, serum concentrations derived from measurements in different surveys could vary for different children from the same mother. The maternal DDE and PCB serum concentrations were categorized as follows: 0 -< 5 microg / L, 5 -< 15 microg / L, 15 -< 25 microg / L, >or=25 microg / L. Using repeated measurement models (Generalized Estimation Equation), we estimated the adjusted mean birth weight controlling for gender, birth order, gestational age, date of delivery as well as maternal age, height, education, and smoking status. RESULTS: We identified 168 offspring who were born after 1968 and had maternal exposure information. We found a reduced birth weight for the offspring of mothers who had a PCB concentration >or=25 microg / L (adjusted birth weight = 2,958 g, p = 0.022). This group, however, was comprised of only seven observations. The association was not reduced when we excluded preterm deliveries. The birth weight of offspring was increased in women with higher DDE concentrations when controlling for PCBs; however, this association was not statistically significant. CONCLUSION: Our results contribute to the body of evidence that high maternal serum PCB concentration may reduce the birth weight in offspring. However, only a small proportion of mothers may actually be exposed to PCB concentrations >or=25 microg / L.

Adolescent↗
PubMed2002

Knowledge of stroke risk factors and warning signs among Michigan adults.

OBJECTIVE: To assess the knowledge of stroke risk factors and warning signs in a representative statewide sample of Michigan adults. METHOD: Respondents to the 1999 Michigan Behavioral Risk Factor Survey, a random-digit-dialed statewide survey of >2,500 adults, were asked to report up to three risk factors and warning signs for stroke. Predictors of inadequate knowledge (defined as not reporting any correct responses) of stroke risk factors and warning signs were identified using multiple logistic regression. RESULTS: Eighty percent reported at least one correct risk factor for stroke, and 28% reported three. The most frequently mentioned risk factors were hypertension (32%), smoking (29%), and physical inactivity (26%). Sixty-nine percent reported at least one correct warning sign of stroke, but only 14% reported three. The most frequently mentioned warning signs were sudden weakness or numbness (46%) and sudden slurred speech, disorientation, or difficulty understanding (30%). Predictors for inadequate knowledge of both stroke risk factors and warning signs were similar and included age, race, sex, education, hypertension, and smoking. CONCLUSIONS: Knowledge of stroke risk factors and warning signs was moderate at best. One in five respondents was not aware of any stroke risk factors, and almost one in three was not aware of any stroke warning signs. Stroke knowledge was poorest among groups that have the highest risk of stroke.

Adolescent↗
PubMed1994

Parkinson's disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990.

Using data from death certificates, we compared underlying causes of death for two populations of Michigan decedents: (1) persons 40 years of age and older for whom Parkinson's disease (PD) was listed as a contributing cause of death and who died in the years 1970 through 1989, and (2) all persons in Michigan over 40 years of age who died in 1970, 1980, or 1990. PD decedents were approximately 1.5 times more likely to die from cerebrovascular disease and three to four times more likely to die from pneumonia/influenza, but they had just 29% of the expected number of deaths due to cancer. These associations were maintained irrespective of gender or race. PD decedents had diabetes mellitus and heart diseases as frequently as decedents in the general population, but liver diseases were less frequent among PD decedents. These trends held throughout the 21-year study period. When we stratified cancers by whether they are known to be (1) highly related, (2) moderately related, or (3) weakly related or unrelated to smoking, there were still 2.5 times fewer cancers unrelated or weakly related to smoking among PD decedents than among decedents in the general population. We believe that the greater frequency of cerebrovascular disease in PD decedents may be due to a detection bias, since PD patients are more likely to be seen by neurologists, who are more apt to diagnose and document diseases of the nervous system. Pneumonia/influenza is more common among PD patients because of their relative immobility near the end of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Implementing regulatory reform: the saga of Michigan's debedding experiment.

This paper traces the implementation of Michigan's program for hospital bed reduction through four phases in the critical first 30 months following enactment: standard-setting, plan development, plan approval, and legislative oversight. Procedural complexity and goal conflict complicated implementation from the start: what began as a simple proposal to close unneeded beds soon became enmeshed in efforts to address long-standing issues of equity in access to care. A combination of administrative, political, and economic factors peculiar to Michigan, as well as the more generic problems incurred in applying a regulatory approach to containing medical care costs, contributed to the difficulties encountered in implementing bed reduction. Long-range prospects for the program depend upon whether the modest results it is likely to achieve are deemed to be worth the costs incurred in administering it.

Certificate of Need↗
PubMed1995

Neurosurgery at the University of Michigan.

Neurosurgery at the University of Michigan was established as a specialty three-quarters of a century ago by Max Minor Peet. It developed under the successive leadership of Edgar Allan Kahn, Richard Coy Schneider, and Julian T. Hoff. Each has made unique contributions to the program, which has a strong tradition of teaching, research, and patient care. This article traces the development of the training program in neurosurgery at Michigan, focusing on its historical background, past accomplishments, present structure, and future directions.

Curriculum↗