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PubMed1993

Silicosis surveillance--Michigan, New Jersey, Ohio, and Wisconsin, 1987-1990.

PROBLEM/CONDITION: Improved surveillance for silicosis is needed to target interventions to prevent this occupational lung disease caused by the inhalation of crystalline silica dust. REPORTING PERIOD COVERED: 1987-1990. DESCRIPTION OF SYSTEMS: State-based silicosis surveillance and intervention programs have been developed in Michigan, New Jersey, Ohio, and Wisconsin as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) Program, initiated in 1987 by the National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1987 through 1990, the SENSOR program confirmed a total of 430 cases of silicosis reported from these four states. Overall, approximately 60% of these cases were in workers employed in primary metal industries, although the types of industries in which cases occurred varied by state. Some cases were attributable to relatively recent exposure, including new cases in seven persons first exposed since 1980 in New Jersey. Silicosis case reports have prompted measurement of respirable silica concentrations at 25 Michigan work sites, and 14 (56%) of these sites were found to have levels that exceeded the legally permissible exposure level. INTERPRETATION: The silicosis surveillance and intervention strategies piloted by state health departments in the NIOSH-funded SENSOR Program have demonstrated the feasibility and effectiveness of identifying specific silica-using work sites that need preventive intervention. ACTIONS TAKEN: On the basis of initial experience in these four states, NIOSH developed guidelines for state-based silicosis surveillance and awarded SENSOR cooperative agreements to three additional states where the applicability of these surveillance methods will be further evaluated.

Humans↗
PubMedDate not supplied

Need for HIV education among public health personnel in Michigan.

Knowledge and attitudes related to human immunodeficiency virus (HIV) and the use of the universal precautions recommended by the Centers for Disease Control and Prevention were investigated among 807 State and 2,797 local public health personnel in Michigan in September 1989. Survey results indicated that the majority of respondents were well-informed regarding the major routes of HIV transmission, but many respondents hold misconceptions regarding nonviable routes of transmission and about policies on HIV counseling and testing. Respondents reporting occupational exposure to blood or semen reported inconsistent use of universal precautions. Most respondents believed in providing the same quality of care for those with HIV infection as for noninfected persons. However, 32.4 percent believed that they should have the right to refuse treatment, and 9.4 percent reported that they would not be willing to provide routine public health services to an HIV-infected client. The results of this research suggest that in Michigan, public health personnel are in need of HIV education that focuses on the correction of misconceptions about HIV transmission, counseling, and testing policies; the development of appropriate attitudes toward persons infected with HIV; and the appropriate use of universal precautions. Findings also suggest that inadequate protective equipment is an important barrier to the consistent use of universal precautions.

Adult↗
PubMed1996

Biopsy-confirmed hypersensitivity pneumonitis in automobile production workers exposed to metalworking fluids--Michigan, 1994-1995.

In 1994, union and management officials and local physicians in southeastern Michigan noted the occurrence among automobile production workers of respiratory illness consistent with hypersensitivity pneumonitis (HP). Local and national health authorities reviewed medical records, and in June 1994, individual employees and the union requested that CDC's National Institute for Occupational Safety and Health (NIOSH) evaluate potential occupational exposures associated with these illnesses. This report summarizes preliminary findings of the evaluation, including detailed information about one HP case and a summary description of the six biopsy-confirmed cases among automobile production workers from three different plants (plants A, B, and C) in southeastern Michigan; all six workers had jobs that entailed frequent exposure to metalworking fluids (MWFs). The findings suggest the need for further evaluation of a possible association of occupational exposure to MWFs with HP.

Alveolitis, Extrinsic Allergic↗
PubMed1995

Mortality among persons with silicosis reported to disease surveillance systems in Michigan and New Jersey in the United States.

Michigan and New Jersey in the United States maintain silicosis disease registers. In 1988-1992, 372 cases of silicosis were confirmed in Michigan, and, in 1979-1992, 288 were confirmed in New Jersey. A proportionate mortality ratio (PMR) analysis was performed on data from 292 deceased silicotics. Increases in PMR values were found for nonmalignant respiratory disease (NMRD) and lung cancer. The PMR values for NMRD were statistically elevated in all the analyses. The overall proportionate cancer mortality ratio (PCMR) for lung cancer was 1.78 [95% confidence interval (95% CI) 1.22-2.61]. For patients having ever smoked cigarettes, the PCMR for lung cancer was 1.82 (95% CI 1.8-2.81). Never smoking silicotics had a lung cancer PCMR of 1.48 (95% CI 0.43-2.86). For those who had never applied for workers' compensation the corresponding PCMR was higher, 2.10 (95% CI 1.21-3.69), than for those who had applied, 1.45 (95% CI 0.70-2.99).

Confidence Intervals↗
PubMed1996

Advertising, computers, and pharmacy liability. A Michigan court's decision has ramifications for pharmaceutical care.

Arbor Drugs, Inc., advertised that its computer could detect dangerous drug interactions. A pharmacist failed to warn a patient accordingly and the patient suffered a stroke as a result of an interaction between tranylcypromine and a decongestant. The Michigan Court of Appeals held that this failure to warn was actionable under the theories of negligence and fraud as well as under the Michigan Consumer Protection Act. The court's basic message is that pharmacies may be held legally responsible for preventing harm when they represent themselves as being capable of doing so.

Advertising↗
PubMed1997

Health risk factor surveys of commercial plan- and Medicaid-enrolled members of health-maintenance organizations--Michigan, 1995.

Behavioral risk factors involving tobacco use, improper diet, physical inactivity, alcohol abuse, and motor-vehicle-related injury contributed to approximately 850,000 deaths in the United States in 1990. CDC's Behavioral Risk Factor Surveillance System (BRFSS) has been the primary means for tracking progress toward reduction of these and other health risks at the state level. This report summarizes the use of telephone surveys conducted by the Michigan Consortium for Quality Improvement in Health Care during April-August 1995 to evaluate the health-risk profiles of commercial plan- and Medicaid-enrolled health-maintenance organization (HMO) members in Michigan. The findings indicate that HMOs can use the BRFSS model to monitor health risks, health status, and use of preventive services among member groups.

Health Behavior↗
PubMed1998

Survival analysis of risk factors associated with the occurrence of lameness in a Michigan horse population.

OBJECTIVE: To evaluate the associations of operation and individual animal-level risk factors with occurrence of lameness in the Michigan horse population. SAMPLE POPULATION: 3,925 horses monitored from 138 randomly selected Michigan operations for a total of 814,753 horse-days. PROCEDURE: All horses monitored < 60 days were eliminated from the source population. From the remaining horses, a prospective unmatched case-control study population was generated that included all cases and a random sample of noncases. Analysis of risk factors associated with occurrence of lameness was conducted, using Cox's proportional hazards regression model. RESULTS: Horses in larger operations, compared with horses in the first operation size quartile, were associated with decreased risk of lameness (2nd quartile [Q]: hazard ratio [HR] = 0.57; 95% confidence interval [CI]: 0.36, 0.91; 3rd Q: HR = 0.74; 95% CI: 0.49, 1.13; 4th Q: HR = 0.46; 95% CI: 0.28, 0.76). Compared with mares, stallions (HR = 1.90; 95% CI: 1.17, 3.07) and geldings (HR = 1.46; 95% CI: 1.02, 2.09) were at increased risk of lameness. Compared with horses used for breeding purposes only, those participating in exercise or performance-related activities including racing (HR = 4.70; 95% CI: 1.70, 13.03) and showing (HR = 2.80; 95% CI: 1.07, 7.28) also were at increased risk of lameness. CONCLUSIONS: Comparison of these results with those conducted using multivariable logistic regression strengthens the argument that there is decreased risk of lameness for horses in larger operations and increased risk of lameness for active horses. Additionally, results of this analysis suggested that stallions and geldings are at increased risk of lameness, compared with mares. CLINICAL RELEVANCE: Lameness prevention strategies in the horse industry should focus principally on horses participating in exercise or performance-related activities, including racing and showing, on male horses, and on horses stabled in smaller operations.

Age Factors↗
PubMed1998

Cancer among a Michigan cohort exposed to polybrominated biphenyls in 1973.

The long-term health effects of human exposure to polybrominated biphenyls are not known. In this nested case-control study, we evaluated the association between site-specific cancer risk and serum polybrominated biphenyl levels among a Michigan cohort accidentally exposed to polybrominated biphenyls in 1973. The Michigan Department of Public Health has followed 3,899 people through 1993, among whom 195 primary cancers were identified in 187 persons. Controls were 696 randomly selected cancer-free individuals who were frequency matched to cases by sex and age (in 5-year strata). Baseline serum polybrominated biphenyl levels were measured using standard methods. We found an increasing dose-response relation for digestive system cancer risk with higher serum polybrominated biphenyl category [4-20 parts per billion (ppb), 21-50 ppb, and > 50 ppb] after adjustment for age, family cancer history, cigarette smoking, alcohol drinking, and baseline serum polychlorinated biphenyl level. Adjusted odds ratios (ORs) for each category were 8.23 [95% confidence interval (CI) = 1.27-53.3], 12.3 (95% CI = 0.80-191), and 22.9 (95% CI = 1.34-392), respectively. Univariate analysis for polybrominated biphenyl level and lymphoma risk also showed a dose-response relation, with corresponding ORs of 3.24 (95% CI = 0.24-95.9), 20.5 (95% CI = 1.51-608), and 32.6 (95% CI = 3.33-861).

Adult↗
PubMed1998

The high prevalence of obesity in Michigan primary care practices. An UPRNet study. Upper Peninsula Research Network.

BACKGROUND: Obesity is a risk factor for several chronic diseases and some cancers. We suspected that patients in our primary care practices were, on the average, heavier than state and national norms. METHODS: Rates of overweight patients in primary care practices were compared with rates from the Michigan Behavioral Risk Factor Survey (MBRFS) of 1993 and the National Health and Nutrition Evaluation Survey (NHANES) III Phase I (1988-91), the most recent state and national surveys for which summarized data were available. The 19 family practice offices of the rural Upper Peninsula Research Network (UPRNet) and two urban clinics in the Lansing area participated. We measured heights and weights of 5267 consecutive patients 18 years of age and older who visited one of the offices or clinics during the study period in 1996. RESULTS: Fifty-three percent of the primary care patients were overweight, and 28.5% were severely overweight. The age-adjusted rates were 51.0% and 27.5%, respectively. These rates are much higher than rates reported from the MBRFS (29.1% for overweight), and NHANES III Phase I (33% overweight, 14% severely overweight). The age-adjusted prevalence of overweight and severely overweight was higher in the rural than the urban sample: 52.5% vs 47.2% for overweight and 33.7% vs 25.6% for severely overweight, respectively. CONCLUSIONS: Compared with data from the Michigan Behavioral Risk Factor Survey of 1993 and the National Health and Nutrition Evaluation Survey III Phase I, a much larger proportion of patients visiting our primary care practices are overweight and severely overweight. The prevalence of obesity in primary care practices may be much higher than rates estimated from population-based surveys.

Adolescent↗
PubMed1994

Contaminants in fishes from Great Lakes-influenced sections and above dams of three Michigan rivers. I: Concentrations of organo chlorine insecticides, polychlorinated biphenyls, dioxin equivalents, and mercury.

Fishes of the Great Lakes contain hazardous chemicals such as synthetic halogenated hydrocarbons and metals. These fish can move from the lakes into the Great Lakes tributaries of Michigan. In doing so, they transport concentrations of contaminants which may represent a risk to wildlife. Concentrations of mercury (Hg), total polychlorinated biphenyls (PCBs), 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TCDD-EQ), total DDT complex, aldrin, endrin, dieldrin, heptachlor, heptachlor epoxide, lindane, hexachlorobenzene, cis-chlordane, oxychlordane, endosulfan-I, methoxychlor, trans-chlordane, and trans-nonachlor were determined in composite samples of fishes from above and below Michigan hydroelectric dams, which separate the fishes which have access to the Great Lakes from fishes that do not. Mean concentrations of total PCBs, TCDD-EQ, DDT, and most of the other pesticides were greater in composite samples of six species of fishes from below than above the dams on the Au Sable, Manistee, and Muskegon Rivers. Concentrations of mercury, were the same or greater above the dams than below. However, this difference was statistically significant only on the Au Sable. Mercury concentrations ranged from less than 0.05 mg/kg to 0.73 mg Hg/kg, ww. Total concentrations of PCBs ranged from 0.02 to 1.7 mg/kg, ww. Concentrations of 2,3,7,8-tetrachlordibenzo-p-dioxin equivalents varied among fishes and locations. The concentrations of TCDD-EQ ranged from 2.4 to 71 micrograms/kg, ww, with concentrations in carp being the greatest. Concentrations of TCDD-EQ were greater than the concentrations which would be expected to occur, due solely to the presence of polychlorinated dibenzo-p-dioxins (PCDD), polychlorinated dibenzofurans (PCDF), and technical mixtures of PCBs.

Animals↗
PubMed1990

A graphic evaluation of the intermaxillary relationship before and after therapy with the Michigan splint.

The effect of the Michigan splint was evaluated graphically in a group of 19 patients. Gothic arch tracings were registered before and after a period of therapy of 4 months, and the two tracings were compared photographically. The position of the apex of the Gothic arch was displaced in most patients, while the shape of the arch was more regular in almost all patients. The validity of the use of the Michigan splint was confirmed.

Adolescent↗
PubMed1977

A material balance study of polychlorinated biphenyls in Lake Michigan.

This paper integrates the known chemical and physical properties of polychlorinated biphenyls (PCB) derived in the laboratory with a mathematical model describing their behavior in Lake Michigan. The conclusion that emerges is that the observed levels of PCB both in Lake Michigan and the fish biomass are consistent with these laboratory measurements. In addition, it is concluded that it will take several years for this ecosystem to cleanse itself of the compounds even if no new input is made. The final sink for PCB is predicted to be degradation in the atmosphere, with some fraction being buried in the underlying sediments of the lake.

Air↗
PubMed2002

Crystal structure of a zinc-activated variant of human carbonic anhydrase I, CA I Michigan 1: evidence for a second zinc binding site involving arginine coordination.

The human genetic variant carbonic anhydrase I (CA I) Michigan 1 results from a single point mutation that changes His 67 to Arg in a critical region of the active site. This variant of the zinc metalloenzyme appears to be unique in that it possesses an esterase activity that is specifically enhanced by added free zinc ions. We have determined the three-dimensional structure of human CA I Michigan 1 by X-ray crystallography to a resolution of 2.6 A. In the absence of added zinc ions, the mutated residue, Arg 67, points out of the active site, hydrogen bonding with the carboxylate of Asn 69. This contrasts with the orientation of His 67, in the native isozyme, which points into the active site. The orientations of His 94, His 96, and His 119, that coordinate the catalytic zinc ion, and of the catalytically critical Thr 199-Glu 106 hydrogen bonding system, are largely unchanged in the mutant. The structure of an enzyme adduct with a second zinc bound was determined to a resolution of 2.0 A. The second zinc ion is coordinated to His 64, His 200, and Arg 67. This arginine residue reverses its orientation on zinc binding and turns into the active site. The residues at these three positions have been implicated in determining the specific kinetic properties of native CA I. This is, to our knowledge, the first example of a zinc ion coordinating with an arginine residue in a Zn(II) enzyme.

Arginine↗
PubMed2001

Comparison of polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) in Lake Michigan salmonids.

Polybrominated diphenyl ethers (PBDEs) have been used extensively over the past two decades as flame retardants in most types of polymers. Many measurements of PBDEs in various environmental matrices from Sweden, Holland, Japan, and elsewhere have been reported, but few measurements are available for North America. PBDEs in 21 coho and chinook salmon taken from Lake Michigan tributaries in 1996 were measured for this study. The salmon samples were extracted and initially analyzed for polychlorinated biphenyl (PCB) congeners. It was demonstrated for these samples that the same extract fraction contains PBDEs. Six PBDE congeners were observed in all 21 samples, and the rank order of concentration of these congeners was similar to that in commercial mixtures of PBDEs. The average concentration across all samples of the sum of PBDE congeners was 80.1 ng/g of wet weight or 2,440 ng/g of lipid. This is much less than the average sum PCB concentration (1,450 ng/g of wet weight; 43,100 ng/g of lipid). However, the average concentration of the most abundant PBDE congener (IUPAC BDE-49: 52.1 ng/g wet, 1,590 ng/g of lipid) was about one-third of the average concentration of the most abundant PCB congener (IUPAC CB-153: 149 ng/g wet, 4,550 ng/g of lipid). On the basis of an extensive literature survey, the concentrations of PBDEs reported here are among the highest in the world for salmon in open waters. The concentrations of PBDEs and PCBs are both correlated with fish length and mass, but not with lipid content. The concentrations of PBDEs and PCBs are highly correlated in individual fish, implying that PBDEs are as prevalent as PCBs in Lake Michigan.

Animals↗
PubMed2001

Accumulation of atmospheric and sedimentary PCBs and toxaphene in a Lake Michigan food web.

Seston, sediment, settling organic matter, and food web members were collected from Grand Traverse Bay, Lake Michigan, between April 1997 and September 1998 to examine PCB and toxaphene biomagnification. Stable isotopes of nitrogen and carbon were analyzed in samples and used to establish trophic structure of the food web and to determine the importance of atmospheric versus sedimentary sources in delivering PCBs to the food web. Nitrogen isotopes were confounded by multiple variables in this system, particularly seasonal variation, and did not display a simple pattern of enrichment among trophic levels. However, delta13C displayed little seasonal variation and was positively correlated with PCB concentrations among food web members (r2 = 0.69). Plots of delta13C vs PCBs separate food web members into three distinct groupings comprised of invertebrates, primary forage fish, and predatory fish. Stable isotope values of the primary organic sources indicate that the atmosphere, and not the sediment, is the most likely source of PCBs to the food web of Lake Michigan. Additionally, we suggest that seston may be important in delivering PCBs to pelagic food web members and species that receive a majority of their nutrition through pelagic sources. In contrast, settling particles are implicated in delivering PCBs to benthic organisms and Mysis relicta.

Animals↗
PubMed2001

Results from the Lake Michigan Mass Balance study: concentrations and fluxes of atmospheric polychlorinated biphenyls and trans-nonachlor.

In this paper, we summarize the data and methods used to estimate atmospheric exchange of polychlorinated biphenyls (PCBs) and trans-nonachlor with Lake Michigan. This work was conducted as part of the Lake Michigan Mass Balance (LMMB) study. For the atmospheric component of the LMMB, more than 400 gas- and particulate-phase samples were collected at eight sites on the shore around the lake (shoreline) and at 14 sites on the lake (over-water). We review the quality of the data set; describe the concentrations in atmospheric gas and particulate phases; report local, instantaneous, net gas fluxes; and estimate annual deposition of the particle-associated compounds. The quality of the data set is high except for a subset of over-water samples where PCB contamination is suspected. Gas-phase trans-nonachlor concentrations (although not the resulting gas fluxes) are inversely correlated with latitude and positively correlated with temperature. Gas-phase sigmaPCBs (sum of 98 congener groups) are highest in concentration at the Chicago site and lowest at the Sleeping Bear Dunes site. The resulting sigmaPCB gas fluxes exhibit a seasonality that reflects elevated summertime gas-phase concentrations not compensated by temperature-corrected Henry's law coefficients. Particulate-phase deposition is much smaller in magnitude than gas fluxes, for either compound. Gas and particulate fluxes are comparable only at the Chicago site and only when large (> 10 microm) particulates are considered.

Hydrocarbons, Chlorinated↗
PubMed1997

Effectiveness of the Michigan splint in reducing functional cervical disturbances: a preliminary study.

There is controversial evidence for a functional link between the masticatory apparatus and the cervical spine. The aim of this work was to perform a preliminary study to evaluate the effectiveness of the Michigan splint for the treatment of functional cervical disturbances. Forty patients with functional cervical disturbances were randomly organized into test and control groups. The patients in each group were examined by a physiologist to ascertain the extent of functional changes. The test group underwent splint therapy (Michigan type) during a two-month period. The other patients were sent home and did not receive active treatment. After two months, all patients were reassessed physiologically. Cervical pain and pain induced by epispinal or paraspinal pressure were reduced to a statistically significant extent in the treated group, compared with those in the control group.

Adolescent↗
PubMedDate not supplied

Michigan assessment-screening test for alcohol and drugs (MAST/AD): evaluation in a clinical sample.

In this study, we sought to evaluate a modification of the Michigan Alcohol Screening Test designed to include problems associated with other drug abuse/dependence besides alcohol. Scores of the lifetime Michigan Assessment-Screening Test/Alcohol-Drug (MAST/AD) were compared to other lifetime measures of substance abuse and dependence and to psychiatric scales reflecting current or recent symptoms. Two university medical centers with alcohol-drug programs located within departments of psychiatry hosted 520 patients with alcohol-drug-related diagnoses. Patients completed their own MAST/AD using a paper-and-pencil format. Based on interviews with the patient, a research associate rated the patients' substance-related problems on the Minnesota Substance Abuse Problem Scale (M-SAPS) and obtained information on lifetime treatment for substance abuse. An addictions psychiatrist determined abuse or dependence and made a current diagnosis of alcohol abuse/dependence only, drug abuse/dependence only, and alcohol plus drug abuse/dependence. The MAST/AD was highly correlated with the M-SAPS and several other measures of substance abuse morbidity. Patients with alcohol-only and drug-only diagnoses did not differ from one another on the MAST/AD, although both groups had lower scores than those with alcohol plus drug diagnoses. Current psychosocial morbidity as assessed by the patient and the psychiatrist was associated with the MAST/AD, although less strongly than with lifetime substance abuse measures. The lifetime MAST/AD demonstrates reliability as a severity measure for alcohol and/or drug abuse. With minor modification, this standard measure can be expanded from alcohol diagnoses to all substance diagnoses. This study in a clinical population did not demonstrate its utility as a screening instrument; additional work is needed to reveal its utility for this purpose.

Adult↗