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BACKGROUND: Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan. METHODS: Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997. RESULTS: Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment. CONCLUSIONS: In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed.
This study reaffirms the diversity and breadth of the veterinary profession. As it turns out, some of the furthest-reaching impacts of the veterinary medical profession were largely non-quantifiable. The veterinary medical profession had a substantial direct economic impact in Michigan during 1995. The total economic contribution of the veterinary medical profession to Michigan during 1995 that was attributable to expenditures on salaries, supplies, services, and their multiplier effect was approximately $500 million. In addition, the profession was associated with nearly 8,500 jobs (combined professional and lay positions). The veterinary medical profession was also considered to have an impact on the prosperity of the live-stock, equine, and pet food industries in Michigan, even though the economic contribution in these areas could not be directly quantified. Economic well-being of the individual businesses in these industries is directly related to the health and productivity of the associated animals, and improvements in output or productivity that accompany improved animal health likely carry substantial economic benefits in these sectors. In addition, progressive animal health management provides a crucial method of managing risk in the animal industries. Similarly, although the economic contribution could not be quantified, the veterinary medical profession enhances the safety and quality of human food through research, regulation, and quality assurance programs in livestock production, minimizing the risk of drug residues and microbial contamination. During 1995, approximately 5.3 million Michigan residents benefitted from the physical, psychological, and emotional well-being that accompanies companion animal ownership. By preserving the health and longevity of companion animals, veterinarians sustain and enhance these aspects of the human-animal bond. As Michigan enters a new century, it is likely that the state's veterinary medical profession will continue to make a highly valued societal contribution. Pets, equines, and food animals will continue to have prominent roles in Michigan for the foreseeable future, as will the human-animal bond, food safety, and medical research. Clearly, for economic and noneconomic reasons, it will be in the interest of the people of Michigan to seek opportunities to maintain and enhance the vitality of the state's veterinary medical profession. It was our hope that results of this study would provide university administrators, legislators, MVMA executives, and others with information needed to justify the ongoing provision of public support for the veterinary medical profession. In addition, we expect that the results will supply useful material for public relations and marketing campaigns by the MVMA and the Michigan State University College of Veterinary Medicine and will provide the media with public interest stories to promote the veterinary profession. Although this study considered the economic and noneconomic impacts of the veterinary medical profession only in Michigan, the results can provide an important reference point for educators, policy markers, and legislators in other states. In addition, this study could serve as a methodologic model for veterinary organizations in other states, or at the national level, to emulate.
On July 15 (1994), Wayne County Circuit Court Judge John Murphy struck down Michigan's 1993 law requiring women seeking abortions to delay 24 hours after receiving state-mandated information. Finding that the Michigan Constitution encompasses a right to privacy, which includes the right to choose abortion, Judge Murphy invalidated the never-enforced law by applying "strict scrutiny"--the judicial standard used to review restrictions on fundamental rights. Although Roe v. Wade established strict scrutiny as the test for evaluating abortion restrictions, the US Supreme Court revised that standard as a matter of federal law when it adopted the less protective "undue burden" standard in Planned Parenthood v. Carey. As a result, the state constitutional right to privacy recognized by Judge Murphy is more protective of childbearing decisions than the corresponding federal right. Judge Murphy further found that the mandatory delay law violates a state constitutional prohibition on unfunded mandates because, while local health departments would be required to distribute the state-printed materials, the legislature did not appropriate monies to cover the costs of this added responsibility. Michigan officials have indicated that they will appeal the decision in Mahaffey v. Attorney General of Michigan, which is 1 of 2 lawsuits that were filed on March 10 against the mandatory delay law. Plaintiffs in the state case--a local health department official and 3 physicians--are represented by the ACLU of Michigan. CRLP attorneys represent more than 2 dozen reproductive health care providers who filed the other challenge, Northland Family Planning Inc. v. Engler, in federal court and obtained a temporary stay of the law. During 4 days of trial beginning on June 20, CRLP presented witnesses who testifed that the mandatory delay law would impose an undue burden on women seeking abortions in Michigan. As a result of Judge Murphy's ruling, CRLP federal case will be put on hold. However, should either the Michigan Court of Appeals or the Michigan Supreme Court reverse Judge Murphy's ruling and order the law enforced, the federal case would again become active.
PURPOSE: Although extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving intervention, the effect of ECMO on neonatal mortality has never been evaluated. In this study, we examined the relationship between increased ECMO utilization and its effect on the neonatal mortality rate in the state of Michigan. METHODS: Neonatal mortality data were obtained from the Michigan State Department of Community Health. Data included total annual live births, total neonatal deaths, and deaths from respiratory causes in neonates > or =35 weeks' gestational age (ie, potential ECMO candidates). Pooled ECMO patient data from Michigan's 3 ECMO centers were obtained from the Extracorporeal Life Support Organization (ELSO) Registry. Associations between ECMO volume and neonatal mortality rates were assessed using simple linear regression. A scatterplot of ECMO volume and mortality rates was created, and the resulting fitted regression lines were superimposed on the plots. Statistical significance of the associations (ie, difference in slope of the regression line from zero) were based on a standard 2-sided Wald test for the regression slope parameter. RESULTS: From 1980 through 1999, 1,061 neonates were treated with ECMO in Michigan, and 875 (82.5%) survived. When annual neonatal mortality rate (from all causes) and the rate from respiratory causes versus ECMO volume (cases per year) are superimposed with fitted regression lines, both are significantly different from zero (P =.041 and P =.002, respectively). The model predicts that for every 100 neonates treated with ECMO in Michigan, 38 lives are saved. The model also can be used to predict the annual neonatal mortality rate in Michigan if ECMO had not been utilized. CONCLUSIONS: A strong association exists between ECMO volume and observed reductions in neonatal mortality seen in Michigan over the last 2 decades. This is the first study to show an association between ECMO and neonatal mortality rate at the population level.
Salmonella Enteritidis is a major cause of foodborne disease worldwide. In the United States, this serotype has been associated with significant morbidity and mortality accounting for about 17% of all human Salmonella infections. Data on risk factors associated with serotype-specific Salmonella infections have not been reported in Michigan before. We carried out this study using surveillance data to identify high-risk groups and regions for S. Enteritidis infection in Michigan. Results of this study may be used to develop better control and prevention measures against this common foodborne pathogen. We analyzed data on Salmonella infections collected by the Michigan Department of Community Health's surveillance system (1995-2001). We computed age, gender, and place of residence-specific incidences of S. Enteritidis infection in Michigan using population-based denominators. We used Poisson regression analysis to study the associations between S. Enteritidis infection and certain predictor demographic variables, while controlling for confounders and covariates. We found an overall 1.87/100,000 average annual S. Enteritidis incidence with 1.91/100,000 in females and 1.81/100,000 in males. A higher incidence of S. Enteritidis infection was associated with Michigan children<5 years old when compared with average national estimates (p<0.01). The final adjusted Poisson model revealed that children<1 year of age [RR: 9.75, CI: 7.99-11.90] and children 1-4 years of age [RR: 3.37, CI: 2.83-4.02] are at higher risk for S. Enteritidis infection compared to adults aged 15-39 years. No significant differences in incidence of S. Enteritidis infections were found between urban and rural dwellers or between genders (p>0.05). The incidence rate of S. Enteritidis infection in the Michigan pediatric population (<5 years) was found to be significantly higher than average national estimates, meriting immediate public health attention. Risk factors for S. Enteritidis infection in Michigan children should be identified in order to devise effective control and prevention measures.