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PubMed1998

Serologic evidence of a natural infection of white-tailed deer with the agent of human granulocytic ehrlichiosis in Wisconsin and Maryland.

White-tailed deer participate in the maintenance of the Ixodes tick life cycle and are reservoirs for some tick-borne infectious agents. Deer may be useful sentinels for tick-transmitted agents, such as ehrlichiae. In order to determine whether white-tailed deer are markers of natural transmission or are reservoirs for the human granulocytic ehrlichiosis (HGE) agent, we performed indirect immunofluorescent-antibody (IFA) tests and immunoblotting with the HGE agent and Ehrlichia chaffeensis on sera from 43 and 294 deer captured in northwest Wisconsin during 1994 and 1995, respectively, and 12 deer from southern Maryland. According to IFA testing, 47% of 1994 Wisconsin sera, 60% of 1995 Wisconsin sera, and 25% of Maryland sera contained HGE agent antibodies. All IFA-positive deer sera tested reacted with the 44-kDa band which is unique to the Ehrlichia phagocytophila group. Serologic reactions to E. chaffeensis were detected by IFA testing in 15 of 337 (4%) Wisconsin deer and in 10 of 12 (83%) Maryland deer, while 60 and 80% of E. chaffeensis IFA-positive Wisconsin and Maryland deer sera, respectively, reacted with the E. chaffeensis 28- to 29-kDa antigens by immunoblotting. A total of 4% of deer from Wisconsin and 25% of deer from Maryland were found by IFA testing to have antibodies to both the HGE agent and E. chaffeensis; 75% of these were confirmed to contain E. chaffeensis antibodies by immunoblotting. These results suggest that white-tailed deer in diverse geographical regions of the United States are naturally infected with the HGE agent, E. chaffeensis, or both and that these animals, and potentially humans, are exposed to infected ticks at a high frequency in nature.

Animals↗
PubMed2004

Holding back the tide: policies to preserve and reconstruct health insurance coverage in Maryland.

Over the past decade, state officials have pursued a variety of strategies to protect and expand health insurance coverage for their residents. This article examines the course of action in Maryland, where new initiatives were shaped around the state's unique hospital payment system and its reimbursement of uncompensated care, an evolving Medicaid and children's health program, and regulation of the small group health insurance market. Several important patterns emerge from the Maryland experience. First, even the most incremental initiatives--programs intended to aid a few thousand beneficiaries--bring into play the very issues that hamper comprehensive reforms: who is deserving of mutual aid and what is the proper role of government versus private entities in administering that aid. In Maryland, these issues generate conflict not only between Democrats and Republicans but also urban and rural interests. Second, all of the important reforms of the past decade were undertaken primarily in reaction to federal policy initiatives. Contrary to rhetoric lauding states as the "laboratories of democracy," the political impetus for reform and basic policy options emerge from interaction between federal and state debates. Third, even with budget surpluses and Democrats in control of the governorship and legislature, Maryland did not move aggressively toward universal health insurance. Now, with a much weaker economy and a new, Republican governor, the primary challenge will be to prevent further erosion of insurance coverage. The Maryland experience reiterates that each step toward greater health security, no matter how small, is a major technical and political challenge and that it will be difficult if not impossible to rely on states to secure coverage for all Americans in the foreseeable future.

Child↗
PubMed2002

Maryland adults' perspectives on oral cancer prevention and early detection.

OVERVIEW: In any given 12-month period, Maryland ranks 27th among all states and the District of Columbia in estimated new cases of oral cancer. The state also has the seventh highest overall mortality rate for oral cancer. Because of earlier research indicating that Maryland adults had little knowledge and many misconceptions about oral cancer, the authors undertook a study to obtain in-depth information from Maryland adults 40 years of age or older on oral cancer, oral cancer examinations and factors associated with having an oral cancer examination. METHODS: The authors conducted a qualitative descriptive study using information gathered from three focus groups consisting of nine, 10 and seven adults respectively, and which met at two locations. The authors hired a private focus group research firm, which randomly selected participants from a telephone list of local residents. A professionally trained moderator conducted all focus groups using a semistructured interview guide. RESULTS: Participants were struck by the fact that they rarely hear about this type of cancer. Many said that they never had had an oral cancer examination and did not know there was such a thing. Many participants also reported that they likely would be more comfortable discussing oral cancer with their physicians than with their dentists. CONCLUSIONS: These findings provide additional in-depth insights to earlier work about Maryland adults' oral cancer knowledge, opinions and practices. The state plans to use this information to develop educational materials and interventions for the public to promote oral cancer prevention and early detection in Maryland. CLINICAL IMPLICATIONS: Extensive public education about oral and pharyngeal cancers should be provided in dental offices and clinics, as well as in mass media of all types. More clinicians should include comprehensive oral cancer screenings in their oral examinations, and they should explain to patients what they are doing when they provide these screenings.

Adult↗
PubMedDate not supplied

Accelerated deployment of an agricultural nutrient management tool: the Maryland Phosphorus Site Index.

In 1998, the Maryland legislature mandated nitrogen (N) and phosphorus (P) nutrient management planning for nearly all of Maryland's commercial agricultural operations. State regulations required that a phosphorus indexing tool (P Index) be used for determining the potential for P losses from agricultural land, even though a reliable P Index did not exist. The development and assessment of the P Index as a dependable tool for the evaluation of the potential for P losses was constrained by a very aggressive implementation schedule imposed by state regulations. The Maryland Phosphorus Site Index (PSI) was evaluated on 646 state-representative field sites beginning in the spring of 1999 and continuing through the spring of 2000. Of the representative fields, 69% were determined to have a "low" P loss rating, 19% were in the "medium" P loss rating category, 8% were determined to be a "high" risk for P loss, and 4% rated as "very high" P loss potential. Fifty-five percent of the fields evaluated had soil test phosphorus (STP) levels less than the 75 mg kg-1 Mehlich-1 P environmental threshold established by state regulations. The frequency distribution of PSI performance was evaluated for several subcategories of the statewide data set. The Maryland PSI will be deployed for use in constructing farm nutrient management plans well before its predictive capabilities can be objectively and rigorously validated. Field validation is essential. In the meantime, the Maryland PSI should function adequately as a tool to assist in the prioritization of field P loss risk potential.

Agriculture↗
PubMed2000

Opportunities and challenges in Medicaid managed care: the experience in Maryland.

OBJECTIVE: The effects of the Maryland Medicaid mandatory managed care programs on Medicaid beneficiaries are examined with the main objective of gaining insight into the initial experience and beneficiary satisfaction with Maryland's Medicaid program. The background of the Maryland Medicaid system, initial implementation, results of beneficiary satisfaction surveys, and future concerns are discussed. STUDY DESIGN: An observational study based on survey data. DATA AND METHODS: Beneficiary surveys mailed to adult and child participants in HealthChoice and the Rare and Expensive Case Management (REM) Medicaid programs in Maryland are analyzed. Descriptive univariate and bivariate data statistics are used. RESULTS: The 4 questions rating satisfaction with primary care provider (PCP), relevant specialists, all providers, and the overall health plan indicate high levels of satisfaction in both adult and child populations. CONCLUSIONS: The Maryland Medicaid programs appear to have met the goal of providing a comprehensive, coordinated healthcare system of quality care during their first year of operation. The satisfaction of these beneficiaries suggests that with an appropriate risk-adjusted capitation approach, managed care organizations (MCOs) can successfully provide for even the most complex needs of Medicaid members.

Community Health Services↗
PubMed1976

Marylanders defeat Philadelphia: yellow fever updated.

Those strategic points which influence this amateur historian to declare a victory for Baltimore and Maryland over Philadelphia are: I. Based upon clinical and epidemiological data, two Marylanders, Potter and Davidge, were among the first to contest Rush and his contagion theory; they told him so and published their views. To prove this point, Potter went to the extreme of inoculating himself with presumedly infected material. Stubbins Ffirth, a young University of Pennsylvania medical student, did the same four years later. To Rush's credit was ultimate abandonment of his originally held views. II. John Crawford, of Baltimore, although not the originator of the insect concept of transmission of infectious agents, published his concepts in 1811. III. Henry Rose Carter, a Maryland graduate, clearly delineated, in 1898, that after identification of an index case of yellow fever an extrinsic incubation period was necessary before the evolution of secondary cases. IV. James Carroll, another University of Maryland graduate, who worked as Deputy under Walter Reed with Lazear and Agramonte, helped prove Finlay's original concept that the Aedes aegypti mosquito was the natural vector of yellow fever. Carroll himself was the first experimentally induced case. V. Studies in primates provide new approaches for management of yellow fever. Nutritional support and treatment with specific anti-viral agents may be useful for therapy of human yellow fever. Maryland members of the Climatological are mindful of Philadelphia's rich medical heritage and of the many battles won in the City of Brotherly Love. Physicians in colonial and early America experienced The best and worst of times, theirs was an age of foolishness and belief, of incredulity and light, of darkness, despair and hope. This tale of two cities ends in peace.

Animals↗
PubMed1994

Immunization coverage in a population-based sample of Maryland children.

OBJECTIVE: To describe the vaccination coverage of a population-based sample of Maryland children. DESIGN: Historical cohort study using stratified cluster sampling. Strata were formed from five state regions and public and private schools within each region. SETTING: Random sample of elementary schools in Maryland. SUBJECTS: Immunization records were obtained for a randomly selected cohort of 1938 first-grade children in Maryland. OUTCOME MEASURES: Age of completion of recommended childhood vaccines and proportion of vaccines given simultaneously. RESULTS: By first grade, 95.2% of the sample of Maryland children were documented to have received at least four doses of the diphtheria and tetanus toxoids and pertussis (DTP) vaccine, three doses of oral poliovirus (OPV) vaccine, and one dose of measles-mumps-rubella (MMR) vaccine. However, only 54.8% of children surveyed had achieved this level of immunization by 24 months of age. For children whose immunizations were up to date on their first birthday (78.7% of children surveyed), vaccine providers failed to administer one dose of DTP, OPV, and MMR vaccines to 30% of these children during the second year of life. Only 16.2% (n = 313) of children sampled received an MMR vaccination simultaneously with any dose of DTP or OPV vaccine. CONCLUSIONS: This study shows that while immunization levels are very high at school entry, there are serious delays in vaccine administration before school entry. These delays are observed regardless of whether children are in public or private schools or attend school in an urban, suburban, or rural area. Physicians and health care providers could play an important role in age-appropriate vaccination by administering vaccines simultaneously.

Child↗
PubMed2005

Colorectal cancer screening: physician recommendation is influential advice to Marylanders.

BACKGROUND: In comparison to the United States, Maryland is facing a significantly higher burden of colorectal cancer incidence and mortality. The primary objective of this study was to determine the predictors of colorectal cancer screening use in Maryland. METHODS: We performed secondary analyses on Maryland Cancer Survey 2002 data from 2994 respondents to investigate important predictors for individual colorectal cancer screening tests. CRC screening outcomes were defined as (1) FOBT within the past year, (2) sigmoidoscopy within the past 5 years, or (3) colonoscopy within the past 10 years. RESULTS: We found that clinician recommendation for a screening test is the best predictor in both age categories (50-64 years and 65+ years); it is a very strong indicator and consistently improves the odds of use by a factor of at least 8 for any screening test. CONCLUSIONS: There remains a great need for improved colorectal cancer screening in Maryland. According to our results, it is clear that the most influential way to improve overall colorectal cancer screening for each test and both age groups is to increase clinician recommendation for these tests.

Aged↗
PubMed2002

Estimation of ambient PM2.5 concentrations in Maryland and verification by measured values.

In 1997, Maryland had no available ambient Federal Reference Method data on particulate matter less than 2.5 microm in aerodynamic diameter (PM23), but did have annual ambient data for PM smaller than 10 microm (PM10) at 24 sites. The PM10 data were analyzed in conjunction with local annual and seasonal zip-code-level emission inventories and with speciated PM2.5 data from four nearby monitors in the IMPROVE network (located in the national parks, wildlife refuges, and wilderness areas) in an effort to estimate annual average and seasonal high PM2.5 concentrations at the 24 PM10 monitor sites operating from 1992 to 1996. All seasonal high concentrations were estimated to be below the 24-hr PM2.5 National Ambient Air Quality Standards (NAAQS) at the sites operating in Maryland between 1992 and 1996. The estimates also indicated that 12 monitor sites might exceed the 3-year annual average PM2.5 NAAQS of 15 microg/m3, but Maryland's air quality shows signs that it has been improving since 1992. The estimates also were compared with actual measurements after the PM2.5 monitor network was installed. The estimates were adequate for describing the chemical composition of the PM2.5, forecasting compliance status with the 24-hr and annual standards, and determining the spatial variations in PM2.5 across central Maryland.

Air Pollutants↗
PubMed2002

The Maryland Division of Correction hospice program.

The Maryland Division of Correction houses 24,000 inmates in 27 geographically disparate facilities. The inmate population increasingly includes a frail, elderly component, as well as many inmates with chronic or progressive diseases. The Division houses about 900 human immunodeficiency virus (HIV)-positive detainees, almost one quarter with an acquired immune deficiency syndrome (AIDS) diagnosis. A Ryan White Special Project of National Significance (SPNS) grant and the interest of a community hospice helped transform prison hospice from idea to reality. One site is operational and a second site is due to open in the future. Both facilities serve only male inmates, who comprise more than 95% of Maryland's incarcerated. "Medical parole" is still the preferred course for terminally ill inmates; a number have been sent to various local community inpatient hospices or released to the care of their families. There will always be some who cannot be medically paroled, for whom hospice is appropriate. Maryland's prison hospice program requires a prognosis of 6 months or less to live, a do-not-resuscitate (DNR) order and patient consent. At times, the latter two of these have been problematic. Maintaining the best balance between security requirements and hospice services to dying inmates takes continual communication, coordination and cooperation. Significant complications in some areas remain: visitation to dying inmates by family and fellow prisoners; meeting special dietary requirements; what role, if any, will be played by inmate volunteers. Hospice in Maryland's Division of Correction is a work in progress.

Aged↗
PubMed2005

Pandemic influenza preparedness in Maryland: improving readiness through a tabletop exercise.

In February 1999, the Maryland Department of Health and Mental Hygiene initiated pandemic influenza planning for the state of Maryland. This process involved several major steps, including the development of the Maryland Pandemic Influenza Preparedness Plan, and culminated in a high-level tabletop exercise to test the plan in April 2004. During the tabletop exercise, participants were presented with nine different fictitious scripts encompassing a single scenario. They were asked to respond to the information presented in each script, discuss organization-specific questions posed by the exercise facilitator, and make decisions regarding action steps that their organization would take in response to the various issues raised. The exercise identified a number of important gaps that need to be addressed, including (1) additional surge capacity specific to a pandemic, (2) greater understanding of the realities and implications of pandemic influenza among elected officials and decision-makers, (3) coordination of pandemic influenza planning with the existing emergency response infrastructure coupled with additional training in incident command, (4) further steps to operationalize several aspects of the Maryland Pandemic Influenza Preparedness Plan, and (5) additional federal guidance.

Disease Outbreaks↗
PubMed2006

Mammal diversity and infection prevalence in the maintenance of enzootic Borrelia burgdorferi along the western Coastal Plains of Maryland.

The primary vector of Borrelia burgdorferi in North America, Ixodes scapularis, feeds on various mammalian, avian, and reptilian hosts. Several small mammal hosts; Peromyscus leucopus, Tamias striatus, Microtus pennsylvanicus, and Blarina spp. can serve as reservoirs in an enzootic cycle of Lyme disease. The primary reservoir in the northeast United States is the white-footed mouse, P. leucopus. The infection prevalence of this reservoir as well as the roles of potential secondary reservoirs has not been established in southern Maryland, a region of low to moderate Borrelia infection in humans. Intensive trapping at 96 locations throughout the western Coastal Plains of Maryland was conducted and we found that 31.6% of P. leucopus were infected with B. burgdorferi. Sequence and phylogenetic analysis revealed that only B. burgdorferi sensu stricto circulated in southern Maryland. Feral house mice and voles also were infected and may serve as secondary hosts. Peromyscus gender, age and month of capture were significantly associated with infection status. Larval I. scapularis were the dominant ectoparasite collected from captured rodents even though host seeking A. americanum and D. variabilis were collected in greater numbers across the sampling region. Our findings illustrate that the enzootic cycle of LD is maintained in the western Coastal Plains region of southern Maryland between I. scapularis and P. leucopus as the dominant reservoir.

Animals↗
PubMed2001

HIV and AIDS surveillance among inmates in Maryland prisons.

The prevalence of those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is higher among inmates of correctional facilities than among the general population. This raises the need to identify inmates living with or at risk of HIV/AIDS and to provide counseling and appropriate services for HIV treatment and prevention. The Maryland Division of Corrections (DOC) offers voluntary testing to all inmates on entry and tests inmates when clinically indicated. We reviewed all 1998 HIV antibody tests and confirmed AIDS cases in the Maryland DOC. Inmate demographics, testing acceptance, rates of seropositivity, and AIDS cases and comparisons based on gender, race/ethnicity, and age were examined. Comparisons were also made to HIV testing and AIDS cases from the nonincarcerated Maryland population. Trends in DOC AIDS diagnoses and AIDS-related deaths over time were also examined. Of the inmates, 39% were voluntarily tested for HIV on entry to the Maryland DOC in 1998 (38% of males and 49% of females). Overall, HIV seropositivity was 3.3% (5% for females and 3% for males). The 888 cumulative AIDS cases diagnosed in the DOC inmate population were concentrated among males (90% vs. 77% statewide), African Americans (91% vs. 75% statewide), and among IDUs (84% vs. 39% statewide). Due to high rates of HIV and AIDS, inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts, especially women. Prison-based programs can identify significant numbers of HIV and AIDS cases and bring HIV prevention interventions to a population characterized by frequent high-risk behavior.

AIDS Serodiagnosis↗
PubMedDate not supplied

Four years of lessons learned: The 2001-2004 Maryland influenza prevention seasons.

More than 36,000 Americans die and 200,000 more are hospitalized because of influenza every\year. Despite the wide availability of a vaccine to prevent influenza, the vast majority of Americans go unimmunized. The Maryland Department of Health and Mental Hygiene (DHMH) and the Maryland Partnership for Prevention (MPP) collect data about the state's local health departments' influenza season practices and experiences and compile them into the annual Maryland Influenza Season Final Report. The report becomes a tool for DHMH, MPP, and the state's 24 local health departments to plan improvements in influenza vaccination services. This article chronicles four influenza seasons. Influenza season challenges experienced in three of the last four influenza seasons underscore the importance of coordination and communication efforts to ensure that vaccine is efficiently delivered to the most vulnerable populations. The partnership between DHMH and MPP has facilitated access to information on ordering and administration practices, communication systems, community partnerships, and lessons learned, thus enabling the state of Maryland to continually optimize its influenza vaccination promotion efforts.

Communication↗
PubMed2002

Maryland power plant cooling-water intake regulations and their application in evaluation of adverse environmental impact.

Maryland's cooling-water intake and discharge regulations, the Code of Maryland Regulations (COMAR) 26.08.03, stem from Sections 316(a) and (b) of the Clean Water Act (CWA). COMAR 26.08.03.05 and litigative and administrative rulings stipulate that the location, design, construction, and capability of cooling-water intake structures must reflect the best technology available (BTA) for minimizing adverse environmental impacts (AEIs), providing that the costs of implementing the BTA are not wholly disproportionate to the expected environmental benefits. Maryland law exempts facilities that withdraw less than 10 million gallons/day (MGD) and less than 20% of stream or net flow by the intake. If not exempt, BTA must be installed if the cost of doing so is less than five times the value of fish impinged annually. Through site-specific studies and the use of a Spawning and Nursery Area of Consequence (SNAC) model applied to Representative Important Species, several power plants were evaluated to determine if they have had an adverse effect on spawning and nursery areas of consequence. Examples of application of the Maryland law to a number of power plants in the state are presented, together with the outcome of their evaluation.

Animals↗
PubMed2005

Dental pain in Maryland school children.

OBJECTIVE: To describe the lifetime prevalence of dental pain among Maryland's school age children. METHODS: Data come from the Survey of Oral Health Status of Maryland School Children conducted in 2000-01. History of dental pain, as reported by an adult respondent, was analyzed for 2,411 kindergarten and third grade students. Percentages with their 95% confidence interval were calculated to obtain state representation of the distribution of dental pain by sociodemographic characteristics and caries status. RESULTS: Overall, 11.8 percent of Maryland school age children in kindergarten and third grade have had some dental pain. Among children who have had caries, the report of dental pain increases to 28.2 percent. Children from families with low educational attainment or eligible for free or reduced meals or covered by Medicaid were more likely to have experienced dental pain. CONCLUSION: Almost a third of Maryland kindergartens and third graders who have caries have experienced dental pain.

Child↗
PubMed1982

Psychiatric manpower and public mental health: Maryland's experience.

From July of 1976 through December 1981, 67 psychiatrists who graduated primarily from American medical schools and who had completed university residency training programs were recruited into Maryland's state mental health system. As of 1981, 43 of these psychiatrists still worked in inpatient facilities; they represented 33 per cent of all state hospital psychiatrists in Maryland. The Maryland Mental Hygiene Administration and the University of Maryland have used two general strategies to develop psychiatric manpower and improve employment conditions. They established close linkages between academia and the public sector and demonstrated positive, effective leadership by psychiatrists within the state mental health system.

Attitude of Health Personnel↗
PubMed1989

Case-mix payment for nursing home care: lessons from Maryland.

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

Activities of Daily Living↗