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PubMedDate not supplied

Michigan basin regional ground water flow discharge to three Great Lakes.

Ground water discharge to the Great Lakes around the Lower Peninsula of Michigan is primarily from recharge in riparian basins and proximal upland areas that are especially important to the northern half of the Lake Michigan shoreline. A steady-state finite-difference model was developed to simulate ground water flow in four regional aquifers in Michigan's Lower Peninsula: the Glaciofluvial, Saginaw, Parma-Bayport, and Marshall aquifers interlayered with the Till/"red beds," Saginaw, and Michigan confining units, respectively. The model domain was laterally bound by a continuous specified-head boundary, formed from lakes Michigan, Huron, St. Clair, and Erie, with the St. Clair and Detroit River connecting channels. The model was developed to quantify regional ground water flow in the aquifer systems using independently determined recharge estimates. According to the flow model, local stream stages and discharges account for 95% of the overall model water budget; only 50% enters the lakes directly from the ground water system. Direct ground water discharge to the Great Lakes' shorelines was calculated at 36 m3/sec, accounting for 5% of the overall model water budget. Lowland areas contribute far less ground water discharge to the Great Lakes than upland areas. The model indicates that Saginaw Bay receives only approximately 1.13 m3/sec ground water; the southern half of the Lake Michigan shoreline receives only approximately 2.83 m3/sec. In contrast, the northern half of the Lake Michigan shoreline receives more than 17 m3/sec from upland areas.

Environmental Monitoring↗
PubMed1978

Liver function tests among Michigan and Wisconsin dairy farmers.

Serum activity of SGOT, SGPT, LDH, and alkaline phosphatase was measured in 614 Michigan adults exposed to PBB and 141 Wisconsin adults not so exposed. The Michigan group had higher prevalence of abnormal SGOT (p less than 0.005) and SGPT (p less than 0.005). A clear sex difference was observed. Michigan men had a higher prevalence of abnormal SGPT (p less than 0.005) and LDH (p less than 0.005) than Michigan women, and a higher prevalence than Wisconsin men of abnormal SGOT (p less than 0.005) and SGPT (p less than 0.01). These differences could not be ascribed to differing patterns of alcohol consumption, laboratory error, or choice of criteria for normality/abnormality. Seven Michigan subgroups were defined on the basis of the criteria by which they had been selected to participate. The two subgroups who were essentially self-invited did not differ from the remaining five randomly selected subgroups combined in prevalence of these abnormal liver function tests. Based on 364 serum PBB analyses thus far analyzed of the 614 Michigan participants, no obvious relationship between serum PBB values and liver function tests was observed. However, this is a tentative conclusion that will be further evaluated when remaining serum PBB analyses are completed. The greater prevalence of abnormal SGPT and SGOT among Michigan dairy farm residents compared to the Wisconsin dairy farm residents is tentatively ascribed to the former group's exposure to PBB.

Adolescent↗
PubMed1995

The use of methylphenidate in Michigan.

OBJECTIVE: To describe the epidemiologic findings associated with the use of methylphenidate hydrochloride among children aged 0 to 19 years in Michigan. DESIGN: A population-based data set of all prescriptions filed with the Michigan Triplicate Prescription Program during February and March 1992 was analyzed, maintaining complete anonymity. SETTING: State of Michigan. PARTICIPANTS: All patients receiving a prescription for methylphenidate who are residents of Michigan, and all physicians prescribing methylphenidate. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Descriptive data. RESULTS: Eleven of 1000 Michigan residents between the ages of 0 and 19 years received a prescription for methylphenidate during the study period. Eighty-four percent were boys. Boys aged 10 or 11 years received more prescriptions for methylphenidate than any other age group--43 per 1000. The number of children receiving prescriptions for methylphenidate ranged from 2.5 to 28 per 1000. The range for boys aged 10 or 11 years was from 9.6 to 117 per 1000. Primary care physicians wrote 84% of all prescriptions; pediatricians wrote 59% of the prescriptions for patients younger than 20 years old. Half of the prescriptions written by pediatricians were written by 5% of the pediatricians in the state. CONCLUSIONS: Michigan has been among the states with the highest per capita consumption of methylphenidate for the past 10 years. The major use of methylphenidate is for treatment of attention deficit hyperactivity disorder. The number of boys in Michigan aged 10 or 11 years who were treated with methylphenidate was similar to the national prevalence of the disorder, 3% to 5%. A tenfold variation was noted in the percentage of children medicated when the data were analyzed by county. Relatively few pediatricians account for the largest proportion of prescriptions. Future studies are needed to link the use of methylphenidate with diagnostic and treatment considerations in attention deficit hyperactivity disorder.

Adolescent↗
PubMed1993

Current methods of estimating severity for occupational injuries and illnesses: data from the 1986 Michigan Comprehensive Compensable Injury and Illness Database.

National and state estimates of the severity of occupational injuries and illnesses (severity = lost work time = missed work days+restricted work days) have come from the annual Survey of Occupational Injuries and Illnesses (Survey) produced by the U.S. Bureau of Labor Statistics. However, we show that the Survey practice of collecting injury information soon after the accident year reduces substantially the accuracy of missed work day estimates, which constitute 85.3% of the Survey lost work time estimate. To develop an independent estimate of missed work days, the research team created the Michigan Comprehensive Compensable Occupational Injury Database (Michigan Database) by linking state files with injury characteristics to files with workers' compensation information for injuries occurring in 1986. The measure of missed work time (days, weeks, or years) is the cumulative duration of compensation from the "date disability commenced," noted on the first payment form, through follow-up to March 1, 1990. Cumulative missed work time has been calculated or estimated for 72,057 injured workers, more than 97% of the 73,609 Michigan workers with compensable occupational injuries in 1986 identified through the close of the study. Our "best" estimate of missed work days, to follow-up, attributable to both fatal and nonfatal compensable occupational injuries and illnesses is 7,518,784, a figure four times that reported for Michigan by the Survey. When insurance industry data on disbursements are also considered, the estimate of missed work days increases to 8,919,079, a figure 4.75 times that reported by the Survey. When insurance data on reserves for future payments are also considered, the estimate of missed work days increases to 16,103,398, a figure 8.58-fold greater than that obtained for Michigan in the Survey. The Michigan data suggest that the national Survey may have failed to identify almost 373 million of 421 million missed work days in the private sector that have resulted, or will result, from 1986 occupational injuries. The present federal/state system for estimating occupational injury severity by measuring lost work days seriously underestimates the magnitude of the problem. The current policy of obtaining incidence and severity data from the same Survey should be reconsidered. We recommend that national estimates of injury severity be obtained from representative states by using state compensation data and that such estimates be used to evaluate current prevention and rehabilitation strategies. The redesigned occupational safety and health Survey (ROSH Survey) should be revised to permit linkage to compensation data.

Accidents, Occupational↗
PubMed2002

The effects of standard enforcement on Michigan safety belt use.

The purpose of this study was to assess the effects of standard enforcement legislation on safety belt use in Michigan through a series of seven statewide direct observation surveys. A secondary purpose of the study was to compare the results in Michigan to the results in other states that have changed the provision of their mandatory safety belt use law from secondary to standard enforcement. The study found that standard enforcement has been effective in increasing safety belt use in Michigan. Immediately following the implementation of standard enforcement, Michigan's belt use rate increased to 83.5%, 13.4 percentage points higher than the highest rate previously observed. One year after the change, safety belt use in Michigan was still nearly 10 percentage points greater than the highest observed rate before standard enforcement legislation was enacted. Results indicated that safety belt use decreased slightly in the year following the implementation of standard enforcement. This appears to be an overall trend across all observed groups, and not due to any single demographic category. The results also suggest that standard enforcement legislation appears to have a greater effect on groups with historically low belt use, such as young people, males, passengers, and Black/African-Americans. When compared with other states that have made the change from secondary to standard enforcement, the increase in the safety belt use rate in Michigan was comparable to the increase seen in states with relatively high safety belt use prior to standard enforcement. However, states that had low safety belt use rates prior to adopting standard enforcement legislation observed a larger percentage point increase in the year following their change to standard enforcement.

Automobile Driving↗
PubMed1997

An analysis of Michigan and California CO remote sensing measurements.

Remote sensing measurements of CO emissions from onroad vehicles were made in California in 1991 and in Michigan in 1992. It was determined that both fleets had a small linear increase in the high emitter frequency (vehicles emitting more than 4% CO) as a function of vehicle age for 1986 and newer model vehicles. Although high emitting vehicles were only a small minority of the fleet, they had a dominant impact on the mean CO and total CO emitted by the fleet. In Michigan, the highest emitting 5% of passenger cars generated 45% of the CO from cars. In California, the highest emitting 5% of passenger cars generated 38% of the CO from cars. There was a high correlation between the mean CO emitted by each model year of vehicle and the frequency of high emitting vehicles within the model year for both the Michigan and California fleets. The frequency of high emitters within any model year had no obvious relation to that model year's certification standards. The high emitter frequencies for vehicles less than nine years old were very similar for the California and Michigan fleets. An increase in the high emitter frequency in the ten-year-old and older Michigan passenger car fleet (relative to the California passenger car fleet), suggests, but does not conclusively demonstrate, that the rate of high emitters in Michigan and California is reduced by the inspection and maintenance (I/M) programs.

Automobiles↗
PubMed2004

Reptile-associated salmonellosis in preschool-aged children in Michigan, January 2001-June 2003.

OBJECTIVES: Determine the incidence of reptile-associated salmonellosis in preschool-aged children in Michigan. METHODS: Cases of reptile-associated salmonellosis in children < or =5 years of age occurring in Michigan January 2001-June 2003 were identified through review of individual patient case-history forms provided by local health departments to the Michigan Department of Community Health and by identification of Michigan Department of Community Health laboratory-confirmed cultures of reptile-associated serotypes, determined by evaluation of the Public Health Laboratory Information System's Clinical Nonhuman Salmonella data for 1990-2001. RESULTS: The incidence of reptile-associated salmonellosis was 11.8% of all Salmonella cases reported in Michigan children aged < or =5 years for the period January 2001 through June 2003. CONCLUSIONS: Despite the recommendations of the Centers for Disease Control and Prevention to avoid the exposure of children <5 years old to reptiles, reptile-associated salmonellosis in preschool-aged children continues to be a public health problem in Michigan.

Animals↗
PubMed1978

Unanticipated prevalence of symptoms among dairy farmers in Michigan and Wisconsin.

Adverse human health effects resulting from exposure to polychlorinated biphenyls (PBBs) were unknown until the accidental contamination of Michigan dairy farm animal feed in 1973-1974. Human exposure resulted from the consumption of contaminated meat, milk, dairy products, and eggs. In November 1976, the Environmental Sciences Laboratory conducted comprehensive examinations of 933 farmers and residents in Mighigan who were likely to have consumed farm products contaminated with PBB. A comparison group of 229 Wisconsin dairy farmers were examined in March 1977 and the same scientific and medical staffs that conducted the Michigan survey were responsible and the same procedures used. A complete history of symptomatology by organ system, including year of first onset, duration, frequency, and severity of each symptom was obtained by a physician on all adults examined. Statistical analysis of the prevalence of symptoms at the time of examination or during the preceding year in the Michigan and Wisconsin populations studied found the Michigan group to have a significantly higher prevalence of skin, neurological and musculoskeletal symptoms. The increase was seen among the younger age groups 16-35 and 36-55. Michigan females had a higher prevalence of neurological symptoms than the Michigan males. The existing differences could not be explained without considering an etiologic role for exposure to PBB.

Adolescent↗
PubMed2002

Field estimate of net trophic transfer efficiency of PCBs to Lake Michigan chinook salmon from their prey.

Chinook salmon (Oncorhynchus tshawytscha) has been the predominant piscivore in Lakes Michigan, Huron, and Ontario since the 1970s, and therefore accurate quantification of its energy budget is needed for effective management of Great Lakes fisheries. A new approach of evaluating a fish bioenergetics model in the field involves field estimation of the efficiency with which the fish retains PCBs from its food. We used diet information, PCB determinations in both chinook salmon and their prey, and bioenergetics modeling to generate a field estimate of the efficiency with which Lake Michigan chinook salmon retain PCBs from their food. Our field estimate is the most reliable field estimate to date because (a) the estimate was based on a relatively high number (N = 142) of PCB determinations for chinook salmon from Wisconsin waters of Lake Michigan in 1985, (b) a relatively long time series (1978-1988) of detailed observations on chinook salmon diet in Lake Michigan was available, and (c) the estimate incorporated new information from analyses of chinook salmon age and growth during the 1980s and 1990s in Lake Michigan. We estimated that chinook salmon from Lake Michigan retain 53% of the PCBs that are contained within their food.

Age Factors↗
PubMed1991

The Caring Program for Children. The Michigan experience.

Public-private partnerships may offer the best opportunity in the near-term for addressing the problem of the uninsured. In Michigan, a broad spectrum of groups has studied the issue of the uninsured and, despite the diversity of the groups, arrived at a consensus that providing coverage to uninsured children is an urgent priority. The Caring Program for Children, a private program initiated by Blue Cross of Western Pennsylvania to provide primary and preventive health care coverage to children in low-income, uninsured families, gained support from the Michigan legislature and advocacy and provider groups as a means to address the problem. Blue Cross Blue Shield of Michigan and the Michigan Department of Social Services joined to expand the Caring Program for Children from a private program to a public-private venture funded by federal and state funds and private donations that has the potential to provide coverage to more than 12,000 children. The Michigan experience may be instructive to other states attempting to devise immediate local solutions to the problem of the uninsured.

Adolescent↗
PubMed2005

Trend and area variation in amphetamine prescription usage among children and adolescents in Michigan.

The increased use of stimulant medications for children and teenagers is an ongoing issue of professional and public concern. Unlike methylphenidate, the growth of prescriptions and patterns of utilization of amphetamines for pediatric populations have not been well documented. The study objectives were to describe the trends of amphetamine prescription utilization among pediatric age groups in Michigan and to compare area variations. A population-based computerized data set from the state of Michigan was used to extract all outpatient prescriptions for Schedule II amphetamines dispensed from 1990 to 1997. The prescribing rates by age groups and by counties were computed with the projected population size of corresponding years, and mapped and analyzed with spatial statistical methods. Counties that did not conform to the global spatial dependence pattern in the prescription rate were identified using Moran scatter plot. A total of 236,661 outpatient prescriptions for amphetamines were dispensed in Michigan during the time frame, including less than 1% for methamphetamine, 24.5% for amphetamine, and 74.8% for dextroamphetamine. The prescribing rate was highest among children 10-14 years old (380 prescriptions per 10,000 people) in 1997, followed by children 5-9 years old (253 prescriptions per 10,000). Over the 8-year period, the prescribing rates of amphetamines increased significantly, ranging from 380% for children 2-4 years to 817% for teenagers older than 14 years. The rates among counties ranged from 60 to 1648 per 10,000 children 5-14 years old, with the highest prescribing rates in the northwestern regions of Michigan. Although spatial dependence explained 36% of the variance, the area variations that are unaccounted for are still considerable. In conclusion, there were substantial increases and unexplained area variations in amphetamine usage in Michigan during the study period. Both phenomena require awareness and evaluation from researchers, policy makers, clinicians, and the public.

Adolescent↗
PubMed2000

Trends in driver and front-right passenger safety belt use in Michigan: 1984-1998.

As part of Michigan's effort to track trends in safety belt use within the state over time, the University of Michigan Transportation Research Institute conducted 20 statewide surveys of safety belt use between 1984 and 1998. Results indicate that Michigan safety belt use trends for drivers and front-right passengers are similar to other statewide and national trends. Belt use in Michigan increased dramatically immediately after the state implemented its mandatory belt use law (secondary enforcement) followed by a smaller decline that leveled off at a rate more than 20 percentage points higher than before the law. Belt use was consistently higher among drivers than front-right passengers, older than younger front-outboard occupants, females than males, and front-outboard occupants exiting freeways than those stopped at local intersections. Examination of belt use trends in Michigan provides useful information for continued efforts to increase belt use in our state and for all states interested in meeting national goals for safety belt use for the year 2000 and beyond.

Adolescent↗
PubMed1996

Attitudes of Michigan physicians and the public toward legalizing physician-assisted suicide and voluntary euthanasia.

BACKGROUND: There has been a continuing public debate about assisted suicide and the proper role, if any, of physicians in this practice. Legislative bans and various forms of legalization have been proposed. METHODS: We mailed questionnaires to three stratified random samples of Michigan physicians in specialties likely to involve the care of terminally ill patients: 500 in the spring of 1994, 500 in the summer of 1994, and 600 in the spring of 1995. Similar questionnaires were mailed to stratified random samples of Michigan adults: 449 in the spring of 1994 and 899 in the summer of 1994. Several different questionnaire forms were used, all of which included questions about whether physician-assisted suicide should be banned in Michigan or legalized under certain conditions. RESULTS: Usable questionnaires were returned by 1119 of 1518 physicians eligible for the study (74 percent), and 998 of 1307 eligible adults in the sample of the general public (76 percent). Asked to choose between legalization of physician-assisted suicide and an explicit ban, 56 percent of physicians and 66 percent of the public support legalization, 37 percent of physicians and 26 percent of the public preferred a ban, and 8 percent of each group were uncertain. When the physicians were given a wider range of choices, 40 percent preferred legalization, 37 percent preferred "no law" (i.e., no government regulation), 17 percent favored prohibition, and 5 percent were uncertain. If physician-assisted suicide were legal, 35 percent of physicians said they might participate if requested--22 percent would participate in either assisted suicide or voluntary euthanasia, and 13 percent would participate only in assisted suicide. Support for physician-assisted suicide was lowest among the strongly religious. CONCLUSIONS: Most Michigan physicians prefer either the legalization of physician-assisted suicide or no law at all; fewer than one fifth prefer a complete ban on the practice. Given a choice between legalization and a ban, two thirds of the Michigan public prefer legalization and one quarter prefer a ban.

Adult↗
PubMed1989

Variation in hospital admissions among small areas. A comparison of Maine and Michigan.

Analysis of age-adjusted hospital admission profiles among small geographic areas has shown marked variation in hospital admissions for both surgical and medical cases in areas ranging from Maine to Manitoba. Much of the work has been led by John Wennberg and has focused on rural areas. This study examines the degree of variation in hospital admissions in small areas in the state of Michigan to determine whether those diseases that demonstrated high variation in Maine also demonstrated the same degree of variation in Michigan. The data on the degree of variation in 111 modified diagnosis-related groups (M-DRGs) from the state of Maine were supplied by Dr. Wennberg. Using the same M-DRGs, we defined age-adjusted, population-based hospital admission rates for the lower peninsula of Michigan for 1980 among 60 previously defined hospital marked communities. The observed hospital discharge counts in each of the M-DRGs were compared to the expected counts in each of the 60 communities, where the expected count was based on an indirect age adjustment. Both the Maine and Michigan small area data were expressed by the M-DRG's systematic standard deviation in which random variation has been accounted for via a Poisson probability model. It was found that the systematic standard deviations of the M-DRGs in Maine and the M-DRGs in Michigan strongly correlated with a Spearman correlation coefficient of 0.71 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis-Related Groups↗
PubMed2004

Assessing what child health information systems should be integrated: the Michigan experience.

This project examined which child health data would be appropriate and useful to integrate with an existing real-time Michigan Department of Community Health (MDCH) application, such as the Michigan Childhood Immunization Registry. A consultant was secured to conduct data gathering analysis activities. An advisory committee of MDCH Administrators convened to guide the project. Interviews were conducted with MDCH administrators, program managers and representatives from the public and private health care provider community. These interviews focused on answering three main questions: (1) What MDCH data resources do you currently use? (2) How do you use and access these data? and (3) What is your vision for expanding, enhancing, and linking these data to meet Michigan's future health goals? Acceptance of the Michigan Childhood Immunization Registry by the pediatric and family practice community demonstrates the utility of providing more information electronically to the medical community in Michigan. The MDCH has completed a stakeholders analysis and is moving forward with requirements gathering sessions in order to create an integrated child health data system. The integrated child health data system will include data from immunizations, newborn screening, newborn hearing, lead, the Women, Infants, and Children program, and Medicaid.

Child↗
PubMed1983

Current status of statewide school health education programs in Michigan.

This study surveyed all Michigan public school principals regarding the current status of comprehensive school health education being provided in Michigan public schools. A 32-item survey was developed, pretested, revised and mailed to all public school principals in Michigan. Followup letters were sent to nonrespondents. A phone survey was conducted to nonrespondent principals after the cut-off date to verify survey responses. All data was analyzed by elementary, junior high school and high school population. The areas of professional preparation, inservice education, application and utilization of the Essential Performance Objectives for Health Education in Michigan, the content and time allotted for health education, and the lack of a well-developed organizational structure for health education have been articulated as deficit areas in the current status of comprehensive school health education. This survey provided much information for future consideration by educators, public and private health organizations, and other individuals and groups interested in school health in Michigan.

Adolescent↗
PubMed2005

Rates of euthanasia and adoption for dogs and cats in Michigan animal shelters.

Estimates of canine and feline euthanasia at U.S. animal shelters--largely based on voluntary surveys with low response rates--make it difficult to estimate the population from which the euthanized animals derive. Estimates of euthanasia rates (animals euthanized per unit of population) have varied widely and been available only sporadically. This study used requirements of Michigan state law (Pet Shops, Dog Pounds, and Animal Shelters Act, 1969) for animal shelters to collect admission and discharge data for all 176 Michigan-licensed animal shelters. In 2003, Michigan shelters discharged 140,653 dogs: Of these, 56,972 (40%) were euthanized; 40,005 (28%) were adopted. This annual euthanasia rate is 2.6% of the estimated 2003 Michigan dog population. Michigan shelters discharged 134,405 cats in 2003: 76,321 (57%) by euthanasia and (24%) by adoption. The estimated ratio of euthanized cats to cats who had owners was 3.1%. Small shelters and privately owned shelters were associated with higher adoption rates. Comparison with historical information from the past 10 to 20 years suggests the number of companion animals being euthanized in shelters has decreased and that progress has been made in reducing the companion animal overpopulation problem.

Animal Husbandry↗
PubMed1999

Surveillance of work-related asthma in selected U.S. states using surveillance guidelines for state health departments--California, Massachusetts, Michigan, and New Jersey, 1993-1995.

PROBLEM/CONDITION: Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. WRA includes new-onset asthma caused by workplace exposure to sensitizers or irritants and preexisting asthma exacerbated by workplace exposures. REPORTING PERIOD: This report reviews cases of WRA identified by state health departments from January 1, 1993, through December 31, 1995, as well as follow-up investigations of cases and associated workplaces conducted through June 30, 1998. DESCRIPTION OF THE SYSTEMS: State-based surveillance and intervention programs for WRA are conducted in California, Massachusetts, Michigan, and New Jersey as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) cooperative agreement program, initiated by CDC's National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1993 through 1995, a total of 1,101 cases of WRA were identified by SENSOR surveillance staff members in California, Massachusetts, Michigan, and New Jersey. Of these 1,101 cases, 19.1% were classified as work-aggravated asthma, and 80.9% were classified as new-onset asthma. Objective evidence substantiating asthma work-relatedness was documented in the medical records of 3.4% of WRA cases identified in the two states (Michigan and New Jersey) where medical records are routinely reviewed for this information. Indoor air pollutants, dusts, cleaning materials, lubricants (e.g., metalworking fluids), and diisocyanates were among the most frequently reported causes of WRA. In addition, a well-recognized cause of occupational asthma - natural rubber latex - was identified in a new setting, the healthcare industry. The most common industries associated with WRA cases included transportation equipment manufacturing (19.3%), health services (14.2%), and educational services (8.7%). Air sampling for agents known to induce occupational asthma was performed in Michigan for comparison with established federal time-weighted average exposure limits. Sixteen (13.4%) of 119 workplaces tested had airborne concentrations exceeding NIOSH recommended exposure limits (RELs); 11 (9.1%) of 121 workplaces had concentrations exceeding permissible exposure limits (PELs) of the Michigan Occupational Safety and Health Act (MIOSHA) program. INTERPRETATION: The surveillance data findings confirm well-recognized causes of asthma and have identified new putative causes (e.g., cleaning materials and metalworking fluids). Because the surveillance program depends on physicians' recognizing asthma work-relatedness and reporting diagnosed cases, the data are considered an underestimate of the magnitude of the WRA problem. The data also indicate that physicians are not commonly performing objective physiologic tests to substantiate a WRA diagnosis. Workplace findings suggest a need to evaluate existing exposure standards for specific agents known to induce occupational asthma (e.g., diisocyanates). Case-based surveillance can help improve the recognition, control, and prevention of WRA. The SENSOR model also provides a mechanism for workers and physicians to request workplace investigations aimed at primary prevention for other workers. PUBLIC HEALTH ACTION: NIOSH and state health department representatives are working to establish a long-term agenda for state-based surveillance of work-related conditions and hazards. The results from the SENSOR WRA programs described in this report support inclusion of WRA as a priority condition warranting surveillance at the state level.

Asthma↗