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PubMed1998

Occupational noise-induced hearing loss surveillance in Michigan.

Occupational noise-induced hearing loss (NIHL) is an important yet often overlooked illness that can affect an individual's safety and performance at work. This article describes a state-based surveillance system for occupational NIHL. The Michigan surveillance system enables us to describe the magnitude of occupational NIHL among Michigan workers and direct public health interventions in the form of enforcement workplace inspections. The data presented are based on interviews of individuals with occupational NIHL reported to the Michigan Department of Consumer and Industry Services (MDCIS) by Michigan's audiologists and otolaryngologists from 1992-1997. From 1992-1997, 1378 individuals with occupational NIHL were reported to the MDCIS and interviewed about their exposures to noise at work. Over 70% of the workplace noise exposure were in manufacturing. At the most recent company where these individuals were exposed to noise, approximately 46% were not provided regular hearing testing. Regular hearing testing was more likely to occur in the larger companies and in industries covered by regulations requiring such testing to be performed. There were improvements over time in the percentages of companies providing regular hearing testing and hearing protection. Construction workers are employees among a group of industries that are not adequately protected from excessive noise exposures by occupational regulations. Regular hearing testing was not provided for over 90% of construction jobs, although hearing protection such as earplugs or earmuffs was provided for approximately half of these jobs. Forty-three state enforcement inspections were conducted at the companies reported by the patients interviewed, because these companies were reported to provide no regular hearing testing or no hearing protection despite exposures to excessive levels of noise. During the 43 inspections, 23 companies had noise levels above dBA, and 17 of those had either no hearing conservation program (HCP) or had one that was cited as being incomplete. The inspections potentially protected 758 similarly exposed workers in the companies with the high noise levels that lacked an HCP or that had a deficient HCP. The number of patients with occupational NIHL is likely a gross underestimate of the true magnitude of the disease. However, the surveillance system has identified workplaces with hazardous levels of noise and no HCP, thereby protecting similarly exposed coworkers of the index patients from further exposures to noise and hearing loss.

Ear Protective Devices↗
PubMedDate not supplied

The Michigan Local Public Health Accreditation Program: many partners--one vision.

The Michigan Local Public Health Accreditation Program ensures the quality of local public health in Michigan by identifying and promoting the implementation of public health standards and evaluating and accrediting local departments' ability to meet them. The program is a collaborative effort between the Michigan Public Health Institute and the Michigan Departments of Agriculture, Community Health, and Environmental Quality. This article presents a case study. From the conceptual stage of designing a mode of collaboration to examining each step in the process, the goal is to provide a basic understanding of objectives of the accreditation program. The article concludes with the early results, providing a platform for future study.

Accreditation↗
PubMed2001

Improving nitrogen efficiency: lessons from Malawi and Michigan.

Two case studies are presented here of nitrogen (N) dynamics in potato/maize systems. Contrasting systems were investigated from (1) the highland tropics of Dedza, Malawi in southern Africa and (2) the northern temperate Great Lakes region of Michigan. Formal surveys were conducted to document grower perceptions and N management strategies. Survey data were linked with N budgets conducted by reviewing on-farm data from representative farms in the targeted agroecosystems and simulation modeling to estimate N losses. Potential N-loss junctures were identified. Interventions that farmers might accept are discussed. The Malawi system uses targeted application of very small amounts of fertilizer (average 18 kg N ha(-1)) to growing plants. This low rate is on the steep part of plant response to N curve and should serve to enhance efficiency; plant growth, however, is generally stunted in Malawi due to degraded soils and weed competition. Very limited crop yields reduce N efficiency from a simulated 60 kg grain per kg N to an actual of approximately 20 kg grain per kg N (at 40 kg N ha(-1) applied). Legume-intensified systems could improve growth potential and restore N use efficiency through amelioration of soil quality and transfer functions and from biological fixation N inputs. In the Michigan system, N efficiency is enhanced currently through multiple, split applications of N fertilizer tailored to plant growth rate and demand. Fertilizer N rates used by growers, however, averaged 32% higher than recommended rates and 40% higher than N removed in crop product. Application of 50 kg N ha(-1) to cover crops in the fall may contribute to the apparent high potential for N leaching losses. Careful consideration of N credits from legumes and residual soil N would improve N efficiency. Overall, N budgets indicated 0 to 20 kg N ha(-1) loss potential from the Malawi systems and tenfold higher loss potential from current practice in Michigan maize/potato rotations. Best management practices, with or without integration of legumes, could potentially reduce N losses in Michigan to a more acceptable level of about 40 kg N ha(-1).

Agriculture↗
PubMed1979

Immunologic dysfunction among PBB-exposed Michigan dairy farmers.

In 1973 inadvertent contamination occurred in a special farm feed supplement for lactating cows. Polybrominated biphenyls (PBBs) were used in place of magnesium oxide resulting in serious harm to farm animals, including cattle, chickens, geese, ducks. Farm families, accustomed to eating their own products, were most heavily exposed. To further study the impact of PBBs, 45 adult Michigan farm residents who were originally examined in a clinical field survey were further studied with respect to their immunologic status. For comparison, 46 dairy farm residents in Wisconsin, who had not eaten PBB-contaminated food, were examined, as were 79 healthy subjects in New York City. Abnormalities in the Michigan group included significant decrease in absolute numbers and percentages of T and B-lymphocytes and increased number of lymphocytes with no detectable surface markers ("null cells"). Significant reduction of in vitro immune function was noted in 35--40% of the Michigan farm residents who had eaten food containing PBB. Despite the absence of any apparent numerical reduction, both T and B lymphocyte subpopulations of peripheral blood lymphocytes showed evidence of functional defect. Ten of the 45 Michigan farmers studied showed impaired PHA-induced blastogeneic response, due to the decreased number and percent of T-cells in the PBLs. The decreased immune function detected among the PBB-exposed farm residents tended to affect families as a unit and was independent of exposed individuals' age or sex, speaking against the possibility of genetic predisposition.

Accidents↗
PubMed1997

Non-smoking policies, tobacco education, and smoking cessation programmes in facilities serving the elderly in Michigan, United States.

OBJECTIVE: To determine the extent of and impetus for smoke-free policies in facilities serving Michigan's elderly, and the extent of tobacco education and smoking cessation programmes for elders and staff of these facilities. DESIGN: Telephone survey in February 1997 of three types of facilities serving Michigan's elderly population. SUBJECTS: Area Agencies on Aging (n = 12), Councils and Commissions on Aging (n = 31), and senior centres (n = 98) located in Michigan, USA. MAIN OUTCOME MEASURES: Prevalence of smoke-free policies, tobacco education, and smoking cessation programmes in facilities serving the elderly. RESULTS: 99% (95% confidence interval (CI) = 97% to 100%) of 141 facilities surveyed have an indoor smoke-free policy. Eighty-five per cent (95% CI = 79% to 91%) of these policies prohibit all smoking inside the facility. Forty-five per cent (95% CI = 37% to 54%) cited a law as requiring the smoke-free policy, whereas 38% (95% CI = 30% to 46%) indicated the policy was adopted voluntarily for health reasons. Forty-two per cent (95% CI = 34% to 50%) of the facilities provided some education on the dangers of tobacco, while 11% (95% CI = 6% to 16%) arranged smoking cessation programmes for staff or elders. CONCLUSIONS: In Michigan, a very high percentage of non-institutional facilities serving the elderly have smoke-free policies, which appear to increase participation at these facilities. Tobacco education programmes are provided in less than half the facilities, and very few arrange smoking cessation programmes for elders or staff.

Aged↗
PubMed2005

Prevalence of three hereditary hemochromatosis mutant alleles in the Michigan Caucasian population.

OBJECTIVE: To investigate the prevalence in the Michigan non-Hispanic Caucasian population of the C282Y, H63D and S65C mutations in the HFE gene associated with hereditary hemochromatosis. METHODS: Polymerase chain reaction and restriction fragment length polymorphism analysis were performed on 3,532 blood samples from newborn screening cards provided by the state of Michigan. RESULTS: More than 30% of Michigan Caucasians carry one HFE mutation, while 6% have two mutations. The allele frequency of the C282Y mutation is 5.7%, significantly higher than expected (p < 0.05), while the frequency of the H63D mutation is 14%, significantly lower than expected (p < 0.01). CONCLUSIONS: This is the first publication to examine HFE allele frequencies in an unbiased sample of the Caucasian population. Results indicate that the C282Y mutation may be more common in the non-Hispanic Caucasian population than previously reported, and medical problems related to iron overload may be a health concern for Michigan non-Hispanic Caucasians. Additional studies of penetrance for the C282Y allele are required to fully understand the impact of this information.

Amino Acid Substitution↗
PubMedDate not supplied

Dose-response in perinatal exposure to polychlorinated biphenyls (PCBs): the Michigan and North Carolina cohort studies.

Two prospective, longitudinal studies-one in North Carolina and one in Michigan-have examined effects of prenatal polychlorinated biphenyl (PCB) exposure on behavioral and cognitive development in infants and children. The Michigan cohort was selected to overrepresent the offspring of women who had eaten relatively large quantities of Lake Michigan fish; the North Carolina cohort was drawn from the general population. Both studies collected umbilical cord serum and maternal serum and milk samples. In both studies, the children were assessed at birth, during infancy, and during the preschool period, and multivariate statistical analysis was used to control for confounding. When exposure was assessed in terms of maternal body burden, effects were seen only in the most heavily exposed children: the top 3-5% of the general population North Carolina sample and the top 11% of the fisheater sample in Michigan.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Michigan's fisheater cohorts: a prospective history of exposure.

Interest in environmental contaminants and their effect on human health emerged as a primary focus in the 1970s following the discovery of significant levels of mercury, dichloro diphenyl trichloroethane (DDT), and polychlorinated bihpenyls (PCBs) in recreationally caught Great Lakes fish. In response to these findings, the Michigan Department of Public Health, in 1971, initiated a series of "fisheater" cohort studies. These studies continue to be conducted today. The evolution of human exposure assessment by serum PCB determination parallels the evolution of more precise and sensitive analytical laboratory procedures over the past 25 years. Early work quantitated PCB with Aroclor 1254 standards. By 1980, the Webb and McCall packed-column method (Webb and McCall, 1972, 1973), which quantitates total PCB with Aroclor 1016 and 1260 standards, had gained the Association of Official Analytical Chemists (AOAC) approval and became the accepted method. This method was used in the 1978-1980 Michigan Great Lakes Fisheater Study, the first sizable study of this kind in the nation. The study confirmed that fisheaters had significantly more exposure (median 21.4 ppb vs 6.6 ppb) than controls. Toxicology studies have indicated the need to quantitate individual PCB congeners, in order to correlate exposure with possible toxicological and health outcomes. Today, capillary column gas chromatography and gas chromatography/mass spectrometry are used to search for trace components of the total PCB dose (Mullen et al., 1984). Because of the legacy of the earlier analytical data, Michigan also continues to conduct packed-column analysis for longitudinal comparisons. The Michigan fisheater study database and registry provide a significantly exposed and historic foundation for research testing health outcome hypotheses.

Cohort Studies↗
PubMed2006

Patterns of antimicrobial susceptibility in Michigan wildlife and bovine isolates of Mycobacterium bovis.

The state of Michigan has recognized the presence of Mycobacterium bovis in its free-ranging white-tailed deer population since 1994. This endemic infection is primarily located in a 12-county area in the northeastern lower peninsula of Michigan. A statewide surveillance and eradication program of the disease has been in effect since 1994. Worldwide, Mycobacterium tuberculosis complex organisms have a known predilection toward development of antimicrobial resistance. The objective of this study was to investigate the antimicrobial susceptibility of M. bovis isolates from white-tailed deer in Michigan and detect any changes in susceptibility over time. M. bovis isolates from 2 fall hunting seasons (1999 and 2004) were used in this study. The fall season of 2004 marked the first documented case of direct transmission of M. bovis from a wild deer to a human in Michigan. Since M. bovis is a zoonotic disease, knowledge of susceptibility can expedite treatment options in humans. M. bovis isolates were obtained from 58 deer, 4 coyotes, 3 cattle, 2 raccoons, and 1 human case from the 2 years combined. Methods of susceptibility testing included 1% proportion agar plates and Bactec radiometric broth testing. M. bovis was found to be uniformly resistant to the antibiotic pyrazinamide; this resistance is common to all M. bovis isolates. No other antimicrobial resistance was found in any of the tested M. bovis isolates, which may be, in part, attributed to the lack of any significant treatment pressure in wildlife.

Animals↗
PubMedDate not supplied

The Michigan Clinical Research Collaboratory: following the NIH Roadmap to the community.

PURPOSE: This case study describes a successful National Institutes of Health (NIH) Roadmap application that has created a new and innovative translational science partnership at the University of Michigan. METHODS: We describe the institution within which the grant application was developed, the role played by the Department of Family Medicine, the role of prior successes in translational and community-based research, the associated infrastructure development, the application development process, and some features of the final project. RESULTS: A partnership among 2 clinical and research centers of excellence at the University of Michigan, 3 practice-based research networks, and a clinical research center was created as the platform to support an NIH Roadmap. The result was a funded 3.3 million dollar, 3-year project supporting the creation of the Michigan Clinical Research Collaboratory (MCRC), a research infrastructure that will support the design, conduct, and dissemination of community-based clinical translation research. The MCRC depends to a considerable degree on the experience, expertise, and infrastructure in community-based translational research of the Department of Family Medicine. CONCLUSIONS: The successful funding of the MCRC grant will support influential translational research programs of high impact and visibility that would not otherwise have occurred. The MCRC grant is an acknowledgment of the important research to be done in the community, the critical nature of infrastructure investment and prior work in competing successfully for such funding, and the personnel and information technology investments required for success. Collaboration between practice-based family medicine investigators and traditional clinical investigators at the University of Michigan has led to successful competition for an NIH Roadmap grant, which has led in turn to greater institutional recognition for the importance and legitimacy of community-based translational research.

Academic Medical Centers↗
PubMed2000

Prevalence of heartworm infection in healthy cats in the lower peninsula of Michigan.

OBJECTIVE: To determine prevalence of heartworm infection among healthy, client-owned cats in the lower peninsula of Michigan. DESIGN: Cross-sectional prevalence study. ANIMALS: 1,348 healthy cats examined at private veterinary practices throughout the lower peninsula of Michigan. PROCEDURE: Sera were tested by use of an ELISA-based antigen test kit to determine infection and 2 commercially available antibody detection kits to determine exposure. A questionnaire was used to collect data to assess risk factors associated with infection. RESULTS: 25 cats had positive results for heartworm antigen, yielding an observed prevalence of 1.9%. Neither antibody test was reliable or provided reproducible results, and neither yielded positive results for more than 20% of the antigen-positive heartworm-infected cats. Multivariate regression indicated that cats from southeastern Michigan and cats > or = 2 years old had a higher risk of infection. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that most (80%) heartworm-infected cats in the lower peninsula of Michigan were from the southeastern part of the state, a pattern that closely paralleled the prevalence of heartworm infection in dogs. Therefore, knowledge of the regional prevalence of heartworm infection in dogs may be useful in assessing the risk of infection in cats. Results also suggested that currently available in-clinic heartworm antibody detection kits have limited utility in the diagnosis of heartworm infection in cats.

Animals↗
PubMed1999

A comparison of profitability and economic efficiencies between management-intensive grazing and conventionally managed dairies in Michigan.

A retrospective cohort study was designed to determine differences in profitability, asset efficiency, operating efficiency, and labor efficiency between Michigan dairy farms implementing management-intensive grazing (MIG) and conventionally managed dairy farms. Financial information and labor use data for the calendar year 1994 were collected with surveys and personal interviews from 35 MIG dairies and 18 conventionally managed dairies. Because the geographic distribution of MIG and conventionally managed farms in this study did not include Michigan's "dairy belt," extrapolation of these results to an average Michigan or Midwest dairy should be made with care. Within the areas represented, however, multivariate linear regression indicated that MIG dairies had more economic profit than conventionally managed dairies. They captured this profit by being more efficient in asset use, operating practices, and labor use. These results suggest that MIG could provide a sustainable alternate management tool for portions of Michigan's dairy industry.

Analysis of Variance↗
PubMed1986

Prevalence of neutralizing antibody to Jamestown Canyon virus (California group) in populations of elk and moose in northern Michigan and Ontario, Canada.

Blood samples were collected from free-ranging elk (Cervus elaphus) harvested in Michigan's northern Lower Peninsula, from moose (Alces alces) relocated from Ontario's Algonquin Provincial Park to Michigan's Upper Peninsula, and from moose from Michigan's Isle Royale National Park. Sera were tested by serum dilution neutralization tests in Vero cell culture for neutralizing antibody to California serogroup viruses, in particular Jamestown Canyon (JC), La Crosse/snowshoe hare (LAC/SSH), and trivittatus (TVT) viruses. Specific neutralizing antibody to JC virus was detected in 71% of 31 and 65% of 20 moose from Algonquin and Isle Royale, respectively. An additional six moose from Algonquin and five from Isle Royale showed evidence of multiple infection. One juvenile moose from Isle Royale had specific neutralizing antibody to TVT virus. Specific neutralizing antibody to JC virus was detected also in 54% of 50 elk from Michigan; 20 of the 50 elk showed evidence of multiple infection. While no single serum sample showed specific neutralizing antibody only to LAC/SSH virus, its presence in sera from some animals may have been masked by the high prevalence of antibody to JC virus.

Animals↗
PubMed2004

Estimating the true prevalence of Mycobacterium bovis in hunter-harvested white-tailed deer in Michigan.

Apparent prevalence, although useful as a consistent index, may underestimate the true prevalence of disease. In Michigan, the ability to estimate the true prevalence of bovine tuberculosis (TB; caused by Mycobacterium bovis) in free-ranging white-tailed deer (Odocoileus virginianus) will become increasingly important to accurately assess progress towards eradication. Our objectives were threefold: to estimate the true prevalence of M. bovis in free-ranging deer in Michigan, to evaluate the effectiveness of existing TB surveillance methods, and to indirectly assess whether TB epidemiologic data from captive cervid herds can be meaningfully extrapolated to free-ranging populations. The study population consisted of all free-ranging deer submitted for TB testing in 2001 from six townships in northeastern Lower Michigan. Tissue samples of tonsil and cranial lymph nodes were collected bilaterally from all deer eligible for the study that did not have gross lesions suggestive of TB (n = 701). Samples were subjected to histopathologic, acid-fast (AF) staining, mycobacterial culture, and polymerase chain reaction (PCR) testing. Seven deer cultured positive for M. bovis that would not have been detected by current surveillance, yielding apparent and true prevalence estimates (95% confidence limits) of 2.7% (1.6, 3.8) and 3.6% (2.3, 4.9), respectively. The sensitivity, specificity, and positive and negative predictive values of the current surveillance protocol were 75, 100, 100, and 99%, respectively. Histologic lesions were present only in tonsils, and ranged from simple necrosis to caseation, suppuration, and granuloma formation. Acid-fast staining and PCR detected M. bovis in only one of the seven culture-positive deer. Our study provides the first estimate of the true prevalence of M. bovis in Michigan's free-ranging deer population and suggests modest underestimation of that prevalence by current surveillance. This study also suggests that caution is warranted when extrapolating epidemiologic data on TB in captive cervids to free-ranging populations and confirms the pivotal role of the tonsil in early infections.

Animals↗
PubMed2005

Mortality of Rocky Mountain elk in Michigan due to meningeal worm.

Mortality from cerebrospinal parelaphostrongylosis caused by the meningeal worm (Parelaphostrongylus tenuis) has been hypothesized to limit elk (Cervus elaphus nelsoni) populations in areas where elk are conspecific with white-tailed deer (Odocoileus virginianus). Elk were reintroduced into Michigan (USA) in the early 1900s and subsequently greatly increased population size and distribution despite sympatric high-density (>or=12/km2) white-tailed deer populations. We monitored 100 radio-collared elk of all age and sex classes from 1981-94, during which time we documented 76 mortalities. Meningeal worm was a minor mortality factor for elk in Michigan and accounted for only 3% of mortalities, fewer than legal harvest (58%), illegal kills (22%), other diseases (7%), and malnutrition (4%). Across years, annual cause-specific mortality rates due to cerebrospinal parelaphostrongylosis were 0.033 (SE=0.006), 0.029 (SE=0.005), 0.000 (SE=0.000), and 0.000 (SE=0.000) for calves, 1-yr-old, 2-yr-old, and >or=3-yr-old, respectively. The overall population-level mortality rate due to cerebrospinal parelaphostrongylosis was 0.009 (SE=0.001). Thus, meningeal worm had little impact on elk in Michigan during our study despite greater than normal precipitation (favoring gastropods) and record (>or=14 km2) deer densities. Further, elk in Michigan have shown sustained population rates-of-increase of >or=18%/yr and among the highest levels of juvenile production and survival recorded for elk in North America, indicating that elk can persist in areas with meningeal worm at high levels of population productivity. It is likely that local ecologic characteristics among elk, white-tailed deer, and gastropods, and degree of exposure, age of elk, individual and population experience with meningeal worm, overall population vigor, and moisture determine the effects of meningeal worm on elk populations.

Age Distribution↗
PubMed1982

Current status of hospital pharmacy technicians in Michigan.

The results of a comprehensive statewide survey of hospital pharmacy technicians are presented. Although this was only a statewide survey, its findings should be of interest to technicians and pharmacists everywhere since very few data of this type are available. In addition, Michigan is a very progressive pharmacy state and has recently implemented a formal technician certification process (described in an appendix) via the Michigan Pharmacists' Association. The survey instrument was mailed to the Directors of Pharmacy at 252 Michigan hospitals. The response rate was 68.7% (173) hospitals). The survey pointed out that Michigan hospitals employ on the average one technician for each pharmacist. Most hospitals required high school graduation and typing skills as a minimum for hiring of a technician. Numerous technician work responsibilities were identified, including the admixture of sterile products. Technicians in this survey had a variable work schedule, and the future job market appeared to be healthy. Most of the technicians were females under the age of 30. Average hourly wages for regular technician position ranged from $5.05 to $6.25 (June 1981). Numerous categories of technicians were noted, and about 20% of the technicians were unionized. Many of the hospitals utilized a formal on-the-job technician training program. The performance of the majority of technicians was evaluated annually, and many opportunities existed for continuing education. The concept of technician certification appeared to be looked upon favorably by most of the pharmacy directors.

Adult↗
PubMed2000

High prevalence of overweight children in Michigan primary care practices. An UPRNet study. Upper Peninsula Research Network.

BACKGROUND: Our goal was to determine whether the prevalence of obesity in children who receive care in Michigan primary care practices is greater than national and state prevalences. METHODS: We compared prevalences of overweight children and adolescents in primary care practices with the results of the National Health Examination Survey (NHES), the National Health and Nutrition Examination surveys, and a contemporary survey of Michigan schoolchildren. We collected data from 19 rural family practice offices and 2 urban clinics. We measured the heights and weights of 993 consecutive patients aged 4 to 17 years who visited one of the participating practices during the spring of 1996. RESULTS: Obesity prevalences were the main outcome measure. Of the boys, 38% were above the 85th percentile of the NHES, and 16% were above the 95th percentile. Of the girls, 33% were above the 85th percentile, and 13% were above the 95th percentile. Prevalences of obesity were much higher among the primary care patients than in the results of the national surveys and the contemporary Michigan schoolchildren survey. CONCLUSIONS: The prevalences of obesity for children and adolescents presenting for care in Michigan primary care practices are higher than the prevalences documented in state and national surveys. A larger systematic study is needed to confirm or refute these findings. If this prevalence of obesity in primary care patients is confirmed, explanations for the differences should be explored.

Adolescent↗
PubMed2001

Prevalence of healthy lifestyle characteristics--Michigan, 1998 and 2000.

Most persons with chronic diseases such as cardiovascular disease, cancer, diabetes, and chronic lung disease share multiple common risk factors and lifestyle behaviors. Tobacco use, poor diet, and physical inactivity have been identified as the leading contributors to overall mortality in the United States, accounting for one third of all deaths; Michigan has a particularly high burden of chronic disease-related mortality. To characterize the prevalence of four healthy lifestyle characteristics (HLCs) (i.e., healthy weight, adequate fruit and vegetable consumption, regular leisure-time physical activity [LTPA], and not smoking) in Michigan residents, data were analyzed from Michigan's Behavioral Risk Factor Surveillance System (BRFSS) for 1998 and 2000. This report summarizes the results of the analysis, which indicate that the proportion of Michigan residents who engaged in all four healthy lifestyle practices was extremely low, and that the prevalence was influenced by sex, education and self-reported health status. The comprehensive assessment of HLCs may be a useful adjunct to chronic disease surveillance.

Adult↗