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PubMedDate not supplied

Developing a health care agenda for Michigan.

Developing a health care agenda for Michigan will require intense dialogue among health care providers, policymakers, employers, communities and individuals. What follows is an outline of the health problems facing Michigan's residents and suggestions for tackling these enormous challenges. We hope that this will stimulate discussion among health care stakeholders in Michigan. Only through committed partnerships can we begin to improve the health of Michigan residents.

Chronic Disease↗
PubMed1992

Completeness and reliability of USRDS data: comparisons with the Michigan Kidney Registry.

A census of 12,730 Medicare-eligible ESRD patients identified in the USRDS database as living in Michigan or as having received treatment in Michigan between 1977 and 1987 was compared to the 13,424 ESRD patients listed in the Michigan Kidney Registry (MKR) who were alive between 1977 and 1987. Of 7,600 USRDS patients with both residence and ESRD treatment in Michigan, 97.8 percent were also found in the MKR, thus providing evidence that the USRDS is not overstating the size of the ESRD population. Overall, 11.4 percent of the cases in the MKR could not be matched to the USRDS; however, the rate of matching showed a slight upward trend over time. Subsequent analysis shows that after excluding those cases expected not to be captured by the Medicare system, only 5 percent of MKR cases were left unmatched to USRDS cases. Some of these unmatched cases from the MKR were found to have short follow-ups, while others belong to groups not covered by Medicare without being noted as such by the MKR database. A high level of exact agreement on data elements for cases found in both databases was documented for demographic variables, above 90 percent. However, differences were found between the USRDS and the MKR databases on elements related to treatment history. It is likely that a lower precision of the dates associated with treatment episodes and difficulty in recording short term treatment episodes in the USRDS could account for the differences found.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗
PubMed1984

Medical Malpractice Arbitration Act: Michigan's experience with arbitration.

In the 1970's, Michigan and other states were confronted with a medical malpractice crisis of astronomical proportions. The escalating number of medical malpractice lawsuits and concomitant increase in malpractice premiums for health care providers fostered a divisive climate among doctors, lawyers and patients. In response to this crisis, the Michigan legislature enacted the Medical Malpractice Arbitration Act. The Act establishes a process whereby patients may agree to arbitrate any claims rather than pursue them through the courts. Part II of this Article discusses the historical evolution of arbitration as a precursor to its establishment as a resolution modality for health care disputes. Part III describes the statutory framework of the Michigan Medical Malpractice Arbitration Act. Part IV discusses the contractual and constitutional challenges to the arbitration statute and their resolution in Morris v. Metriyakool. As the law respecting arbitration becomes less vulnerable to judicial perforation, this Author suggests that other jurisdictions treat the Michigan Medical Arbitration Program as an archetype, susceptible to replication.

Civil Rights↗
PubMedDate not supplied

Michigan hospice oral healthcare needs survey.

PURPOSE: Very little research has been conducted about the state of oral healthcare for the terminally ill in Michigan hospice programs. The purpose of this study was to assess the oral healthcare services currently being provided by caregivers in Michigan hospice programs and to determine the needs for oral healthcare in-service training for nurses, home health aides, and volunteers who may provide basic oral care. METHODS: In October 1991, a four-page questionnaire was mailed to the patient care coordinators of the 90 hospice programs listed in the 1990/1991 Michigan Hospice Organization Directory. Frequency data were compiled for each question. RESULTS: Coordinators from 50 programs responded for a 56% response rate. Results showed that 100% of nurses and aides and 88% of volunteers were providing oral healthcare for clients. Some services, such as oral cleansing and denture care, were more likely to be provided by aides or volunteers. Referrals to dental professionals, and palliative measures for relief of pain or other oral symptoms, were more likely to be provided by nurses. Sixty percent of patient care coordinators reported that the amount of oral healthcare in-service information being received by caregivers was less than sufficient. Only 6% of hospice programs reported using a dentist or dental hygienist as in-service presenters. Eighty-seven percent of hospice programs surveyed had no written oral healthcare protocol. Eighty percent of patient care coordinators stated that clients or their families express concerns about oral health needs at least occasionally. Eighty-three percent stated that hospice staff assess client oral conditions at least occasionally and 92% agree that oral care is important to clients. CONCLUSIONS: Although a wide range of oral healthcare services are being provided for terminally ill clients in Michigan hospice programs by nurses, aides, and volunteers, the majority of providers may not receive adequate information to provide complete and effective services. Based on these results, it is recommended that the dental hygienist take a leadership role in providing oral health information to hospice caregivers.

Chi-Square Distribution↗
PubMed1994

Surveillance for occupational asthma--Michigan and New Jersey, 1988-1992.

PROBLEM/CONDITION: A case of occupational asthma is a sentinel health event indicating a need for preventive intervention. REPORTING PERIOD COVERED: 1988-1992. DESCRIPTION OF SYSTEMS: As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) Program, initiated by CDC's National Institute for Occupational Safety and Health in 1987, state-based surveillance and intervention programs for occupational asthma (OA) have been under development in Michigan and New Jersey. The initial 5-year projects in these states have been completed. RESULTS: From 1988 through 1992, the SENSOR programs in these states identified a total of 535 cases of occupational asthma and related conditions. Of these 535 cases, 328 cases met the SENSOR surveillance case definition for OA. In addition, 128 cases were classified as possible OA, 42 as reactive airways dysfunction syndrome, and 37 as occupationally aggravated asthma. In both Michigan and New Jersey, manufacturing was the industrial sector with the largest proportion of cases. In Michigan, > 40% of the case-patients worked in transportation equipment manufacturing. In New Jersey, 15% of case-patients worked in manufacturing of chemicals and allied products. Overall, isocyanates were the most frequently reported asthma-causing agents (19.4% of cases). Follow-up industrial hygiene sampling measured suspect agents at airborne concentrations generally below the permissible exposure limits established by the Occupational Safety and Health Administration. INTERPRETATION: In its first 5 years, the SENSOR system has led to the identification of previously unrecognized causes of occupational asthma. Overall findings indicate the need for more comprehensive control of such well-known occupational allergens as the isocyanates. In addition, SENSOR interventions have prompted improvements in protection for workers. ACTIONS TAKEN: Approaches to state-based surveillance and intervention for OA are being developed through newly funded 5-year SENSOR projects in four states (California, Massachusetts, Michigan, and New Jersey). The goal is to develop a model for effective state-based OA surveillance that can be applied by any state health department.

Asthma↗
PubMed1993

Neonatal intensive care and birth weight-specific perinatal mortality in Michigan and Lorraine.

This study investigated the factors influencing use of neonatal intensive care and perinatal mortality in regions of the United States and France, two countries with similar health care systems but different approaches to health financing. The study employed birth certificates from Michigan and a birth registry from Lorraine in 1984. The study showed that geographic access and socioeconomic status were important in determining use of neonatal intensive care in both regions. Socioeconomic factors in perinatal mortality were also shown for both regions, after controlling for gestational age, birth weight, and neonatal intensive care use. In Michigan, infants of mothers with low education had higher mortality rates and in Lorraine residents of low income areas had higher mortality rates. A higher proportion of Michigan women delivered in hospitals with neonatal intensive care than in Lorraine, in all weight/gestation categories. Perinatal mortality rates were also lower in Michigan than in Lorraine, overall and within birth weight categories.

Birth Certificates↗
PubMed1996

Injury surveillance in correctional facilities--Michigan, April 1994-March 1995.

Following an outbreak of Legionnaires disease in a Michigan prison in 1993 (1), which was first recognized at a civilian hospital, the Michigan Department of Public Health (MDPH) recommended that surveillance for acute infectious diseases be established in the Michigan Department of Corrections (MDOC). In April 1994, MDOC and MDPH implemented a pilot system to monitor trends and detect clusters of selected acute infectious diseases and injury in six Michigan state correctional facilities. This report summarizes the findings of injury surveillance during April 1994-March 1995.

Accidents, Occupational↗
PubMed1997

Prevalence of rabies in bats in Michigan, 1981-1993.

OBJECTIVES: To analyze the species distribution of animals submitted to the Michigan Department of Public Health (MDPH) for rabies testing during 1993. To determine whether any of the 9 species of bats residing in Michigan carries a disproportionate rabies burden, and to determine whether bats contributed the most cases of confirmed rabies during 1981 through 1992. DESIGN: Epidemiologic study. PROCEDURE: Records of animals submitted to the MDPH for rabies testing during 1993, and between 1981 and 1992, were reviewed. Information regarding type of animal submitted, specific species if the animal was a bat, county from which the animal was obtained, the identity of the submitting individual, species of the animal exposed, month of the submission, and results of rabies testing was extracted from these records. RESULTS: During 1993, the MDPH received 2,045 submissions for rabies testing. Seventeen rabid animals were identified: 1 cat, 1 skunk, and 15 bats. Two hundred forty-six bats were submitted for testing. Eptesicus fuscus, the big brown bat, accounted for 97.2% (239) of bat submissions and was the only species of bat that had positive results of testing for rabies. Annual percentages of submitted bats found to be rabid ranged from 2.0 to 11.0%, with a 13-year mean of 6.2%. CONCLUSIONS: 100% of the confirmed cases of rabies in bats reported in Michigan in 1993 were associated with in E fuscus. During 1981 through 1992, most of Michigan's confirmed cases of rabies in animals developed in bats.

Animals↗
PubMed1997

Michigan takes a shot at immunization registry.

September 30, 1997, is the target date to have all of Michigan activated under the new Michigan Childhood Immunization Registry. In 1994, when the Centers for Disease Control reported Michigan had the lowest immunization rates for children under two years of age, the state took steps to increase the percentage of children receiving immunizations. During the past three years, community efforts have raised immunizations rates from 61 percent in 1994 to 74 percent in 1997. Furthermore, legislation was passed in 1996 allowing Michigan to establish a state-wide immunization registry.

Humans↗
PubMed1996

Assisting suicide in Michigan.

Perhaps no American state has seen more legal activity on assisting suicide than Michigan, but despite legislation, a study Commission, several legal cases and a state Supreme Court ruling, the state seems much further from a humane resolution of the question than when the activities of Dr. Jack Kevorkian began in June of 1990. This note summarizes major legal events over a twelve-month period (ending May '95), which included jury acquittal of Dr. Kevorkian, the inconclusive report of the Michigan Commission on Death and Dying, the failure of the state legislature to enact legislation to replace the expired absolute but temporary prohibition, and the decision of the Michigan Supreme Court in Mich. v. Kevorkian declaring assisting suicide a common law felony and ruling that in certain circumstances a person assisting suicide can be prosecuted for murder. The Commission's model decriminalization proposal and the bills subsequently introduced in the legislature (all of which to varying degrees surrounded assisting suicide with restrictions and safeguards), as well as the decision of the Supreme Court, are discussed. Certain puzzling features of the latter, especially with regard to the kind of causation that can turn helping another commit suicide into murder are noted.

Advisory Committees↗
PubMed2005

Brominated flame retardants in sediment cores from Lakes Michigan and Erie.

The history of polybrominated diphenyl ethers (PBDEs) and the major polybrominated biphenyl congener (BB-153) was studied in dated sediment cores taken from Lakes Michigan and Erie. The surficial concentration of total PBDE (65 [corrected] ng/g dry weight) in Lake Michigan was about 1.6 [corrected] times higher than that in Lake Erie (40 ng/g) and about 5 times higher than that [corrected] in Lake Superior (approximately 12 ng/g). The concentrations of total PBDEs in these sediments have increased rapidly, with doubling times of 5-10 years, reflecting the increasing market demand for these flame retardants over the last 30 years. BDE-209 was found to be the predominant congener in both sediment cores, making up approximately 95% [corrected] of the total PBDE load. The inventories of total PBDEs in Lakes Michigan and Erie were both [corrected] 40 ng/cm2 [corrected] The total burdens of these compounds in the sediment of Lakes Michigan and Erie were 23 [corrected] and 10 metric tons, respectively. We estimate [corrected] the total burden of these compounds in all of the Great Lakes is on the order of 100 [corrected] tons. In both lakes, BB-153 was found to increase rapidly during the 1970s and to peak around 1980.

Environmental Monitoring↗
PubMed2006

Partitioning and bioaccumulation of PBDEs and PCBs in Lake Michigan.

Water from Lake Michigan and fish from all five Great Lakes have been sampled and analyzed for a suite of six polybrominated diphenyl ether (PBDE) congeners and 110 polychlorinated biphenyl congeners (PCBs). The Lake Michigan dissolved phase PBDE congener concentrations (0.2 to 10 pg/L) are similar to dissolved phase PCB congener concentrations (nondetected to 13 pg/L). Partitioning of PBDEs between the particulate and dissolved phases exhibits behavior similar to that of PCBs. Organic-carbon-normalized water-particle partition coefficients (log K(OC)s) ranged from 6.2 to 6.5. Lake trout are depleted in BDE-99 relative to dissolved phase concentrations, and in contrast to what is expected from the PCB congener patterns. This reflects suspected debromination of BDE-99 in the food web of Lake Michigan. A regression of the log of the bioaccumulation factor (BAF) and the log of the octanol-water partition coefficent (K(OW)) indicated a positive relationship for both PCB congeners and PBDE congeners. BDE-99 does not appear to followthe same trend, a further indication that it is subject to biotransformation. Using the PBDE BAFs for Lake Michigan and the PBDE fish concentrations from the other Great Lakes it is expected that the dissolved phase concentrations of congeners in the other lakes would range from 0.04 to approximately 3 pg/L.

Animals↗
PubMed2005

Detection of genetic markers of fecal indicator bacteria in Lake Michigan and determination of their relationship to Escherichia coli densities using standard microbiological methods.

Lake Michigan surface waters impacted by fecal pollution were assessed to determine the occurrence of genetic markers for Bacteroides and Escherichia coli. Initial experiments with sewage treatment plant influent demonstrated that total Bacteroides spp. could be detected by PCR in a 25- to 125-fold-higher dilution series than E. coli and human-specific Bacteroides spp., which were both found in similar dilution ranges. The limit of detection for the human-specific genetic marker ranged from 0.2 CFU/100 ml to 82 CFU/100 ml culturable E. coli for four wastewater treatment plants in urban and rural areas. The spatial and temporal distributions of these markers were assessed following major rain events that introduced urban storm water, agricultural runoff, and sewage overflows into Lake Michigan. Bacteroides spp. were detected in all of these samples by PCR, including those with <1 CFU/100 ml E. coli. Human-specific Bacteroides spp. were detected as far as 2 km into Lake Michigan during sewage overflow events, with variable detection 1 to 9 days postoverflow, whereas the cow-specific Bacteroides spp. were detected in only highly contaminated samples near the river outflow. Lake Michigan beaches were also assessed throughout the summer season for the same markers. Bacteroides spp. were detected in all beach samples, including 28 of the 74 samples that did not exceed 235 CFU/100 ml of E. coli. Human-specific Bacteroides spp. were detected at three of the seven beaches; one of the sites demonstrating positive results was sampled during a reported sewage overflow, but E. coli levels were below 235 CFU/100 ml. This study demonstrates the usefulness of non-culture-based microbial-source tracking approaches and the prevalence of these genetic markers in the Great Lakes, including freshwater coastal beaches.

Bacteriological Techniques↗
PubMed1989

Pulmonary function in histology technicians compared with women from Michigan: effects of chronic low dose formaldehyde on a national sample of women.

Chronic workplace exposure to formaldehyde and solvents at low doses reduced pulmonary function in 280 non-smoker white women working as histology technicians. They were studied during national workshops at four United States cities for four years. Height and age adjusted comparisons of pulmonary function were made with women in a stratified random population sample of Michigan and with a selected subset of the population that was used to model predictive pulmonary equations for function. The major functional change in histology technicians was a steeper decrement in vital capacity and flows from age 20 to 60 by regression analysis than occurred in the modelled Michigan population. Furthermore non-smoking and currently smoking women studied at two sites had significantly lower flows than were found in the sample of Michigan women. There was no consistent effect of an aerosol bronchodilator on flows of women at the four sites. Diffusing capacity for carbon monoxide single breath and alveolar volume were below the comparison group of Michigan women only when tested at Washington DC.

Adult↗
PubMed1997

Parasites of the deepwater sculpin, Myoxocephalus thompsoni (Cottidae), from Lake Michigan and Lake Huron.

A total of 190 deepwater sculpins, Myoxocephalus thompsoni, collected in 1995 from Michigan waters of Lake Michigan and Lake Huron was examined for parasites. Five parasite species occurred in sculpins from Lake Michigan with Echinorhynchus salmonis being most common. Six parasite species infected sculpins from Lake Huron, with Haplonema sp. the most common. Haplonema sp. is the only gravid helminth species reported from deepwater sculpins. Pleistophora sp. and Trichodina sp. infected sculpins from Lake Huron and Lake Michigan. Parasite species richness for sculpins at the 3 locations ranged from 5 to 6; mean values ranged from 1.18 to 1.39 for examined fish. The restricted diet of deepwater sculpin, which may be related to the depth of its habitat, appears to determine its helminth fauna. Deepwater sculpin may be an important transport host for E. salmonis, Cyathocephalus truncatus, and Eubothrium salvelini to lake trout and burbot that commonly feed on them.

Acanthocephala↗
PubMed2002

Broad-spectrum insecticide resistance in obliquebanded leafroller Choristoneura rosaceana (Lepidoptera: Tortricidae) from Michigan.

Nineteen insecticides, belonging to nine chemical classes, were bioassayed by dietary exposure against two strains of obliquebanded leafroller, Choristoneura rosaceana, collected from Michigan apple orchards. Berrien is a putatively organophosphate-resistant strain from a commercial orchard with a history of insecticide use, and Kalamazoo a susceptible strain from an isolated and unsprayed orchard. The Berrien strain was moderately resistant (about 25-fold) to organophosphates such as azinphos-methyl and chlorpyrifos. Very low resistance (< 10-fold) was also observed to pyrethroids such as cypermethrin, zeta-cypermethrin, bifenthrin, deltamethrin and esfenvalerate, to the ecdysone agonists tebufenozide and methoxyfenozide, and to the chlorinated pyrrole chlorfenapyr. Endosulfan and carbamates such as thiodicarb, methomyl and carbaryl had low intrinsic toxicities against both strains, with little difference in sensitivity between them. There was no resistance to spinosad. Emamectin benzoate was found to be the most toxic insecticide against C rosaceana, with slightly higher lethal doses required for the Berrien strain. Unexpectedly, Berrien exhibited a very high level of resistance (> 700-fold) to indoxacarb, which has never been used in Michigan to control this insect pest. The active metabolite of indoxacarb, DCJW, was considerably more toxic than the parent compound, but the resistance against DCJW was comparable to that seen with indoxacarb. This indicates that a failure to activate indoxacarb was not the mechanism of resistance in Berrien. The low level of resistance to several chemistries recorded in Michigan C rosaceana can be managed at this stage by adopting a rotation of chemistries having different modes of action.

Animals↗
PubMed1997

Cumulative risk of second primary cancers in women with index primary cancers of uterine cervix and incidence of lower anogenital tract cancers, Michigan, 1985-1992.

A retrospective cohort study of women with cancers of the lower anogenital tract was derived from the Michigan Tumor Registry records for the years 1985-1992. Incidence rates of invasive cervical, vulvar, vaginal and anal cancers were analyzed with respect to age, race, year of diagnosis, stage at diagnosis, and histopathology. The incidence of metachronous primary cancers following initial primaries of the cervix was also investigated. Anogenital cancers constituted about 4% of all cancers in Michigan women between 1985 and 1992. Age-adjusted incidence rates per 100,000 women per year for each site were found to be as follows: 10.1 (cervix), 1.9 (vulva), 1.0 (vagina), and 0.6 (anus). The incidence rates of women in the United States for cancers in the anogenital region were higher in blacks than in whites, with the exception of vulvar cancer. U.S. blacks were more likely to develop squamous cell carcinomas, but less likely to develop adenocarcinomas of the cervix and vagina when compared to whites. Over the 5- to 8-year follow-up period, 6.5% of the women with index cases of cervical cancer developed second primary cancers. This represented a 40% increase in the risk of incident primary cancers compared to the risk in the general population of Michigan women. The significant occurrence of second primaries of the vagina following index primaries of the cervix suggests a shared etiology, such as infection with human papillomavirus. The incidences of cancers related to smoking, including cancers of the urinary bladder, lung/bronchus, and lower anogenital tract were also increased.

Adolescent↗
PubMed1995

Contaminants of fishes from Great Lakes-influenced sections and above dams of three Michigan rivers: III. Implications for health of bald eagles.

Recently, there have been discussions of the relative merits of passage of fishes around hydroelectric dams on three rivers (Au Sable, Manistee, and Muskegon) in Michigan. A hazard assessment was conducted to determine the potential for adverse effects on bald eagles that could consume such fishes from above and below dams on the three primary rivers. The hazard assessments were verified by comparing the reproductive productivities of eagles nesting in areas where they ate primarily fish from either above or below dams on the three primary rivers, as well as on two additional rivers in Michigan, the Menominee and Thunder Bay. Concentrations of organochlorine insecticides (OCI), polychlorinated biphenyls (total PCBs), 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TCDD-EQ), and total mercury (Hg) were measured in composite samples of fishes from above and below hydroelectric dams on the Manistee and Muskegon Rivers, which flow into Lake Michigan, and the Au Sable River, which flows into Lake Huron. Mean concentrations of OCI, total PCBs, and TCDD-EQ were all greater in fishes from below the dams than in those from above. The hazard assessment indicated that current concentrations of Hg and OCI other than DDT (DDT+DDE+DDD) in fish from neither above nor below dams would present a significant hazard to bald eagles (Haliaeetus leucocephalus). Both total PCBs and TCDD-EQ in fishes from below the dams currently present a significant hazard to bald eagles, since their mean hazard quotients (HQ) were all greater than one.

Animals↗