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PubMed1989

Resizing--what two Detroit Hospitals learned, achieved. Interview by Lynn D. Kahn.

Mike Fritz has spent his entire career with Harper Grace Hospitals, a subsidiary corporation of Detroit Medical Center. After 25 years with the hospitals and three years as their president and chief executive officer, Fritz resigned earlier this summer. During the time he served as CEO, Fritz and his management team undertook a dramatic resizing initiative--one that has proven to be effective for both 650-bed Harper Hospital and 300-bed Grace Hospital. In an interview with Lynn D. Kahn, Health Care Strategic Management's managing editor, Fritz discusses what led to the resizing, how it was undertaken and what it accomplished.

Employment↗
PubMed1989

Homeless women with minor children in the Detroit metropolitan area.

Eighty-seven homeless families served by the emergency shelter of the Coalition on Temporary Shelter in Detroit during the first quarter of 1987 were studies through a review of admission data. Most of the families were black and contained an adult female with one or two minor children. Most of the mothers were young, did not have a high school diploma, and had no income. Some had histories of psychiatric disorders or substance abuse. Many had been in a dependent living situation before becoming homeless. Children accounted for more than one-fourth of admissions during the study period. Policies should address prevention of homelessness through income support programs, provision of low-income housing, basic living skill training programs, and mental health service delivery. When available resources fail in prevention, programming should address the effects of homelessness on children, because these effects perpetuate a cycle that will increase the homeless population in future generations.

Adolescent↗
PubMed2000

Unfair treatment, neighborhood effects, and mental health in the Detroit metropolitan area.

Why do racial differences in many indicators of mental and emotional well-being show inconsistent patterns? We propose that mental and emotional well-being are influenced by aspects of the social context, including experiences of unfair treatment and the concentration of households with incomes below the poverty level, and that differential exposure to these factors influences racial differences in mental well-being. We analyze the reporting of psychological distress and life satisfaction in a multistage area probability sample of 1,139 African American and white residents of the Detroit metropolitan area aged 18 and older. Both psychological distress and life satisfaction are significantly associated with exposure to unfair treatment and with the proportion of households in the census block group that were below the poverty level. Racial differences in psychological distress and life satisfaction were eliminated or reversed once differentials in the percent of households living below the poverty line and exposure to unfair treatment were accounted for. These findings contribute to a growing body of evidence that "race" effects operate through multiple pathways that include race-based residential segregation and its attendant economic disinvestment at the community level, and interpersonal experiences of unfair treatment.

Adolescent↗
PubMed1975

Narcotic abuse among homicide victims in Detroit.

A record of 751 homicides occurred in Detroit in 1973. An attempt was made to explore the relationship between narcotics and a random sample of these homicides. It was demonstrated that in the group studied, 43% were narcotic users. It is suggested that if one includes pushers and dealers (possibly victims of a "drug war"), people killed by addicts, and those cases where a narcotic might not be detected in the biological sample, the percentage of homicide victims associated with narcotics traffic could be as high as 60 to 70%. An investigation into the manner (executed, killed in a robbery attempt, etc) helps substantiate this suggestion. Finally, unlike the majority of homicide victims, ethanol is infrequently found in the victim using narcotics.

Adult↗
PubMedDate not supplied

Cigarette use among Arab Americans in the Detroit metropolitan area.

Use of cigarette tobacco by large proportions of the population of Middle Eastern countries has been reported; however, little is known about smoking behavior in one of America's fastest growing minorities, the Arab Americans. The purpose of this study was to examine cigarette smoking behavior of 237 randomly selected Arab American adults from a telephone listing in the Detroit area. Participants lived in the geographic Arab American community and identified with a Middle Eastern cultural heritage. Nurses, who spoke both English and Arabic, interviewed one adult family member using the 59-item self-report from the Cardiovascular Risk Factor Survey developed by Rice. Mean age of respondents was 40.4 years, 97 percent had been born in the Middle East, and 67 percent had been living in the United States 15 years or less. Current smokers rate was 38.9 percent, former smokers rate was 11.1 percent, never smokers rate was 50 percent, and the quit ratio (proportion of ever smokers who are former smokers) was 22.2 percent. Fifty-four percent of the current smokers were between 25 and 34 years of age; fewer women than men were former smokers, and the highest proportion of current smokers were Lebanese. Subjects who had smoked for the longest time were the least well educated. Arab Americans in this sample had a higher smoking rate, a lower quitting rate, and a much lower quit ratio when compared with national and State of Michigan data. With the growing numbers of Middle Eastern immigrants, there is potential for a dramatic increase in smoking-related health problems.

Adolescent↗
PubMed1992

The emerging role of HTLV-I/II and HIV-1 among intravenous drug users in Detroit.

During 1987-1988, a seroprevalence study of the human immunodeficiency virus (HIV-1) and the human T-cell lymphoma/leukemia virus (HTLV-I/II) was performed among Detroit intravenous drug users unaffiliated with substance abuse programs. Seroprevalence data along with patient demographic information were compared to a similar study performed in 1985-1986. In the earlier study, 12 (12.5%) of 96 individuals tested positive for HIV-1. Of the 74 available negative samples retested in 1987-1988 for retroviruses, 7 (9.5%) tested positive for HTLV-I/II. Thus, the overall retroviral (HIV-1, HTLV-I/II) seropositive rate for 1985-1986 was 22%. In 1987-1988, 11 (15.7%) of 70 individuals tested positive for HIV-1 and 7 (10%) tested positive for HTLV-I/II. Concomitant infection with both viruses was found in 2 (2.9%) of the 70 individuals. Thus, retrovirus seroprevalence in 1987-1988 was 22.9%. In 1987-1988, significant differences between the retroviral-positive group and the retroviral-negative group consisted of intravenous drug use greater than 16 years (P = 0.059) for an odds ratio of 3.80 (CI 1.12-12.89) and sex with female prostitutes (P = 0.029) for an odds ratio of 5.38 (CI 1.38-20.95).

Adult↗
PubMedDate not supplied

Detroit's Henry Ford Health System awarded Foster G. McGaw Prize.

Henry Ford Health System, Detroit, is named winner of the prestigious Foster G. McGaw Prize for excellence in community service. The organization received 100,000 dollars from the sponsors, the American Hospital Association, The Baxter International Foundation and the Cardinal Health Foundation.

Awards and Prizes↗
PubMed1991

Epidemiology of hepatitis C virus infection in a suburban Detroit community.

A serum analysis for antibodies to the hepatitis C virus (HCV) was performed on a group of patients in a large suburban Detroit community hospital. The first 50 anti-HCV-positive patients with clinically suspected chronic non-A, non-B hepatitis were studied. Blood transfusions (58%) and intravenous drug use (22%) were the source of infection in most of these patients. A significant difference in age-related epidemiology was observed (p = 0.001). A remote history of intravenous drug use or tattoo application was elicited in 55% of individuals less than 40 yr old. "Sporadic" transmission occurred in 28% of individuals older than 50 yr. Sixteen percent (8/50) had no identifiable risk factors. Five of these eight patients (63%) were born and raised outside North America. Eighty percent of the 35 persons who underwent liver biopsy were found to have either chronic active hepatitis or cirrhosis. Twenty-nine percent (5/17) of the patients with anti-HCV-related cirrhosis presented with hepatocellular carcinoma. None of the patients with noncirrhotic liver disease had a primary liver tumor. We conclude that a significant number of patients in suburban America with chronic hepatitis C have no identifiable risk factors for HCV. Sporadic transmission of hepatitis C may play an important role in patients with chronic HCV-related liver disease, especially among patients born and raised outside North America.

Adult↗
PubMedDate not supplied

AIDS risk behaviors of minority youth living in Detroit.

During summer 1989, 30 Hispanic (15 men, 15 women) and 34 African American (17 men, 17 women) adolescents and young adults from Detroit participated in face-to-face interviews designed to provide preliminary descriptive data of this population's AIDS and condom knowledge, sexual behavior, and condom and needle use behavior. Results suggest almost all knew that AIDS could be transmitted sexually or by needle sharing, and most participants knew condoms protect against AIDS. Although many sexually active participants reported using condoms, the majority reported engaging in unprotected vaginal intercourse. More Hispanic women reported episodes of unprotected intercourse than any other group. The following results may be useful in designing AIDS prevention strategies. Many participants seemed unaware of the ineffectiveness of nonlatex condoms. Hispanic female participants seemed to have a low level of knowledge concerning their own reproductive health. Small numbers of Hispanic and African American participants reported that people in their neighborhood used needles to self-administer steroids or vitamins.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Detroit's avoidable mortality project: breast cancer control for inner-city women.

Mammography remains substantially under-used in low-income minority populations despite its well-established efficacy as a means of breast cancer control. The Metropolitan Detroit Avoidable Mortality Project is a 2-year controlled clinical trial of coordinated interventions which seek to improve the use of early breast cancer detection services at five clinical sites providing primary health care services to inner-city women. Baseline assessment for two of the five participating clinic populations demonstrated that only one-quarter of women who visited these clinics were referred for mammography in 1988, and only half of those who were referred were able to complete the procedure. Patient characteristics including age, marital status, ethnicity, and insurance status were not associated with use of mammography during the baseline period. Each of the project's intervention components is a cue to action: a physician prompt for mammography referral within the medical record of procedure-due women, a reminder postcard for scheduled appointments, and a telephone call to encourage rescheduling of missed appointments. The interventions are initiated by a computerized information management system in the existing network of health care services. The patient's out-of-pocket mammography expense has been eliminated in three of the five sites. Although their efficacy as individual interventions has been well established, a controlled trial of computer prompts to physicians, reduced expense for patients, and patient appointment reminders as an integrated system in inner-city medical care settings has not been previously described. We have implemented the prompting, facilitated rescheduling procedures, and eliminated patient expense for mammography at three of five eventual clinical sites. This report provides an overview of the study's design, data management system, and methodology for evaluation.

Adult↗
PubMed1986

Poverty and Homicide in Detroit, 1926-1978.

The effect of poverty on crime is a controversial issue, mostly because past research has produced only weak evidence of a relationship between economic hardship and crime rates. A review of the literature suggests, however, that time-series data have not been fully exploited in studies of the poverty-crime relationship. This paper helps fill that gap by presenting a regression equation that links poverty and the homicide rate in Detroit from 1926 to 1978. The equation uses a measure based on the infant mortality rate in order to avoid problems associated with monetary indicators of poverty, and it allows for lagged effects across time. The results strongly support the idea that increases in the level of poverty lead to increases in homicide rates.

Cross-Sectional Studies↗
PubMed1985

Disease patterns in the Detroit Zoo: a study of the avian population from 1973 through 1983.

A retrospective study was conducted to evaluate disease patterns in birds at the Detroit Zoo from 1973 through 1983. Data were derived from the zoo's medical and animal census records; the mean (+/- SD) population of birds during the study period was 469 +/- 42. Overall annual morbidity rates were 12.5% to 21.5%, with spring months having the highest morbidity rates. Annual mortality rates were 3.1% to 15.2%; 23.9% of the deaths were caused by microbial agents (particularly Erysipelothrix rhusiopathiae, hemolytic Escherichia coli, Salmonella spp, Aeromonas spp and Proteus spp), 15.4% by trauma, and 42.5% by nondetermined causes. The mute swan (Cygnus olor), mallard duck (Anas platyrhynchos), common gallinule (Gallinula chloropus), common rhea (Rhea americana), and red-billed hornbill (Tockus erythrorhynchus) were the 5 species most frequently affected of the 1,032 deaths from 1973 through 1983. The most frequently isolated parasites were Microtetramere spp, coccidian species, Diplotriaena spp, and Trichomonia spp.

Animals↗
PubMed1985

Disease patterns in the Detroit Zoo: a study of reptilian and amphibian populations from 1973 through 1983.

A retrospective study was conducted to determine disease patterns in reptilian and amphibian populations at the Detroit Zoo from 1973 through 1983. In the reptilian population (mean +/- SD = 285.2 +/- 28), overall annual mortality rates were 1% to 40%. Mortality rates were highest in the fall months (20%) and lowest in the winter months (6%). The most frequently affected reptiles were iguana (Iguana iguana), reticulated python (Python reticulatus), rattlesnakes (Crotalus spp), common boa (Constrictor constrictor), and lizards (various genera of suborder Lacertilia). Of the 1,300 reptilian deaths from 1973 through 1983, 36.6% were caused by microbial agents, 12% by parasites, 11.6% by trauma, and 9.3% by nutritional deficiencies. The main microbial organisms that caused death were Aeromonas spp, Salmonella spp, Pseudomonas spp, Proteus spp, and Edwardsiella spp. The main parasites that caused death were Entamoeba spp and lungworms. Among amphibians, frogs and toads were the most frequently affected, and starvation and trauma were the most frequent causes of death.

Amphibians↗
PubMed1985

Disease patterns in the Detroit Zoo: a study of the mammalian population from 1973 through 1983.

A retrospective study was conducted to evaluate disease patterns in the mammals at the Detroit Zoo from 1973 through 1983. The reindeer (Rangifer tarandus), common eland (Taurotragus oryx), rednecked Wallaby (Protemnodon rufogrisea), sitatunga (Tragelaphus spekii), and kangaroo (Macropus spp)- were the most frequently affected mammalian species. Parasitic agents (80% of which were internal parasites) caused morbidity in 60.2% of the mammals evaluated (n = 2,475) and microbial agents caused morbidity in 20.8% of the animals. Strongyloides spp, Trichostrongylus spp, coccidian species, Diphyllobothrium spp, and Trichuris spp were the internal parasites most frequently found. Overall annual mortality rate was 14% to 34%, with microbiological agents causing the highest mortality (26.5%). Pasteurella spp, beta-hemolytic Streptococcus spp, pathogenic Escherichia coli, Corynebacterium spp, and Klebsiella pneumoniae were the most frequent microbial causes of death. Cause of mortality could not be determined in 21.5% of the animals evaluated. The percentage of animals successfully treated increased from 1973 through 1983. Generally, however, the percentage of successfully treated animals was low (21% to 39%).

Animal Diseases↗
PubMedDate not supplied

[Persistence of lymphocytic choriomeningitis virus in a transplantable line of Detroit-6 cells].

Defective LCM virus was found to persist in Detroit-6 cells. The persisting virus was not infectious for susceptible mice and some cell cultures. Its antigenic properties were enhanced to detectable levels in the CFT by cocultivation with LSV5 cells only. No reversion to its pathogenic properties, however, occurred either after 8 subpassages of the cocultivated cells or after blind passages of these cells in suckling mouse brains. The cytogenetic analysis, and the pattern of antigen fluorescence (IIF) revealed similarities between HeLa and D-6 cell lines persistently infected with LCM virus. The highest intensity of LCM virus antigen coincided with the period of maximum miotic activity of D-6-LCM cells, indicating a correlation between synthesis processes in the cells and reproduction of the persisting virus. Upon superinfection of D-6-LCM cells with homo- and isologous viruses no increase in the percentage of the antigen-containing cells was observed. No detectable interferon was found in the D-6-6CM system.

Cell Line↗
PubMed1983

Occupation and cancer of the lower urinary tract in Detroit.

The relationship between occupation and cancer of the lower urinary tract in Detroit was examined by means of a population-based case-control study conducted as part of the National Bladder Cancer Study. Three hundred three white male patients with transitional or squamous cell carcinoma of the lower urinary tract and 296 white male controls selected from the general population of the study area were interviewed to obtain lifetime occupational histories. Our findings suggested that truck drivers have a significant increased risk of lower urinary tract cancer [relative risk = 2.1; 95% confidence interval (Cl) = 1.4-4.4]. A significant trend in risk was apparent with increasing duration of employment as a truck driver (P = 0.004); the relative risk estimated for truck drivers employed at least 10 years was 5.5 (Cl = 1.8-17.3). Truck drivers with a history of operating vehicles with diesel engines experienced a significant elevated risk compared to non-truck drivers (relative risk = 11.9; Cl = 2.3-61.1), but whether the increased risk observed among truck drivers was attributable to diesel exposure could not be evaluated. Nonsignificant excess risks were also seen for tool and die makers as well as for workers in several other industries and occupations. Employment in the motor vehicle manufacturing industry was associated with no significant excess risk of lower urinary tract cancer (relative risk = 1.1; Cl = 0.8-1.5).

Adult↗
PubMedDate not supplied

Determinants of drug treatment maintenance among hypertensive persons in inner city Detroit.

Drug treatment maintenance among a group of 206 hypertensive persons was examined in relation to their health beliefs, knowledge about hypertension, barriers to receiving medical care, health status, and personal characteristics. The data came from a cross-sectional survey of approximately 800 adults living in Detroit, Mich., which included blood pressure measurements of respondents. Treatment maintenance was defined as continuing to take antihypertensive medication following a diagnosis of hypertension. Twenty-one percent of the 206 hypertensives interviewed reported discontinuing drug treatment for their high blood pressure without being advised by a physician to do so. The only factor that distinguished drop-outs from nondrops was the respondents' perception of their health status; the poorer a person perceived his or her health to be, the more likely the person was to remain in treatment. Among persons who dropped out of drug treatment, the most common reason given for discontinuing was that they felt well without the medicine. Given the asymptomatic nature of hypertension, it is suggested that many of those who stop taking medication do so because they see no need to continue therapy. The findings from this study point out the need for providers to emphasize to their hypertensive patients the reasons for continuing on treatment even when they feel well.

Black or African American↗