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PubMed2005

Cultural competence among Ontario and Michigan healthcare providers.

PURPOSE: To examine variables associated with cultural competence among urban, hospital-based healthcare providers in Ontario (Canada) and Michigan (US). DESIGN AND SAMPLE: A cross-sectional descriptive design with a convenience sample of hospital-based providers was used. The sample was 145 providers (n=71 Ontario; n=74 Michigan). METHODS: Providers completed a survey which included the Cultural Competence Assessment (CCA) instrument. Regression analysis was used to examine associations. FINDINGS: Providers with diversity training and higher levels of educational attainment scored significantly higher on cultural awareness and sensitivity and on cultural competence behaviors. CONCLUSIONS: Variables significantly associated with cultural competence included prior training in cultural competency and higher educational attainment among both Ontario and Michigan healthcare providers.

Adult↗
PubMed2006

Results from the 2004 Michigan Farm-to-School Survey.

The purpose of this study was to investigate Michigan school food service directors' interest in, and opportunities and barriers to, implementing a farm-to-school program. Farm-to-school may be a timely and innovative approach to improving the school food environment and helping food service directors meet their nutrition goals for school meals. Health and agriculture advocates have recognized the importance of farm-to-school in addressing health issues and creating opportunities for farmers and rural communities. Research subjects were 664 food service directors representing school districts across Michigan. Respondents (n = 383) reported a high degree of interest in sourcing food from local producers (73% reported being very interested or interested). Interest was significantly augmented (83%) when respondents were asked to assume that these foods were available through current vendors. Interest was independent of free/reduced lunch participation rate or school district location (rural, suburban, urban location). Food service directors expressed diverse motivations for their interest in farm-to-school, including supporting the local economy and community; accessing fresher, higher-quality food; and potentially increasing students' fruit and vegetable consumption. The most frequently reported barriers and concerns included cost, federal and state procurement regulations, reliable supply, seasonality of fruits and vegetables, and food safety. Michigan school food service directors appear ready to make linkages with local agriculture. However, there is need to address the concerns and barriers through education; inclusion of community partners, such as current vendors; funding; and state and federal policies that support local purchasing.

Administrative Personnel↗
PubMed2002

Bovine tuberculosis in Michigan wildlife and livestock.

Since 1994, the state of Michigan has recognized a problem with bovine tuberculosis (TB), caused by Mycobacterium bovis, in wild white-tailed deer from a 12-county area in northeastern Lower Michigan. A total of 65,000 free-ranging deer have been tested, and 340 have been found to be positive for M. bovis. The disease has been found in other wildlife species, and, in 1998, in domestic cattle, where to date 13 beef cattle and 2 dairy cattle herds have been diagnosed with bovine TB. Unfortunately, the situation is unique in that there have never been reports of self-sustaining bovine TB in a wild, free-ranging cervid population in North America. Scientists, biologists, epidemiologists, and veterinarians who have studied this situation have concluded that the most logical theory is that high deer densities and the focal concentration caused by baiting (the practice of hunting deer over feed) and feeding are the factors most likely responsible for the establishment of self-sustaining TB in free-ranging Michigan deer. Baiting and feeding have been banned since 1998 in counties where the disease has been found. In addition, the deer herd has been reduced by 50% in the endemic area with the use of unlimited antlerless permits. The measures of apparent TB prevalence have been decreased by half since 1997, providing hopeful preliminary evidence that eradication strategies are succeeding.

Animals↗
PubMedDate not supplied

A descriptive study of Guillain-Barré syndrome in high and low Campylobacter jejuni incidence regions of Michigan: 1992-1999.

The incidence rate of Guillain-Barré syndrome (GBS) was compared between high and low Campylobacter jejuni incidence counties in Michigan, USA, between 1992 and 1999. Data on GBS was obtained from cases reported to the Michigan Department of Community Health. Poisson confidence intervals were used to compare incidence rates. There was no significant difference in the overall rate between high and low C. jejuni incidence regions in Michigan. Though no differences in age-specific, gender-specific, and seasonal rates were significant, GBS was more common in spring and summer in the high C. jejuni incidence region than in the low C. jejuni incidence region. Differences in the distribution of cases by age group and gender are described, though no difference was statistically significant.

Adolescent↗
PubMed2005

Improved quality of stroke care for hospitalized Medicare beneficiaries in Michigan.

BACKGROUND AND PURPOSE: We reported previously that acute ischemic stroke patients encountered delays in obtaining neuroimaging and receiving thrombolysis, and that deep venous thrombosis prophylaxis was used only in a minority of eligible patients. We investigated whether these and other measures improved after a quality improvement initiative. METHODS: Medicare fee-for-service ischemic stroke and transient ischemic attack discharges in 136 acute care hospitals in Michigan were identified by International Classification of Diseases, 9th Revision, Clinical Modification codes. Only patients with stroke symptoms persisting for >1 hour and present on arrival were included in the analysis. Seven quality indicators were abstracted from chart review at baseline (discharges between July 1, 1998, and June 30, 1999) and at remeasurement (discharges between January 1, 2001, and June 30, 2001) after an intensive quality improvement initiative throughout Michigan hospitals. Quality indicators were compared at baseline and remeasurement. RESULTS: Indicators of care were determined in 5146 patients at baseline and 4980 patients on remeasurement. Four quality-of-care indicators showed significant improvement on remeasurement: antithrombotic prescribed at discharge (81.9 baseline versus 83.7% remeasurement; P=0.026), avoidance of sublingual nifedipine in patients with acute ischemic stroke (97.1 versus 99.7%; P<0.0001), documentation of a computed tomography (CT)/MRI during hospitalization (98.0 versus 99.1%; P=0.024), and appropriate deep venous thrombosis prophylaxis (13.8 versus 26.9%; P<0.0001). Time to CT/MRI did not significantly change, but time to thrombolysis improved (113 versus 88.5 minutes; P=0.045). CONCLUSIONS: Improvement occurred in several indicators of quality of care in Michigan Medicare beneficiaries presenting with acute stroke symptoms.

Administration, Sublingual↗
PubMedDate not supplied

Fish consumption and other characteristics of reproductive-aged Michigan anglers--a potential population for studying the effects of consumption of Great Lakes fish on reproductive health.

There has been considerable interest in the benefits and risks of eating Great Lakes fish, particularly with regard to reproductive health. We report the results of a survey conducted from 1993-1995 among Michigan anglers. The survey was designed to identify a reproductive-aged cohort of persons who consume high or low levels of Great Lakes fish in order to study the impact of polyhalogenated biphenyl (PHB) compounds and other toxins on human reproduction outcomes. Using fishing license data obtained from the Michigan Department of Natural Resources, we identified anglers of early reproductive age (18-34 years) in ten Michigan counties. The screening survey ascertained demographic, behavioral, fish consumption, and reproductive history information on anglers and their partners. Over 4,000 angler households were contacted. One thousand nine hundred fifty questionnaires were returned from 1,168 households. The median age of respondents was 30 years; 58% were male and 64% reported being married. Slightly more than one-half the respondents had attended or graduated from college, and less than 10% had not completed high school. In the past year, most respondents (46%) reported having eaten sport-caught fish 1-12 times, while 20% reported having eaten no sport-caught fish; 20% had consumed 13-24 meals. More sport-caught fish was consumed in the spring and summer than in the fall and winter, and males reported eating more fish than females. About 43% of our respondents reported that they intend to have one or more children in the next five years. Of these respondents, 287 couples had no identified impairments to reproduction and therefore would be eligible to participate in the future reproductive study.

Adolescent↗
PubMed2006

Evaluating Michigan's community hospital access: spatial methods for decision support.

BACKGROUND: Community hospital placement is dictated by a diverse set of geographical factors and historical contingency. In the summer of 2004, a multi-organizational committee headed by the State of Michigan's Department of Community Health approached the authors of this paper with questions about how spatial analyses might be employed to develop a revised community hospital approval procedure. Three objectives were set. First, the committee needed visualizations of both the spatial pattern of Michigan's population and its 139 community hospitals. Second, the committee required a clear, defensible assessment methodology to quantify access to existing hospitals statewide, taking into account factors such as distance to nearest hospital and road network density to estimate travel time. Third, the committee wanted to contrast the spatial distribution of existing community hospitals with a theoretical configuration that best met statewide demand. This paper presents our efforts to first describe the distribution of Michigan's current community hospital pattern and its people, and second, develop two models, access-based and demand-based, to identify areas with inadequate access to existing hospitals. RESULTS: Using the product from the access-based model and contiguity and population criteria, two areas were identified as being "under-served." The lower area, located north/northeast of Detroit, contained the greater total land area and population of the two areas. The upper area was centered north of Grand Rapids. A demand-based model was applied to evaluate the existing facility arrangement by allocating daily bed demand in each ZIP code to the closest facility. We found 1,887 beds per day were demanded by ZIP centroids more than 16.1 kilometers from the nearest existing hospital. This represented 12.7% of the average statewide daily bed demand. If a 32.3 kilometer radius was employed, unmet demand dropped to 160 beds per day (1.1%). CONCLUSION: Both modeling approaches enable policymakers to identify under-served areas. Ultimately this paper is concerned with the intersection of spatial analysis and policymaking. Using the best scientific practice to identify locations of under-served populations based on many factors provides policymakers with a powerful tool for making good decisions.

Cluster Analysis↗
PubMed1982

Legislating hospital bed reduction: the Michigan experience.

A variety of programs aimed at health care cost containment have been initiated at the state level. This article presents a case study of one state's effort to deal with health care cost issues, focusing on the formulation of adoption of legislation to reduce the number of hospital beds. The Michigan bed-reduction legislation was the creature of a coalition of powerful, organized "professional consumers" of health services who placed hospital cost containment on the political agenda and framed a solution. The provisions of the legislation were reshaped during the legislative process to grant concessions to a variety of interest groups, particularly the Michigan Hospital Association. Many additional criteria for determining excess bed capacity, some subjective, were added. Cost containment as a goal was, if not subordinated, at least made competitive with other goals--access to care, equity among types of providers, and quality of services. While the initial proposal was attractive as a seemingly simple extension of the certificate-of-need process within the existing regulatory framework, the legislation became increasingly complex in response to new issues raised by political actors who contributed to the shaping of the final version of the legislation. The formulation and adoption of Michigan's overbedding legislation appears to underscore what many other observers have noted: there are no purely technical solutions to health policy problems.

Certificate of Need↗
PubMed1978

Polybrominated biphenyl (PBB) contamination of the Pine River, Gratiot, and Midland Counties, Michigan.

Michigan Chemical Corporation, St. Louis, Michigan manufactured PBB from 1970 until November 20, 1974. Studies in 1974 showed significant quantities of PBB in effluent discharged from the facility and in water, fish, ducks, and sediments from the Pine River. Fish uptake rates and bioconcentration factors were estimated. Followup surveys over the three year period since the termination of PBB production indicate a decline in PBB loadings to the river but no significant corresponding decline of PBB levels in sediments, fish and duck tissue. A Michigan Department of Public Health warning against consumption of Pine River fish from St. Louis downstream to its confluence with Chippewa River remains in effect.

Animals↗
PubMed1978

Carcinoembryonic antigen (CEA) plasma levels in Michigan and Wisconsin dairy farmers.

Carcionogenic embryonic antigen (CEA) titers were determined for 611 Michigan farmers exposed to PBB and a control nonexposed population of 139 Wisconsin farmers. The overall prevalence of elevated CEA titers was slightly higher in the Michigan study group, but the difference was not statistically significant. Smoking and/or significant past or present conditions (inflammatory bowel disease, ulcers, polyps, liver disease, chronic lung disease, or malignancies) were found to result in higher prevalence of elevated CEA titers, in both the Michigan study group and the Wisconsin control group, thus confirming previous reports. In addition, serum PBB concentrations appeared to be positively correlated with CEA titers. The possibility that the effect of PBB concentrations appeared to be positively correlated with CEA titers. The possibility that the effect of PBB may be additive to that of other factors which are known to result in an increased prevalence of elevated CEA titers is discussed.

Adolescent↗
PubMed2001

Michigan's unique approach to treating impaired health care professionals.

The practice of health care professionals impaired by alcohol or other substance abuse is an often hidden, but continuing problem. Established by law in 1994, the Michigan Health Professional Recovery Program (MHPRP) provides a new approach to treating impaired health professionals. It is unique nationally, both in its umbrella approach to most health professional licensees in the State of Michigan, and in the arrangement by which the program is run through a private contract, awarded after bidding, to five of the state's professional organizations. The arrangement maintains separation from the established professional regulatory/licensing boards unless a licensee is non-compliant. MHPRP operates under specific policies, procedures, guidelines, and criteria established by the Health Professional Recovery Committee which includes a member appointed by each health care licensing board plus two public members. As of June 30, 2000 over 1600 health care professionals in Michigan had been included in the program.

Aftercare↗
PubMed2004

Camp health services in the state of Michigan.

CONTEXT: Every summer, 10 million campers attend summer camp in the United States. In Michigan, each camp is required to have a camp health officer (CHO) on-site. OBJECTIVE: To document the medical training, local emergency medical services and physician support, and off-camp medical facility use of CHOs. DESIGN: Anonymous institutional review board-approved mail survey of all Michigan CHOs during the summer of 2001. RESULTS: A total of 129 responses (50% response rate). Forty-seven percent of the CHOs reported caring for campers with significant medical needs. Almost half (45%) of the CHOs were registered nurses; however, 44% of the CHOs had paramedic training or less. Forty percent reported an ambulance response time of more than 10 minutes. Nearly all (97%) reported having a physician who reviewed their standing orders, and yet 75% reported using an acute care facility (emergency department or urgent care) more than half of the time for medical care not on-site. The CHOs reported that a small or rural hospital was the ambulance-receiving hospital 71% of the time. Two of the camps that responded have an automatic external defibrillator, and 22% are planning to buy one. CONCLUSIONS: In Michigan, CHOs have limited training, tend to use emergency department or urgent care facilities as their medical backup, and, in some instances, have prolonged times to definitive care. This preliminary study shows some of the opportunities that exist to improve health care for campers on a local and national level.

Adolescent↗
PubMed1981

Height, weight, and triceps skinfold thickness of Michigan children, 1978.

Height, weight, and triceps skinfold measurements were made on 258 Michigan males and 225 females, age 2 to 18 years, comprising a representative sample of Michigan children in 1978. Boys of most age groups and younger girls were slightly taller, heavier, and fatter than their US counterparts, studied between 1963 and 1974. Older Michigan girls were slightly shorter but heavier and fatter than their earlier US counterparts.

Adolescent↗
PubMed1982

A comparison of height, weight, and triceps skinfold thickness of children ages 5-12 in Michigan (1978), Forsyth County North Carolina (1978), and HANES I (1971-1974).

Height, weight, and triceps skinfold measurements were made on 1,668 Forsyth County, North Carolina students ages 5-12 during 1978. These data were compared to a representative sample of Michigan children taken during the same year and to their United States counterparts in HANES I (1971-74). The North Carolina children more closely resembled their US counterparts than did the Michigan group, casting doubt on the secular trend toward heavier children suggested by the Michigan researchers. (Am J Public Health 1982; 72:730-733.)

Black or African American↗
PubMed1995

Diabetes care policies and practices in Michigan nursing homes, 1991.

OBJECTIVE: To describe local standards of care for nursing home patients with diabetes, to characterize the care that nursing home patients with diabetes receive in Michigan, and to determine if the care provided meets local and national standards. RESEARCH DESIGN AND METHODS: In March 1991, a questionnaire was administered and chart reviews were conducted as part of the Medical Review and Nursing Evaluation conducted by the Michigan Department of Public Health. The questionnaire was completed by the head nurses at 17 skilled nursing homes to learn about local institutional standards of care. Chart reviews were conducted on a sample of five patients with diabetes from each nursing home to describe the care provided and to compare it with local and national standards. RESULTS: Almost all nursing homes had some diabetes care orders or protocols. Standing orders were most often present to guide nutritional and nursing care (e.g., diet, blood glucose monitoring, foot care). Standing orders were less often present to guide medical care (e.g., blood glucose parameters to contact physician) and surveillance of complications (e.g., eye exams). In general, the care provided did not meet local or national standards for diabetes care. Care practices were closer to national standards when registered dietitians (RDs) participated in meal planning and written institutional policies existed. CONCLUSIONS: In this sample of Michigan nursing homes, those with RDs and standing orders provided care more in keeping with guidelines. There is room for improvement in diabetes care practices in nursing homes. It may be time for diabetes-related organizations to re-examine standards for diabetes care in nursing homes.

Aged↗
PubMed2006

Evaluation of historical factors influencing the occurrence and distribution of Mycobacterium bovis infection among wildlife in Michigan.

OBJECTIVES: To determine historical events leading to establishment of bovine tuberculosis in the white-tailed deer population in the northeastern corner of the lower peninsula (NELP) of Michigan and describe factors relevant to the present outbreak of bovine tuberculosis in Michigan. SAMPLE POPULATION: Cattle and white-tailed deer in Michigan from 1920 to 1990. PROCEDURES: A search of extant historical documents (eg, scientific journals, books, public reports, and correspondence and internal reports from governmental agencies) was conducted. Factors investigated included the number of cattle and prevalence of tuberculosis, deer population and density levels, and changes in regional environments affecting the population and management of cattle and wild deer. RESULTS: High deer numbers and severe winter feed shortages resulting from habitat destruction in the NELP in 1930 contributed to the transmission of tuberculosis from cattle to deer. Starvation increased the susceptibility of deer to infection and modified behavior such that exposure to infected cattle was increased. Relocation of deer resulted in spread of infection to other sites, including locations at which spatial clusters of tuberculosis presently exist. Ribotyping of Mycobacterium bovis from a human patient suggests that the strain of M. bovis presently infecting white-tailed deer in the region is the same strain that affected cattle farms at that time. CONCLUSIONS AND CLINICAL RELEVANCE: Feeding deer to maintain numbers above the normal carrying capacity of the NELP led to deer depending on consumption of livestock feed for survival during winter and increased contact with domestic cattle. This practice should be avoided.

Animals↗
PubMedDate not supplied

Historical overview of the development of family-centered, community-based, coordinated care in Michigan.

Caring for children with special health care needs (SHCN) is a challenge that has been faced with commitment and concern in this country. However, by the late 1970s, it was clear to some that an analysis of the efficacy of the existing structure of care was long overdue. As scrutiny of the current processes began to unfold, new and improved ideas were emerging throughout the United States. A continuous theme through that process was the need and desire to create care systems that were family-centered, aimed at coordinating care, and were close to the child and family's community. These activities provided a conceptual background from which Michigan began to redesign existing programs and develop new initiatives. Simultaneously, Michigan's experiences were influencing national efforts to create family-centered, community-based, coordinated care structures for children with SHCN. This article highlights key national efforts and individuals who influenced program development for children with SHCN in Michigan. In addition, specific family-centered efforts that occurred in the state since the early 1980s, and that continue to date, are described.

Child↗
PubMed1979

Impaired immune function and identification of polybrominated biphenyls (PBB) in blood compartments of exposed Michigan dairy farmers and chemical workers.

In 1973 PBB's were accidentally mixed into animal feed, resulting in marked toxic effects. Meat and dairy products were widely consumed in Michigan. To determine the impact of PBB's, 55 exposed Michigan farm residents, 11 Michigan chemical workers and 46 non-exposed Wisconsin farmers were examined. Abnormalities included decreased number of T-lymphocytes with concomitant increase of lymphocytes with no detectable surface markers, "null cells", and altered lymphocyte function. Data obtained from skin testing using standard recall antigens, showed no consistent correlation between the delayed cutaneous hypersensitivity response and the impaired lymphocyte function. PBB (hexa) in separated white blood cells and red cells was positively identified and quantified by gas chromatography-mass spectrometry. PBB and immunological abnormalities were not detected in non-exposed Wisconsin dairy farm residents.

Agricultural Workers' Diseases↗