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1.
Accid Anal Prev ; 192: 107297, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37703601

RESUMO

Motorcyclist hazardous actions (e.g., particularly speed too fast or failing to stop in assured clear distance (ACD)) are commonly identified as risk factors that significantly impact the motorcyclist injury severity. However, endogenous effects resulting from motorcyclist hazardous actions have seldom been considered, which may cause the biased estimates. Specifically, two important sources of endogeneities (i.e., endogeneity arising from observed confounding factors and endogeneity caused by unobserved confounders) tend to yield a biased relationship between hazardous actions and motorcyclist injury severity. To jointly account for two sources of endogeneities and provide more robust estimates, the study tries to assess the effects of speed-too-fast and failing to stop in ACD on motorcyclist injury severity via a hybrid method by integrating the generalized propensity score approach with instrumental variable model. Specifically, we adopt a generalized propensity score matching method to reduce the endogeneity bias arising from observed confounders. Furthermore, the matched data are used to develop an instrumental variable model with random parameters to handle the endogeneity resulting from unobserved confounders and unobserved heterogeneity, which consists of random parameters binary logit models modelling the motorcyclist hazardous actions in the first stage and a random parameters logit model with heterogeneity in means modelling the motorcyclist injury severity in the second stage. The proposed approach is estimated based on Michigan motorcycle crash data from 2015 to 2018. Results suggest that alcohol use leads motorcyclists to engage in speed-too-fast, while alcohol use and signal control cause motorcyclists to be involved in failing to stop in ACD. Middle-aged and elderly motorcyclists, alcohol use, speed too fast, speed limit ≥50 mph, wet surface, and head-on/angle crashes significantly increase the injury severity of motorcyclists. Moreover, failing to stop in ACD produces a random parameter with heterogeneity in means, while intersection increases the mean effects of failing to stop in ACD on motorcyclist minor injury. These findings further provide insights for a better understanding of hazardous actions and motorcyclist injury severity via the impact analysis of various explanatory variables.


Assuntos
Acidentes de Trânsito , Consumo de Bebidas Alcoólicas , Idoso , Pessoa de Meia-Idade , Humanos , Pontuação de Propensão , Modelos Logísticos , Michigan
2.
Front Biosci (Landmark Ed) ; 28(8): 180, 2023 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-37664945

RESUMO

BACKGROUND: Recent studies suggest that numerous naturally occurring agents have the potential to kill cancer cells via mitochondrial dysfunction. Solanum nigrum is a herb widely used in alternative medical systems. This study aimed to investigate the cytotoxic effect of Solanum nigrum water extract (SNWE) against Michigan Cancer Foundation-7 (MCF-7) and MD Anderson-Metastatic Breast Cancer-231 (MDA-MB-231) cells. METHODS: We used an MTT reduction assay for cytotoxicity analysis. To explore the mode of action, the cellular adenosine triphosphate (ATP) levels and mitochondrial membrane potential were analyzed using a colorimetric ATP assay and Rhodamine-123 fluorescent staining, respectively, during SNWE treatment for 72 h. RESULTS: The cytotoxic effect was significant in both cell lines, with IC50 values of 4.26 µg/mL and 5.30 µg/mL in MCF-7 and MDA-MB-231 cells, respectively. The 24, 48, and 72 h treatments of 100 µg/mL SNWE showed 0.85 ± 0.07, 0.38 ± 0.1, and 0.20 ± 0.1 nM ATP in MCF-7 cells and 0.94 ± 0.07, 0.84 ± 0.2 and 0.46 ± 0.2 nM in MDA-MB-231 cells, respectively. The SNWE treatment altered the mitochondrial membrane potential (ΔΨm) in a concentration-dependent manner in both the breast cancer cell lines, to 29.6 ± 4.1% in MCF-7 and 28.7 ± 4.17% in MDA-MB-231 cells, when compared with healthy mitochondria (100% ΔΨm). CONCLUSIONS: The cytotoxic effects of Solanum nigrum against breast cancer cells are associated with energy metabolism. Additional studies are warranted to test the anticancer effect of Solanum nigrum using an animal model of breast cancer.


Assuntos
Antineoplásicos , Neoplasias , Solanum nigrum , Animais , Humanos , Células MCF-7 , Michigan , Trifosfato de Adenosina , Mitocôndrias , Água
3.
J Dent Hyg ; 97(4): 60-69, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37553276

RESUMO

Purpose Non-surgical periodontal therapy (NSPT) is considered to be fundamental in the treatment of periodontal disease. Advanced area specific instruments were designed to increase the clinician's ability to effectively access root furcation areas during NSPT. The purpose of this study was to explore clinical dental hygienists' familiarity, utilization, and perceived efficacy of advanced instruments in root furcation areas during NSPT.Methods A randomized sample (n=3,500) of licensed dental hygienists in Michigan was invited to participate in a paper-based, mail survey. The 10-item instrument consisted of demographic, multiple choice, Likert scale, and open-ended questions. Descriptive and inferential statistics were used to analyze the data.Results A total of 1,156 surveys were returned; 858 met the inclusion criteria for a response rate of 24.5%. Respondents who graduated between 2010-2020 than those who graduated between 1990-1999 were more likely to utilize advanced instruments and those who graduated in 1989 or earlier (16.0% and 19.9% respectively). Respondents familiar with advanced instruments were more likely to use them in furcation areas during NSPT than those less familiar with the instruments (95% CI [18.1, 29.6], p<0.001). Respondents who perceived advanced instruments to be effective in furcation areas were more likely to utilize them (95% CI [1.0, 8.0], p<0.05) during NSPT. Most respondents indicated that they became familiar with advanced instruments during their dental hygiene education or through continuing education courses.Conclusion Familiarity with advanced instruments and perceived efficacy of these instruments for accessing root furcations increased the likelihood of clinical dental hygienists utilizing them during NSPT. Dental hygiene education and continuing education programs should continue to provide opportunities for students and practicing clinicians to learn NSPT instrumentation techniques utilizing advanced instruments designed for furcation access.


Assuntos
Higienistas Dentários , Educação Continuada , Humanos , Higienistas Dentários/educação , Michigan , Estudantes , Inquéritos e Questionários , Atitude do Pessoal de Saúde
4.
Eur J Cardiothorac Surg ; 64(2)2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37653577

RESUMO

The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS), a pioneer in initiating and nurturing quality improvement strategies in statewide cardiothoracic surgery, has been running the Quality Collaborative (MSTCVS-QC) program since 2001. This initiative has significantly grown over the years, facilitating at least 4 in-person meetings annually. It actively engages cardiac and general thoracic surgeons, data managers and researchers from all 32 non-federally funded cardiothoracic surgery sites across Michigan. Broadening its influence on joint learning and clinical outcomes, the MSTCVS-QC formed a strategic partnership with Blue Cross Blue Shield of Michigan, the state's largest private insurer, to further promote its initiatives. The MSTCVS-QC, operating from a dedicated QC centre employs an STS-associated database with additional aspects for data collection and analysis. The QC centre also organizes audits, facilitates collaborative meetings, disseminates surgical outcomes and champions the development and implementation of quality improvement initiatives related to cardiothoracic surgery in Michigan. Recognizing the MSTCVS-QC's successful efforts in advancing quality improvement, the European Association for Cardiothoracic Surgery (EACTS) introduced a fellowship program in 2018, facilitated through the EACTS Francis Fontan Fund (FFF). This program allows early-career academic physicians to spend 4-6 months with the MSTCVS-QC team in Ann Arbor. This article chronicles the evolution and functionality of the MSTCVS-QC, enriched by the experiences of the inaugural 4 EACTS/FFF fellows. Our objective is to emphasize the critical importance of fostering a culture of quality improvement and patient safety in the field of cardiothoracic surgery with open discussion of audited, high-quality data points. This principle, while implemented locally, has implications and value extending far beyond Europe, resonating globally.


Assuntos
Bolsas de Estudo , Cirurgiões , Humanos , Michigan , Europa (Continente) , Bases de Dados Factuais
5.
Health Aff (Millwood) ; 42(8): 1162-1172, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37549335

RESUMO

Michigan's recently revised Lead and Copper Rule requires water utilities to inventory existing water service lines by 2025 and replace all lead-containing lines by 2041. This article summarizes a cost-benefit analysis using new inventory data on the number of lead service lines in the state, the projected cost of their replacement, and the estimated lifetime benefits from reduced lead exposure. Replacing 423,479 lead service lines would reduce lead exposure for 420,800 newborns and result in $3.24 billion in future benefits (compared with replacement costs of $1.33 billion). This would generate net savings of $1.91 billion and a societal return on investment of $2.44 per dollar invested. These estimates are conservative and include only quantified benefits for newborn children in Michigan for the period 2020-60. More than 153,100 of the children benefiting would be non-White (of whom 78,400 would be Black or African American), and 106,900 would be in households with incomes below the federal poverty level. Sensitivity analyses show that accelerating the replacement pace would increase the societal return on investment. This primary prevention-driven policy has the potential to reduce childhood lead exposure and improve health equity.


Assuntos
Equidade em Saúde , Água , Recém-Nascido , Humanos , Criança , Michigan , Chumbo , Análise Custo-Benefício
6.
PLoS One ; 18(8): e0288383, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37651422

RESUMO

BACKGROUND: COVID-19 has had a disproportionate impact on racial and ethnic minorities compared to White people. Studies have not sufficiently examined how sex and age interact with race/ethnicity, and potentially shape COVID-19 outcomes. We sought to examine disparities in COVID-19 outcomes by race, sex and age over time, leveraging data from Michigan, the only state whose Department of Health and Human Services (DHSS) publishes cross-sectional race, sex and age data on COVID-19. METHODS: This is an observational study using publicly available COVID-19 data (weekly cases, deaths, and vaccinations) from August 31 2020 to June 9 2021. Outcomes for descriptive analysis were age-standardized COVID-19 incidence and mortality rates, case-fatality rates by race, sex, and age, and within-gender and within-race incidence rate ratios and mortality rate ratios. We used descriptive statistics and linear regressions with age, race, and sex as independent variables. RESULTS: The within-sex Black-White racial gap in COVID-19 incidence and mortality decreased at a similar rate among men and women but the remained wider among men. As of June 2021, compared to White people, incidence was lower among Asian American and Pacific Islander people by 2644 cases per 100,000 people and higher among Black people by 1464 cases per 100,000 people. Mortality was higher among those aged 60 or greater by 743.6 deaths per 100,000 people vs those 0-39. The interaction between race and age was significant between Black race and age 60 or greater, with an additional 708.5 deaths per 100,000 people vs White people aged 60 or greater. Black people had a higher case fatality rate than White people. CONCLUSION: COVID-19 incidence, mortality and vaccination patterns varied over time by race, age and sex. Black-White disparities decreased over time, with a larger effect on Black men, and Older Black people were particularly more vulnerable to COVID-19 in terms of mortality. Considering different individual characteristics such as age may further help elucidate the mechanisms behind racial and gender health disparities.


Assuntos
COVID-19 , Feminino , Humanos , Masculino , COVID-19/etnologia , COVID-19/mortalidade , Estudos Transversais , Michigan/epidemiologia , Grupos Raciais
7.
JAMA Netw Open ; 6(7): e2322581, 2023 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-37428502

RESUMO

Importance: Collaborative quality improvement (CQI) models, often supported by private payers, create hospital networks to improve health care delivery. Recently, these systems have focused on opioid stewardship; however, it is unclear whether reduction in postoperative opioid prescribing occurs uniformly across health insurance payer types. Objective: To evaluate the association between insurance payer type, postoperative opioid prescription size, and patient-reported outcomes in a large statewide CQI model. Design, Setting, and Participants: This retrospective cohort study used data from 70 hospitals within the Michigan Surgical Quality Collaborative clinical registry for adult patients (age ≥18 years) undergoing general, colorectal, vascular, or gynecologic surgical procedures between January 1, 2018, and December 31, 2020. Exposure: Insurance type, classified as private, Medicare, or Medicaid. Main Outcomes and Measures: The primary outcome was postoperative opioid prescription size in milligrams of oral morphine equivalents (OME). Secondary outcomes were patient-reported opioid consumption, refill rate, satisfaction, pain, quality of life, and regret about undergoing surgery. Results: A total of 40 149 patients (22 921 [57.1%] female; mean [SD] age, 53 [17] years) underwent surgery during the study period. Within this cohort, 23 097 patients (57.5%) had private insurance, 10 667 (26.6%) had Medicare, and 6385 (15.9%) had Medicaid. Unadjusted opioid prescription size decreased for all 3 groups during the study period from 115 to 61 OME for private insurance patients, from 96 to 53 OME for Medicare patients, and from 132 to 65 OME for Medicaid patients. A total of 22 665 patients received a postoperative opioid prescription and had follow-up data for opioid consumption and refill. The rate of opioid consumption was highest among Medicaid patients throughout the study period (16.82 OME [95% CI, 12.57-21.07 OME] greater than among patients with private insurance) but increased the least over time. The odds of refill significantly decreased over time for patients with Medicaid compared with patients with private insurance (odds ratio, 0.93; 95% CI, 0.89-0.98). Adjusted refill rates for private insurance remained between 3.0% and 3.1% over the study period; adjusted refill rates among Medicare and Medicaid patients decreased from 4.7% to 3.1% and 6.5% to 3.4%, respectively, by the end of the study period. Conclusions and Relevance: In this retrospective cohort study of surgical patients in Michigan from 2018 to 2020, postoperative opioid prescription size decreased across all payer types, and differences between groups narrowed over time. Although funded by private payers, the CQI model appeared to have benefitted patients with Medicare and Medicaid as well.


Assuntos
Analgésicos Opioides , Medicare , Adulto , Humanos , Feminino , Idoso , Estados Unidos , Pessoa de Meia-Idade , Adolescente , Masculino , Analgésicos Opioides/uso terapêutico , Michigan , Estudos Retrospectivos , Qualidade de Vida , Padrões de Prática Médica , Medidas de Resultados Relatados pelo Paciente
8.
Womens Health (Lond) ; 19: 17455057231178118, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37449491

RESUMO

BACKGROUND: Despite the high cost of low birth weight and the persistent challenge of racial inequities affecting the Arab American community, there has been limited research to identify and examine risk factors for these inequities with validated data on Arab American ethnicity and recent population stressors. OBJECTIVES: This study examined whether the 2016 presidential election is associated with low birth weight among non-Hispanic White, Arab American, Hispanic, and non-Hispanic Black women. DESIGN: This population-based study of singleton births in Michigan (2008-2017) used an algorithm to identify mothers who were of Arab descent. METHODS: We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between race/ethnicity and the odds of low birth weight. We examined whether these associations differed before and after the 2016 presidential election and according to maternal education. RESULTS: There were 1,019,738 births, including 66,272 (6.5%) classified as low birth weight. The odds of having a low-birth-weight infant were higher among all minority women compared to non-Hispanic White women. The association was similar before and after the 2016 presidential election and stronger among women with higher levels of education. CONCLUSION: This is the first study to estimate low birth weight among Arab American women in the context of political events. There are opportunities for future studies to discuss this issue in depth.


Assuntos
Árabes , Recém-Nascido de Baixo Peso , Política , Estresse Psicológico , Feminino , Humanos , Recém-Nascido , Hispânico ou Latino , Michigan/epidemiologia , Brancos , Asiático , Negro ou Afro-Americano
9.
Prog Community Health Partnersh ; 17(2): 265-276, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37462555

RESUMO

BACKGROUND: The ways in which researchers may need to adapt traditional community-based participatory research engagement strategies during ongoing community trauma are understudied. We describe our efforts to engage the Flint, Michigan community in community-based participatory research in the aftermath of the Flint Water Crisis. OBJECTIVES: This manuscript describes 1) recruitment strategies selected before the Flint Water Crisis, 2) engagement lessons learned in the context of the Flint Water Crisis, and 3) barriers and facilitators encountered while engaging African American churches. METHODS: Researchers collaborated with community partners to engage and recruit a traumatized Flint community into the Church Challenge, a multilevel intervention to reduce chronic disease burden. LESSONS LEARNED: Recruitment and engagement strategies must be flexible, innovative, and may require nontraditional methods. CONCLUSIONS: Flexibility and adaptability are crucial for engaging with a traumatized community. Community-based participatory research work in traumatized communities must acknowledge and respond to community trauma to be successful.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Projetos de Pesquisa , Humanos , Negro ou Afro-Americano , Michigan , Água Potável , Poluição da Água
10.
JAMA Netw Open ; 6(7): e2321558, 2023 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-37399011

RESUMO

Importance: Acute stroke treatment rates in the US lag behind those in other high-income nations. Objective: To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. Design, Setting, and Participants: This nonrandomized controlled trial of the Stroke Ready intervention took place in Flint, Michigan, from October 2017 to March 2020. Participants included adults living in the community. Data analysis was completed from July 2022 to May 2023. Intervention: Stroke Ready combined implementation science and community-based participatory research approaches. Acute stroke care was optimized in a safety-net ED, and then a community-wide, theory-based health behavior intervention, including peer-led workshops, mailers, and social media, was conducted. Main Outcomes and Measures: The prespecified primary outcome was the proportion of patients hospitalized with ischemic stroke or transient ischemic attack from Flint who received thrombolysis before and after the intervention. The association between thrombolysis and the Stroke Ready combined intervention, including the ED and community components, was estimated using logistic regression models, clustering at the hospital level and adjusting for time and stroke type. In prespecified secondary analyses, the ED and community intervention were explored separately, adjusting for hospital, time, and stroke type. Results: In total, 5970 people received in-person stroke preparedness workshops, corresponding to 9.7% of the adult population in Flint. There were 3327 ischemic stroke and TIA visits (1848 women [55.6%]; 1747 Black individuals [52.5%]; mean [SD] age, 67.8 [14.5] years) among patients from Flint seen in the relevant EDs, including 2305 in the preintervention period from July 2010 to September 2017 and 1022 in the postintervention period from October 2017 to March 2020. The proportion of thrombolysis usage increased from 4% in 2010 to 14% in 2020. The combined Stroke Ready intervention was not associated with thrombolysis use (adjusted odds ratio [OR], 1.13; 95% CI, 0.74-1.70; P = .58). The ED component was associated with an increase in thrombolysis use (adjusted OR, 1.63; 95% CI, 1.04-2.56; P = .03), but the community component was not (adjusted OR, 0.99; 95% CI, 0.96-1.01; P = .30). Conclusions and Relevance: This nonrandomized controlled trial found that a multilevel ED and community stroke preparedness intervention was not associated with increased thrombolysis treatments. The ED intervention was associated with increased thrombolysis usage, suggesting that implementation strategies in partnership with safety-net hospitals may increase thrombolysis usage. Trial Registration: ClinicalTrials.gov Identifier: NCT036455900.


Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Humanos , Feminino , Idoso , Michigan/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Incidência , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Terapia Trombolítica
11.
J Insect Sci ; 23(4)2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37399115

RESUMO

Until now, little is known about the population structure and mobility of temperate dung beetles including the rainbow scarab, Phanaeus vindex (MacLeay 1819), although this knowledge is essential for their conservation as pastures become increasingly rare and the landscape fragmented by monocultures and urbanization. Here, we estimated population size, longevity, and dispersal within and between pastures. For 3 yr, we life-trapped beetles every week on 2 adjacent farms in SE Michigan, determined their sex, male morph, and size, and marked their elytra with individual tattoo patterns before releasing them. We marked a total of 470 rainbow scarabs of which 14 were recaptured once and 2 were recaptured twice. The sex ratio was not significantly sex-biased but fluctuated between months with no apparent uniformity between years. While the minor to major male ratios were unbiased in 2019 and 2020, they were marginally minor-biased in 2021. The gross population estimates for the 2 farms were 458-491 and 217 rainbow scarabs, respectively. Beetles traveled distances of up to 178 m within farms. No beetles dispersed between farms. One large female was recaptured after 338 days documenting the first cold hardiness and long lifespan of a cold-temperate dung beetle species in the wild. The low population estimates on both farms indicate 2 vulnerable populations with no or extremely limited connectivity. Supplementary funding for the land stewardship of small-scale cattle farmers could stabilize populations of native dung beetles and maintain their ecosystem services.


Assuntos
Besouros , Masculino , Feminino , Animais , Bovinos , Ecossistema , Michigan , Densidade Demográfica , Fezes
12.
Indian J Ophthalmol ; 71(7): 2856-2861, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37417134

RESUMO

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. Methods: A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances. Results: Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1). Conclusion: This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.


Assuntos
COVID-19 , Retinopatia Diabética , Oftalmologia , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Michigan , Hospitais Comunitários , Estudos Retrospectivos , Encaminhamento e Consulta
13.
JAMA Intern Med ; 183(9): 933-941, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37428491

RESUMO

Importance: Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases antibiotic resistance and adverse events. Objective: To determine whether diagnostic stewardship (avoiding unnecessary urine cultures) or antibiotic stewardship (reducing unnecessary antibiotic treatment after an unnecessary culture) is associated with better outcomes in reducing antibiotic use for ASB. Design, Setting, and Participants: This 3-year, prospective quality improvement study included hospitalized general care medicine patients with a positive urine culture among 46 hospitals participating in a collaborative quality initiative, the Michigan Hospital Medicine Safety Consortium. Data were collected from July 1, 2017, through March 31, 2020, and analyzed from February to October 2022. Exposure: Participation in the Michigan Hospital Medicine Safety Consortium with antibiotic and diagnostic stewardship strategies at hospital discretion. Main Outcomes and Measures: Overall improvement in ASB-related antibiotic use was estimated as change in percentage of patients treated with antibiotics who had ASB. Effect of diagnostic stewardship was estimated as change in percentage of patients with a positive urine culture who had ASB. Effect of antibiotic stewardship was estimated as change in percentage of patients with ASB who received antibiotics and antibiotic duration. Results: Of the 14 572 patients with a positive urine culture included in the study (median [IQR] age, 75.8 [64.2-85.1] years; 70.5% female); 28.4% (n = 4134) had ASB, of whom 76.8% (n = 3175) received antibiotics. Over the study period, the percentage of patients treated with antibiotics who had ASB (overall ASB-related antibiotic use) declined from 29.1% (95% CI, 26.2%-32.2%) to 17.1% (95% CI, 14.3%-20.2%) (adjusted odds ratio [aOR], 0.94 per quarter; 95% CI, 0.92-0.96). The percentage of patients with a positive urine culture who had ASB (diagnostic stewardship metric) declined from 34.1% (95% CI, 31.0%-37.3%) to 22.5% (95% CI, 19.7%-25.6%) (aOR, 0.95 per quarter; 95% CI, 0.93-0.97). The percentage of patients with ASB who received antibiotics (antibiotic stewardship metric) remained stable, from 82.0% (95% CI, 77.7%-85.6%) to 76.3% (95% CI, 68.5%-82.6%) (aOR, 0.97 per quarter; 95% CI, 0.94-1.01), as did adjusted mean antibiotic duration, from 6.38 (95% CI, 6.00-6.78) days to 5.93 (95% CI, 5.54-6.35) days (adjusted incidence rate ratio, 0.99 per quarter; 95% CI, 0.99-1.00). Conclusions and Relevance: This quality improvement study showed that over 3 years, ASB-related antibiotic use decreased and was associated with a decline in unnecessary urine cultures. Hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship) to reduce antibiotic treatment related to ASB.


Assuntos
Bacteriúria , Humanos , Feminino , Idoso , Masculino , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Antibacterianos/uso terapêutico , Estudos Prospectivos , Urinálise , Michigan
14.
Public Health ; 222: 13-20, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37499437

RESUMO

OBJECTIVES: A growing body of research has incorporated the Social Vulnerability Index (SVI) into an expanded understanding of the social determinants of health. Although each component of SVI and its association with individual-level mental health conditions have been well discussed, variation in mentally unhealthy days (MUDs) at a county level is still unexplored. To systematically examine the geographically varying relationships between SVI and MUDs across the US counties, our study adopted two different methods: 1) aspatial regression modeling (ordinary least square [OLS]); and 2) locally calibrated spatial regression (geographically weighted regression [GWR]). STUDY DESIGN: This study used a cross-sectional statistical design and geospatial data manipulation/analysis techniques. Analytical unit is each of the 3109 counties in the continental USA. METHODS: We tested the model performance of two different methods and suggest using both methods to reduce potential issues (e.g., Simpson's paradox) when researchers apply aspatial analysis to spatially coded data sets. We applied GWR after checking the spatial dependence of residuals and non-stationary issues in OLS. GWR split a single OLS equation into 3109 equations for each county. RESULTS: Among 15 SVI variables, a combination of eight variables showed the best model performance. Notably, unemployment, person with a disability, and single-parent households with children aged under 18 years especially impacted the variation of MUDs in OLS. GWR showed better model performance than OLS and specified each county's varying relationships between subcomponents of SVI and MUDs. For example, GWR specified that 69.3% (2157 of 3109) of counties showed positive relationships between single-parent households and MUDs across the USA. Higher positive relationships were concentrated in Michigan, Kansas, Texas, and Louisiana. CONCLUSIONS: Our findings could contribute to the literature regarding social determinants of community mental health by specifying spatially varying relationships between SVI and MUDs across US counties. Regarding policy implementation, in counties containing more social and physical minorities (e.g., single-parent households and disabled population), policymakers should attend to these groups of people and increase intervention programs to reduce potential or current mental health illness. The results of GWR could help policymakers determine the specific counties that need more support to reduce regional mental health disparities.


Assuntos
Vulnerabilidade Social , Regressão Espacial , Criança , Humanos , Adolescente , Estudos Transversais , Análise Espacial , Michigan
15.
BMC Prim Care ; 24(1): 132, 2023 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-37370035

RESUMO

BACKGROUND: Multimorbidity management can be extremely challenging in patients with dementia. This study aimed to elucidate the approaches of primary care physicians in Japan and the United States (US) in managing multimorbidity for patients with dementia and discuss the challenges involved. METHODS: This qualitative study was conducted through one-on-one semi-structured interviews among primary care physicians, 24 each from Japan and Michigan, US. Thematic and content analyses were performed to explore similarities and differences among each country's data. RESULTS: Primary care physicians in Japan and Michigan applied a relaxed adherence to the guidelines for patients' chronic conditions. Common challenges were the suboptimal consultation time, the insufficient number or ability of care-coordinating professionals, patients' conditions such as difficulties with self-management, living alone, behavioral issues, and refusal of care support. Unique challenges in Japan were free-access medical systems and not being sure about the patients' will in end-of-life care. In Michigan, physicians faced challenges in distance and lack of transportation between clinics and patients' homes and in cases where patients lacked the financial ability to acquire good care. CONCLUSIONS: To improve the quality of care for patients with multimorbidity and dementia, physicians would benefit from optimal time and compensation allocated for this patient group, guidelines for chronic conditions to include information regarding changing priority for older adults with dementia, and the close collaboration of medical and social care and community resources with support of skilled care-coordinating professionals.


Assuntos
Demência , Médicos de Atenção Primária , Humanos , Estados Unidos/epidemiologia , Idoso , Multimorbidade , Japão/epidemiologia , Michigan , Doença Crônica , Demência/epidemiologia , Demência/terapia
16.
Lupus ; 32(9): 1075-1083, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37378450

RESUMO

OBJECTIVES: Medication access and adherence play key roles in determining patient outcomes. We investigated whether cost-related non-adherence (CRNA) to prescription medications was associated with worse patient-reported outcomes in a population-based systemic lupus erythematosus (SLE) cohort. METHODS: Sociodemographic and prescription data were collected by structured interviews in 2014-2015 from patients meeting SLE criteria in the established Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We examined the associations between CRNA and potential confounders such as sociodemographics and health insurance coverage, and outcome measures of SLE activity and damage using multivariable linear regression. RESULTS: 462 SLE participants completed the study visit: 430 (93.1%) female, 208 (45%) Black, and mean age 53.3 years. 100 (21.6%) participants with SLE reported CRNA in the preceding 12 months. After adjusting for covariates, CRNA was associated with both higher levels of current SLE disease activity [SLAQ: ß coeff 2.7 (95% CI 1.3, 4.1), p < 0.001] and damage [LDIQ ß coeff 1.4 (95% CI 0.5, 2.4), p = 0.003]. Race, health insurance status, and fulfilling Fibromyalgia (FM) Survey Criteria were independently associated with both higher (worse) SLAQ and LDIQ scores; female sex was further associated with higher SLAQ scores. CONCLUSION: Patients with SLE who reported CRNA in the previous 12 months had significantly worse self-reported current disease activity and damage scores compared to those not reporting CRNA. Raising awareness and addressing barriers or concerns related to financial implications and accessibility issues in care plans may help to improve these outcomes.


Assuntos
Lúpus Eritematoso Sistêmico , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Michigan/epidemiologia , RNA Complementar/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Prescrições , Medidas de Resultados Relatados pelo Paciente
17.
Sci Total Environ ; 894: 165013, 2023 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-37353028

RESUMO

Central Michigan University (CMU) participated in a state-wide SARS-CoV-2 wastewater monitoring program throughout the 2021-2022 academic year. Wastewater samples were collected weekly from ten on-campus sites and nine off-campus wastewater treatment plants servicing small metropolitan and rural communities. SARS-CoV-2 genome copies were quantified using droplet digital PCR. Case data reported by Central Michigan District Health Department and CMU were collected and compared with wastewater data. During the delta wave, wastewater detection and on-campus case reports increased rapidly with the start of the academic semester and peaked quickly, compared with a more gradual and prolonged increase in detection and case reports off-campus. During the omicron wave, transmission dynamics were similar on-campus and off-campus. Normalization of on-campus and off-campus wastewater data with pepper mild mottle virus gene expression suggested lower SARS-CoV-2 shedding per person in on-campus compared to off-campus samples during the delta wave, but no difference in virus shedding during the omicron wave. We discuss the possibility that a higher on-campus vaccination rate may have reduced virus shedding per person during the delta wave, but that this effect was lost with the omicron variant. This study suggests that wastewater monitoring is effective in rural and small metropolitan communities when used in conjunction with case reports to understand regional transmission dynamics and the impact of public health policies at a public university on virus shedding in the community.


Assuntos
COVID-19 , Humanos , Michigan , População Rural , SARS-CoV-2/genética , Águas Residuárias
18.
J Dent Hyg ; 97(3): 7-12, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37280103

RESUMO

Dental hygienists (DHs) are well positioned to be part of primary care teams to increase access to oral health care, particularly for those who encounter barriers to oral care, such as pregnant people. The Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) integrates DHs into obstetrics and gynecology (OB/GYN) clinics in federally qualified health centers (FQHCs) to improve pregnant people's oral health. Evaluation of the MIMIOH program revealed that selecting DHs with personal characteristics desirable for integrated-care delivery was a major factor for successfully integrating DHs into OB/GYN clinics. Additionally, designing appropriate clinical workflows, gaining buy-in from prenatal health care professionals, presenting oral health care as part of prenatal care, having co-located OB/GYN and dental clinics, and maintaining adequate funding were all critical to program success. Analysis of Medicaid data showed that the MIMIOH model increased the percentage of pregnant people receiving oral health care at FQHC dental clinics. Innovative programs like MIMIOH add to the evidence that integrating DHs into primary care settings can increase access to oral health care, especially for those who face difficulties accessing the traditional oral health care system. There is great potential for DHs to leverage collaborative practice agreements and remote supervision to increase access to oral health care for the public. Providing DHs with autonomy to practice to the highest level of their scope of practice and permitting direct Medicaid reimbursement for DHs would make oral health care more accessible for underserved populations.


Assuntos
Obstetrícia , Saúde Bucal , Feminino , Gravidez , Estados Unidos , Humanos , Michigan , Higienistas Dentários , Atenção à Saúde
19.
Artigo em Inglês | MEDLINE | ID: mdl-37297521

RESUMO

BACKGROUND: The COVID-19 pandemic posed new challenges for cognitive aging since it brought interruptions in family relations for older adults in immigrant communities. This study examines the consequences of COVID-19 for the familial and social support systems of aging Middle Eastern/Arab immigrants in Michigan, the largest concentration in the United States. We conducted six focus groups with 45 participants aged 60 and older to explore participant descriptions of changes and difficulties faced during the pandemic relating to their cognitive health, familial and social support systems, and medical care. The findings indicate challenges around social distancing for older Middle Eastern/Arab American immigrants, which generated three overarching themes: fear, mental health, and social relationships. These themes provide unique insights into the lived experiences of older Middle Eastern/Arab American adults during the pandemic and bring to light culturally embedded risks to cognitive health and well-being. A focus on the well-being of older Middle Eastern/Arab American immigrants during COVID-19 advances understanding of how environmental contexts inform immigrant health disparities and the sociocultural factors that shape minority aging.


Assuntos
COVID-19 , Envelhecimento Cognitivo , Emigrantes e Imigrantes , Humanos , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Idoso , Árabes/psicologia , Pandemias , Autorrelato , COVID-19/epidemiologia , Michigan/epidemiologia
20.
Front Public Health ; 11: 1178515, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37333521

RESUMO

Introduction: Throughout the coronavirus disease 2019 (COVID-19) pandemic, wastewater surveillance has been utilized to monitor the disease in the United States through routine national, statewide, and regional monitoring projects. A significant canon of evidence was produced showing that wastewater surveillance is a credible and effective tool for disease monitoring. Hence, the application of wastewater surveillance can extend beyond monitoring SARS-CoV-2 to encompass a diverse range of emerging diseases. This article proposed a ranking system for prioritizing reportable communicable diseases (CDs) in the Tri-County Detroit Area (TCDA), Michigan, for future wastewater surveillance applications at the Great Lakes Water Authority's Water Reclamation Plant (GLWA's WRP). Methods: The comprehensive CD wastewater surveillance ranking system (CDWSRank) was developed based on 6 binary and 6 quantitative parameters. The final ranking scores of CDs were computed by summing the multiplication products of weighting factors for each parameter, and then were sorted based on decreasing priority. Disease incidence data from 2014 to 2021 were collected for the TCDA. Disease incidence trends in the TCDA were endowed with higher weights, prioritizing the TCDA over the state of Michigan. Results: Disparities in incidences of CDs were identified between the TCDA and state of Michigan, indicating epidemiological differences. Among 96 ranked CDs, some top ranked CDs did not present relatively high incidences but were prioritized, suggesting that such CDs require significant attention by wastewater surveillance practitioners, despite their relatively low incidences in the geographic area of interest. Appropriate wastewater sample concentration methods are summarized for the application of wastewater surveillance as per viral, bacterial, parasitic, and fungal pathogens. Discussion: The CDWSRank system is one of the first of its kind to provide an empirical approach to prioritize CDs for wastewater surveillance, specifically in geographies served by centralized wastewater collection in the area of interest. The CDWSRank system provides a methodological tool and critical information that can help public health officials and policymakers allocate resources. It can be used to prioritize disease surveillance efforts and ensure that public health interventions are targeted at the most potentially urgent threats. The CDWSRank system can be easily adopted to geographical locations beyond the TCDA.


Assuntos
COVID-19 , Doenças Transmissíveis , Humanos , Michigan/epidemiologia , COVID-19/epidemiologia , Águas Residuárias , SARS-CoV-2 , Vigilância Epidemiológica Baseada em Águas Residuárias
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