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By enacting administrative rule 325.176 (12), Michigan added a vaccine education component as a precondition to granting vaccine waivers to vaccine-hesitant parents wishing to file a nonmedical vaccine exemption for their school-aged child. The purpose of the study was to identify best practices for reaching vaccine-hesitant parents during face-to-face vaccine education sessions conducted by vaccine waiver educators in Michigan. This study utilized qualitative descriptive content analysis of semi-structured phone interviews with vaccine waiver educators from local health departments (LHDs) in Michigan. Participants were vaccine waiver educators who were employed by a local health department in Michigan and had conducted at least 30 vaccine waiver education sessions. Strategies, resources, and techniques identified by educators as beneficial included using and providing information from a variety of sources, compiling their own educational materials, creating a positive experience, holding personalized sessions, and streamlining exemption and vaccination sessions. However, unexpected themes that emerged from the interviews revealed that vaccine waiver educators need additional training in discussing vaccine ingredients with parents, handling religious vaccine exemption requests, and assessing the role of schools. Implementing successful vaccine education interventions targeting vaccine-hesitancy is crucial to public health. Charging LHDs with overseeing vaccine education via a face-to-face discussion is a novel intervention strategy, the effective implementation of which may inform vaccine education intervention nationwide and may even be translated into international contexts and prove useful to current COVID-19 vaccination efforts.

Objective This study explored vaccine exemption clustering in Michigan and examined whether vaccine exemptions clustered by exemption type (medical, religious, and philosophical). Furthermore, the study investigated whether Michigan’s nonmedical vaccine exemption policy change had an impact on type-specific vaccine exemption clusters following its implementation. Methods The study used the ArcGIS optimized hot spot analysis tool to visually examine vaccine exemption clustering by type in Michigan. The study analyzed secondary kindergarten vaccine exemption data from 2301 elementary school buildings in Michigan for years spanning 2008 to 2015 and 2016 to 2017 post policy change. Results Clustering of vaccine exemptions by type was present both before and after implementation of the policy with fewer statistically significant features and differences regarding the distribution of hot spot clusters following the policy change. Conclusion Considering the heterogeneity in vaccine exemption hot spot clustering by type can help to inform public health officials to areas/communities at high risk for vaccine preventable disease outbreaks. Such analysis can allow for the implementation of vaccine exemption interventions that are exemption type specific and tailored for a given area, thus maximizing impact and making best use of limited public health resources. This analysis was also able to showcase the impact of Michigan’s nonmedical vaccine exemption policy on vaccine exemption hot spot clusters.

How people cope with the stress of poverty and engage with its causes and potential solutions impacts their capacity to survive, manage and work to improve their situation. Problem-focused coping i...

The US opioid epidemic is a complex problem that has resulted in legislative actions to make treatment more accessible to patients. Physician assistants (PAs) have taken an active role in expanding their scope of practice to keep up with treatment needs. This article describes opioid use disorder in the United States, treatment gaps, safe treatment with buprenorphine, and PA prescriptive authority.

Admissions models facilitate the selection of MSW candidates who are both academically prepared for graduate study and professionally suited to social work, characteristics often referred to as fit-to-the-profession. This study attempted to identify the relationship between the criteria used in the admissions model of a medium-sized MSW program and student success in the program. Specific criteria and the associated measurement tools within the model were evaluated in relation to student success. The study found that undergraduate grade point average is significantly associated with MSW grade point average while neither academic criteria nor fit to the profession criteria were predictive of graduation. The study also offered new information regarding the admission of students with a criminal history. Students with a criminal history were eight times less likely to graduate than their non-offending peers, even when controlling for age, gender, race, and program type. The study supports the development of new fit-to-the-profession criteria with the possible elimination of the written statement.

This study examines the challenges faced by youth in foster care who are making the transition from high school to college. Forty-three high school and college students from across the state of Michigan who are or were in foster care spoke before panels of policymakers at two public forums. Transcripts from their testimony were analyzed. Eight main barriers to high school completion and college access were identified. The most frequently cited was a lack of supportive relationships with caring adults. This research demonstrates how the voice of youth in foster care can have an impact on the policies that affect their lives.

This study uses administrative data from Michigan State University to examine whether students who are former foster youth are more likely to drop out of college than low-income, first generation students who had not been in foster care. Former foster youth were significantly more likely to drop out before the end of their first year (21% vs. 13%) and prior to degree completion (34% vs. 18%) than their non-foster care peers. This difference remained significant even after controlling for gender and race.

This article presents the findings of a secondary analysis of the National Longitudinal Transition Study 2 that explored the predictive association between training in access technology and performance on the Woodcock-Johnson Tests of Academic Achievement: III. The results indicated that the use of access technology had a limited predictive relationship to performance on tests. Practical implications are discussed.

The American Diabetes Association (ADA) Risk Test, often used for decisions to blood glucose screen or not, lacks studies reporting the reliability or validity for the Spanish version of the tool. The objective of this study is to further validate the utility of the Spanish version of the ADA's Risk Test for Latino Populations. A convenience sample of 316 Latinos participated in this study. A positive but weak statistical correlation was found between blood glucose and the Risk Test score (.138), suggesting low reliability and validity of the Spanish version of the instrument. Two internal consistency estimates of reliability techniques were computed for the Risk Test for diabetes scale items, indicating low reliability.

Date Presented 4/1/2017 This study demonstrates that occupational therapy fall prevention interventions are beneficial for improving quality of care as part of a coordinated care team within a primary care setting and should further be examined in expanded populations, settings, and interventions. Primary Author and Speaker: Lydia Royeen Contributing Authors: Kieran J. Fogarty, Brenda Koverman

In response to the recognized need for a training system to support an integrated food safety system in the U.S., the International Food Protection Training Institute (IFPTI) in Battle Creek, Michigan, designed a career-spanning curriculum framework. IFPTI collaborated with a national curriculum team consisting of regulatory officials and university academics. The curriculum framework encompasses and organizes existing professional development for the estimated 45,000 federal, state, and local food regulators in the U.S. into efficient, standards-driven learning paths. This article describes the development process leading to an integrated national food protection training curriculum framework.

The link between ET and PD has frequently been debated in the literature and such patients developing PD after ET are named ETPD, however, the development of dementia has not been described in patients with ETPD. In this study, we have described a clinical case series of 17 patients with initially diagnosed as ET, who developed parkinsonism and subsequent development of dementia. We named this combination of ET, PD and dementia as ETPDD and in these patients, using clinical presentation and FDG-PET studies, the similarities and differences to Parkinson Disease Dementia and other dementia are described. Methods: All patients underwent a detailed neurologic history and examination by samemovement disorders specialist. Medical informations of patients were obtained from the patients and family members to clarify the relationship between these disorders. The patient’s global cognitive status and severity of dementia were assessed with MMSE and CDR. Demographic and historical data including age, sex, age at tremor onset, duration of postural tremor, type of tremor, age at parkinsonism and dementia onset, the time between ETand PD and PD and dementia, family history of PD, ET, other movement disorders and dementia, and similarities and differences to other dementia were recorded. The diagnosis of PD was established according to the UK-PD Society Brain Bank criteria and the criteria for dementia from DSM-IV was applied. Results: RESULTS Patients who met the following criteria were classified as having ETPDD. (1) presence of both postural-action hand tremor as first symptom on their medical history. (2) symptoms of postural-action tremor for at least 3 to 5 years prior to the onset of other signs of PD.(3) cognitive dysfunctions, impaired activities of daily living and measured by MMSE. Conclusions: Present study specifically focused on the similarities and differences to PD dementia and other dementia, including clinical presentation and FDG-PET studies, leading clinicians to suspect a link among them. To our knowledge, this is the first case series to describe the coincidental occurrence of these three disorders in a single patient.

OBJECTIVE: The objective of this study was to determine factors that are involved in shoulder injury rates among high school athletes who participate in organized baseball and softball. METHODS: Baseball- and softball-related injury data were collected during the 2005–2008 academic years from ∼74 nationally representative high schools via High School Reporting Information Online. RESULTS: Certified athletic trainers reported 91 baseball shoulder injuries and 40 softball shoulder injuries during 528147 and 399522 athlete exposures, respectively. The injury rate was 1.72 injuries per 10000 athlete exposures for baseball and 1.00 injuries per 10000 athlete exposures for softball. Muscle strain/incomplete tears were the most common injuries in both baseball (30.8%) and softball (35.0%). In practices, throwing, not including pitching, caused more than half of softball injuries (68.2%) as compared with competition injuries (23.5%; injury proportion ratio [IPR]: 2.90 [95% confidence interval (CI): 1.17–7.15]; P = .015), whereas pitching was the most common mechanism in causing shoulder injuries during baseball practice (41.9%) compared with competitions (25.6%; IPR: 1.64 [95% CI: 0.88–3.04]; P = .17). Eighty-one percent of the baseball shoulder injuries and 82.5% of the softball shoulder injuries were new. Ten percent of baseball athletes and 5.3% of softball athletes sustained injuries that required surgery (IPR: 1.40 [95% CI: 0.32–6.10]; P = .93). Injuries that were sustained while the athlete was on the pitcher's mound were significantly more likely to result in surgery than any other field position (IPR: 2.64 [95% CI: 1.65–4.21]; P = .0061). Injured baseball players were more than twice as likely to be pitchers. CONCLUSIONS: Although rates and patterns of shoulder injuries are similar between baseball and softball players, injury rates and patterns differ between field positions within each sport, as well as by injury severity and the athletes' year in school.

Background From 2000–2002, the Centers for Disease Control and Prevention (CDC) funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs). Program managers at CDC recognized the potential of a geographic information system (GIS) to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1) geopolitical boundaries and 2) geographic distance. Results The survey response rate was 70.3%, i.e. 1,020 of 1,450 community-based organizations responded. The number of HIV prevention programs administered by each CBO ranged from 1 to 23. The survey provided information about 3,028 prevention programs, including descriptions of intervention types, risk populations, race and ethnicity, CBO location and geographic service area. We incorporated this information into a large GIS database, the HIV Prevention Services Database. The use of geopolitical boundaries provided more accurate results than geographic distance. The use of a reference map with the questionnaire improved completeness, accuracy and precision of service area data. Conclusion The survey instrument design and database development procedures that we used for this study successfully met our objective. The development of the HIV Prevention Services Database for CDC is an important step toward the implementation of a spatial decision support system. Due to the costs involved in a nationwide survey such as this, we recommend that future data collection efforts use Web-based survey methodologies that incorporate interactive maps.

Objective. Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997. Methods. The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates. Results. During the 1997–1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000–2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county's seventh grade population. Conclusions. The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.

Teenagers in the United States are one of the populations whose HIV infection rates are increasing most rapidly. This study was designed to measure college students' knowledge of HIV transmission methods using Kittleson and Venglarcik's HIV Transmission Survey. Participants ( N = 167) were divided into two groups, 99 students from a rural background and 68 students from an urban background. Students from an urban background were significantly more knowledgeable about documented HIV transmission modes than students from a rural background. Men were significantly less aware of documented HIV transmission modes than women. These results suggest that education about AIDS needs to be improved. The current educational procedures do not properly inform students in a fashion which exhibits the true risk of infection and those behaviors which increase risk. Fifteen years after the discovery of the HIV virus students are still largely unaware that they are at risk for contracting a fatal disease.

This study was conducted to assess the prevalence of scores on homophobia among 104 college students at a northeastern urban university. Participants reported their attitudes regarding homosexuals and homosexual behavior on Hudson and Rickett's Index of Homophobia. The 33 men indicated more negative attitudes about homosexuals and homosexual situations than the 71 women.