Are Michigan hospitals facing a shortage of trained personnel?

The 1990 MHA Health Personnel Shortage Survey requested information on 31 personnel positions to determine the extent of personnel shortages, the sources of replacement personnel, the positions for which it is most difficult to recruit applicants, and the positions for which it is most difficult to retain personnel. In addition, hospitals were asked about the impact of personnel shortages on hospital services, the strategies they had implemented to alleviate the problems caused by shortages, and their commitment to, and involvement in, training and educational programs to increase the availability of health care personnel in Michigan. A total of 77 Michigan hospitals and health care institutions responded to the survey. Analyses were performed on a sample of 69 community hospitals distributed similarly, with respect to hospital bed size category and geographic location, to the state total of 176 Michigan community hospitals. For more information, or for a copy of the complete 1990 MHA Health Personnel Shortage Survey report, contact the MHCI Health Policy Analysis Department.

Hemodynamic effects of quinapril, a novel angiotensin-converting enzyme inhibitor.

The hemodynamic effects of quinapril, a novel nonsulfhydryl-containing angiotensin-converting enzyme (ACE) inhibitor, were assessed in 10 patients with mild-to-moderate essential hypertension. Compared with placebo, quinapril (20 mg) administered twice daily for 4 weeks significantly lowered blood pressure by decreasing total peripheral resistance without producing tachycardia, an increase in cardiac output, or a rise in plasma catecholamines. Quinapril significantly reduced renal, but not forearm, vascular resistance. Renal blood flow, glomerular filtration rate, and filtration fraction remained unchanged. Left ventricular wall stress was markedly reduced by quinapril, but during the relatively short treatment period, only a nonsignificant trend toward reduction in left ventricular mass was observed. These findings suggest that quinapril is an effective antihypertensive agent that lowers peripheral resistance without increasing cardiac output or disturbing autoregulation of renal hemodynamics.

The Tecumseh Blood Pressure Study. Normative data on blood pressure self-determination.

In Tecumseh, Mich, we obtained blood pressure (BP) self-determination data in 608 healthy adults (327 men, 281 women; average age, 32.6 +/- 3.5 years) representing a wide range of educational backgrounds. The average (+/- SD) home BP (average 12.7 readings over 1 week) was 120.7/74.8 +/- 10.4/8.6 mm Hg for men and 110.9/69.9 +/- 10.1/7.7 for women. One hundred thirty-three subjects remeasured their home BP 1 year later and a strong correlation between the two readings was obtained (r = .70). Large-scale BP self-determination is feasible. Based on the BP distribution in Tecumseh, the upper limit of normalcy for home BP (2 SDs above the mean) is 142/92 mm Hg for men and 131/85 mm Hg for women.

Predictors of blood pressure and hypertension in Tecumseh, Michigan.

Correlates of present blood pressure status are analyzed in 576 subjects (271 males, average age 32 years) in Tecumseh, Michigan. In addition to the current values, anthropometric and blood pressure data are available when the subjects were, on average, 6.9 and 22.2 years of age. Data on 351 fathers and 368 mothers when they were, on average, 32 years old are also available. Moderate, but significant correlations were found between present and past blood pressure and between past weight or skinfold thickness and the present blood pressure. These correlations were much weaker for childhood values than for values at age 22. When multiple regression techniques were used with blood pressure values at age 22 and parental values as independent variables, 40% of the present systolic blood pressure variance could be explained. Prediction of present hypertension status (blood pressure greater than 140 and/or 90 mm Hg) was evaluated by discriminant analysis. Three variables (weight at age 22, systolic blood pressure at age 22, and father's diastolic blood pressure) entered the model and accurately predicted the present blood pressure classification in 89% of the sample. When current blood pressure status was assessed with respect to previous blood pressure classification (upper 20%), family background, and overweight, a gradient of risk for hypertension was found. On the low end of risk was high childhood pressure (risk 19.1% versus 12.1% in the overall population). The highest risk occurred for those with high pressure and overweight at 22 years who also had a family background of high blood pressure (44% versus 12.1%). The prediction of hypertension from young adulthood to the early fourth decade of life is feasible and permits delineation of populations targeted for primary prevention.

Assessment of quality of life in end-stage renal disease.

Ten different multi-item indexes and nine single-item measures were used to assess the quality of life of patients undergoing one of four major modalities of treatment for end-stage renal disease (ESRD). Assessments were made on a population-based sample of Michigan patients with onset of ESRD after November 1, 1981, during the period May 1984 to September 1986. The nature of these measures is described and correlations among them are reported. The correlations suggest that these indexes tend to represent either function or feeling, with moderate relationships within the two clusters but little between them. Findings are also reported in terms of age, race, and sex. Depending on the measure chosen to assess quality of life, different conclusions about the relationship of quality of life to these demographic characteristics will be reached. These conclusions may help readers think more critically about the nature of quality of life in arriving at judgments on the relative validity of these different measures.

A comparison of employment rates of patients treated with continuous ambulatory peritoneal dialysis vs in-center hemodialysis (Michigan End-Stage Renal Disease Study).

This study examines factors associated with employment status in a stratified subsample of the Michigan End-Stage Renal Disease Study population. To reduce the variation in employment potential, the subsample consisted of nondiabetic patients aged 20 to 64 years. The patients were stratified on the basis of their treatment histories as follows: (1) treated by in-center hemodialysis only; (2) primarily treated by continuous ambulatory peritoneal dialysis; and (3) failed continuous ambulatory peritoneal dialysis, substituted by another form of dialysis. A significantly higher percentage of the patients undergoing stable continuous ambulatory peritoneal dialysis were in the labor force than were those undergoing in-center hemodialysis (27.4% vs 9.6%). Using logistic regression, even when adjusted for sex, race, age, education, marital status, primary diagnosis, and duration of end-stage renal disease, the stable continuous ambulatory peritoneal dialysis group was significantly more likely to be employed than the group undergoing either in-center hemodialysis only or the group that failed continuous ambulatory peritoneal dialysis.

Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates.

Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)