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PubMed1994

Physician profiling. An analysis of inpatient practice patterns in Florida and Oregon.

BACKGROUND: Physician profiling is a method of cost control that focuses on patterns of care instead of on specific clinical decisions. It is one cost-control method that takes into account physicians' desire to curb the intrusion of administrative mechanisms into the clinical encounter. To provide a concrete example of profiling, we analyzed the inpatient practice patterns of physicians in Florida and Oregon. METHODS: Data for 1991 from Medicare's National Claims History File were used to profile 12,720 attending physicians in Florida and 2589 in Oregon. For each attending physician, we determined the total relative value of all physicians' services delivered during each patient's hospital stay. Relative value was measured in relative-value units (RVUs), according to the resource-based relative-value scale used by Medicare in determining payments to physicians. The mean number of RVUs per admission was then adjusted for the physician's case mix according to the patients' assigned diagnosis-related groups. The influence of the physician's specialty and of selected types of services (such as imaging and endoscopy) was also examined. RESULTS: Florida physicians used markedly more resources, on average, than their colleagues in Oregon (46 vs. 30 case-mix-adjusted RVUs per admission). The difference was apparent for all specialties and all types of service. To illustrate the profiling data potentially available to the medical staffs of individual hospitals, we examined specific data on individual attending physicians and for various types of service for three hospitals' staffs. Despite similar overall profiles that fell below the national mean, each staff had a different practice pattern and would require different efforts to improve efficiency. CONCLUSIONS: In an effort to encourage further debate, we have described one method of physician profiling. Profiling data help identify and characterize differences in practice style to which individual physicians or hospital staffs can respond. Because profiling is not based on rigid rules, it is a cost-containment strategy that can easily accommodate legitimate exceptions; it is therefore preferable to methods in which the appropriateness of each clinical decision is judged separately.

Cost Control↗
PubMed2005

Cumulative and residual effects of repeated sewage sludge applications: forage productivity and soil quality implications in South Florida, USA.

BACKGROUND, AIM AND SCOPE: The cow-calf (Bos taurus) industry in subtropical United States and other parts of the world depends almost totally on grazed pastures. Establishment of complete, uniform stand of bahiagrass (BG) in a short time period is important economically. Failure to obtain a good BG stand early means increased encroachment of weeds and the loss of not only the initial investment costs, but production and its cash value. Forage production often requires significant inputs of lime, N fertilizer, and less frequently of P and K fertilizers. Domestic sewage sludge or biosolids, composted urban plant debris, waste lime, phosphogypsum, and dredged materials are examples of materials that can be used for fertilizing and liming pastures. Perennial grass can be a good choice for repeated applications of sewage sludge. Although sewage sludge supply some essential plant nutrients and provide soil property-enhancing organic matter, land-application programs still generate some concerns because of possible health and environmental risks involved. The objectives of this study were to evaluate the cumulative and residual effects of repeated applications of sewage sludge on (i) bahiagrass (BG, Paspalum notaturn Flügge) production over years with (1997-2000) and without (2001-2002) sewage sludge applications during a 5-yr period, and (ii) on nutrients status of soil that received annual application of sewage sludge from 1997 to 2000 compared with test values of soils in 2002 (with no sewage sludge application) in South Florida. METHODS: The field experiment was conducted at the University of Florida Agricultural Research and Education Center, Ona, FL (27 degrees 26'N, 82 degrees 55'W) on a Pomona fine sandy soil. With the exception of the control, BG plots received annual sewage sludge and chemical fertilizers applications to supply 90 or 180 kg total N ha(-1) yr(-1) from 1997 to 2000. Land application of sewage sludge and fertilizer ceased in 2001 season. In early April 1998, 1999, and 2000, plots were mowed to 5-cm stubble and treated with the respective N source amendments. The experimental design was three randomized complete blocks with nine N-source treatments: ammonium nitrate (AMN), slurry biosolids of pH 7 (SBS7), slurry biosolids of pH 11 (SBS11), lime-stabilized cake biosolids (CBS), each applied to supply 90 or 180 kg N ha(-1), and a nonfertilized control (Control). Application rates of sewage sludge were calculated based on the concentration of total solids in materials as determined by the American Public Health Association SM 2540G method and N in solids. The actual amount of sewage sludge applications was based on the amount required to supply 90 and 180 kg N ha(-1). Sewage sludge materials were weighed in buckets and uniformly applied to respective BG plots. Soil samples were collected in June 1997, June 1999, and in June 2002 from 27 treatment plots. In 1997 and 1999, soil samples were collected using a steel bucket type auger from the 0- to 20-, 20- to 40-, 40- to 60-, and 60- to 100-cm soil depths. Forage was harvested on 139, 203, 257, and 307 day of year (DOY) in 1998; 125, 202, 257, and 286 DOY in 1999; 179, 209, 270, and 301 DOY in 2000; and on 156 and 230 DOY in 2002 (no sewage sludge applications) to determine the residual effect of applied sewage sludge following repeated application. Forage yield and soils data were analyzed using analysis of variance (PROC ANOVA) procedures with year and treatment as the main plot and sub-plot, respectively. As a result of significant year effects on forage yield, data were reanalyzed annually (i.e., 1998, 1999, 2000, and 2002). RESULTS AND DISCUSSION: All sewage sludges used in this study were of class B in terms of USEPA's pathogens and pollutant concentration limit. Pathogen and chemical composition of the class B sewage sludge that were used in the study were all in compliance with the USEPA guidelines. The liquid sludge (SBS11) had the lowest fecal coliform counts (0.2 x 10(6) CFU kg(-1)) while the cake sewage sludge (CBS) had the greatest coliform counts of 178 x 10(6) CFU kg(-1). The fecal coliform counts for SBS7 was about 33 x 10(6) CFU kg(-1). Average soil test values in June 2002 exhibited: i) decrease in TIN (NO3-N + NH4-N), TP, K, Ca, Mg, Mn, and Fe; and ii) slight increase in Zn and Cu when compared with the June 1997 soil test results. The overall decrease in soil test values in 2002 might be associated with nutrient cycling and plant consumption. Although the average BG forage yield in 2002 (2.3 +/- 0.7 Mg ha(-1)) was slightly lower than in 2000 (3.5 +/- 1.2 Mg ha(-1)), yield differences in 2002 between the control (1.2 +/- 0.2 Mg ha(-1)) and treated plots (2.3 +/- 0.5 Mg ha(-1) to 3.3 +/- 0.6 Mg ha(-1)) were indicative of a positive residual effect of applied sewage sludge. This study has shown that excessive build up of plant nutrients may not occur in beef cattle pastures that repeatedly received sewage sludge while favoring long-term increased forage yield of BG. All sources of N (sewage sludge and AMN) gave better forage production than the unfertilized control during years with sewage sludge application (1997-2000) and also during years with no sewage sludge application (2001-2002). The favorable residual effects of applied sewage sludge in 2002 may have had received additional boost from the amount of rainfall in the area. CONCLUSIONS: Repeated applications of sewage sludge indicate no harmful effects on soil quality and forage quality. Our results support our hypothesis that repeated land application of sewage sludge to supply 90 and 180 kg N ha(-1) would not increase soil sorption for nutrients and trace metals. Results have indicated that the concentrations of soil TIN and TP declined by almost 50% in plots with different nitrogen sources from June 1997 to June 2002 suggesting that enrichment of nitrogen and phosphorus is insignificant. The concentrations of soil nitrogen and phosphorus in 2002 following repeated application of sewage sludge were far below the contamination risk in the environment. The residual effect of these sewage sludge over the long term can be especially significant in many areas of Florida where only 50% of the 1 million ha of BG pastures are given inorganic nitrogen yearly. RECOMMENDATION AND OUTLOOK: Successive land application of sewage sludge for at least three years followed by no sewage sludge application for at least two years may well be a good practice economically because it will boost and/or maintain sustainable forage productivity and at the same time minimize probable accumulation of nutrients, especially trace metals. Consecutive applications of sewage sludge may result in build up of some trace metals in some other states with initial high metallic content, but in this study, no detrimental effects on soil chemical properties were detected. The possibilities for economically sound application strategies are encouraging, but more and additional research is required to find optimal timing and rates that minimizes negative impacts on soil quality in particular or the environment in general. For proper utilization of sewage sludge, knowledge of the sewage sludges' composition, the crop receiving it, are absolutely crucial, so that satisfactory types and rates are applied in an environmentally safe manner. There is still much to be learned from this study and this investigation needs to continue to determine whether the agricultural and ecological objectives are satisfied over the longer term.

Animals↗
PubMed1975

Edwardsiella tarda infections in Florida racoons, Procyon lotor.

Edwardsiella tarda was isolated from the large intestine of seven (17%) of 42 racoons from Florida. The rate varied from 12% in South Florida to 25% in North Florida. In addition, 52% of the racoons examined were carrying Salmonella, with numerous serotypes represented.

Animals↗
PubMedDate not supplied

Corticosterone, reproductive status, and body mass in a cooperative breeder, the Florida scrub-jay (Aphelocoma coerulescens).

In the cooperatively breeding Florida scrub-jay, nonbreeders are subordinate to the breeders with which they share a territory. Corticosterone is secreted in response to a wide range of stressors, including social stress, and suppresses reproductive and territorial behaviors in several taxa; thus, elevated baseline levels of corticosterone might be a causal mechanism of reproductive suppression. To test the hypothesis that nonbreeder Florida scrub-jays are reproductively suppressed through the actions of corticosterone, we compared corticosterone levels of nonbreeders and breeders and found no differences. However, baseline corticosterone levels only provide information about a bird's current hormonal status. Virtually all species exhibit a rapid rise in glucocorticoids in response to an acute stressor. If the adrenocortical response of nonbreeders is greater than that of breeders, this might be a mechanism whereby nonbreeders remain reproductively quiescent. We compared the responses of breeders and nonbreeders to the acute stress of being captured and held for 1 h. Both exhibited significant but equivalent increases in corticosterone titers. Because in some species heavier or fatter individuals have reduced glucocorticoid responses to stressors, we examined whether body mass was correlated with corticosterone titers. Both baseline and maximum corticosterone levels covaried with body mass, and the effect of body mass on corticosterone levels explained the increase due to capture and handling. Our data do not support the hypothesis that Florida scrub-jay nonbreeders are reproductively suppressed through the actions of corticosterone.

Analysis of Variance↗
PubMed1991

Origin of stable flies (Diptera: Muscidae) on west Florida beaches: electrophoretic analysis of dispersal.

Stable fly adults were collected from 16 locations within the state of Florida and from locations in six other states in an attempt to determine the source of stable fly populations along Florida beaches on the Gulf of Mexico. Electrophoretic analyses were made of a minimum of 10 enzymes in each of 37 separate populations. Extremely low heterozygosity resulted in an inability to use standard genetic identity and distance procedures for determining the divergence of allopatric populations to establish the source of flies captured from beach areas where reproduction was unlikely. Comparisons of rare alleles in populations grouped geographically, computations of number of possible migrants, and analysis of conditional average frequency of alleles led to the conclusion that flies captured on Florida beaches come from a variety of sites, with locations northwest of the beaches contributing the majority of flies in outbreaks.

Alleles↗
PubMed1996

Transmission patterns of St. Louis encephalitis and eastern equine encephalitis viruses in Florida: 1978-1993.

Sentinel chickens were maintained at field sites in 40 Florida counties for varying periods between 1978 and 1993. For each county, the total number of St. Louis encephalitis virus (SLE) or eastern equine encephalitis (EEE) virus seroconversions were divided by the number of chickens exposed to calculate a mean annual seroconversion rate. These rates were used to evaluate the annual and geographical distributions of these viruses within Florida. For SLE, the rates in counties that reported human SLE cases during a widespread epidemic in 1990 were compared with adjusted mean annual seroconversion rates calculated by excluding the epidemic year seroconversion data. In general, actual rates were higher than adjusted rates in counties where human SLE cases were reported in 1990. Similar calculations were made for EEE virus that was unusually abundant in northern Florida during the spring and summer of 1991. In general, EEE virus was distributed in the panhandle and northern regions and SLE virus in the central and southern regions of the state. However, this distribution was not exclusive, and during years of high transmission, either virus can extend beyond its normal range. The annual distribution of SLE and EEE viruses was sporadic, ranging from years with little detectable activity to years with widespread, high-level transmission.

Animals↗
PubMed1991

The risk of Vibrio illness in the Florida raw oyster eating population, 1981-1988.

In the period 1981-1988, 333 cases of bacteriologically confirmed Vibrio illness were reported in Florida adult residents. A total of 197 patients (59.2%) had consumed raw oysters the week prior to becoming ill, and among those 197, 38 (19.3%) had a liver disease, 13 (6.6%) had past gastric surgery, and 15 (7.6%) were diabetic. To calculate a population-based incidence rate, the authors obtained prevalence estimates of annual raw oyster consumption, liver disease, previous gastric surgery, and diabetes through a random telephone survey of Florida adult residents and applied them to the January 1985 Florida population. The estimated age-standardized annual incidence of Vibrio illness per million was 95.4 for raw oyster eaters with liver disease, 9.2 for raw oyster eaters without liver disease, and 2.2 for non-raw oyster eaters. Those with prior gastric surgery had a moderately increased risk of Vibrio illness. The annual incidence for Vibrio septicemia was 82.8 for raw oyster eaters with liver disease, 2.0 for raw oyster eaters without liver disease, and 0.4 for non-raw oyster eaters. While estimates on which these data are based are subject to a number of potential biases, this is the first study to provide estimates of the risk of Vibrio illness in raw oyster eaters, and it supports the recommendation that raw oyster consumption should be avoided by persons with liver disease.

Adolescent↗
PubMed1992

Characteristics of mothers of live infants with congenital syphilis in Florida, 1987-1989.

The incidence of congenital syphilis in Florida increased sixfold from 1985 through 1989, and more than 80% of the cases occurred in metropolitan areas of southern Florida. To characterize the population of pregnant women in Florida at high risk of delivering an infant with congenital syphilis, the authors conducted a case-control study using birth certificates. Birth certificates were obtained for 256 of the 344 live infants reported as having congenital syphilis from 1987 through 1989 (74%); the 246 of these infants born in hospitals were matched for hospital and week of birth with an equal number of controls. In conditional multiple logistic regression, the following maternal characteristics were independent risk factors for congenital syphilis: young age, black race, single marital status, absence of a father's name on the birth certificate, previous pregnancy, substance abuse, and lack of prenatal care. Although the national origin of the mother was not a significant risk factor, the infants of black mothers born in the United States were at greater risk than the infants of black mothers born outside the United States. Mothers who had < or = 3 prenatal visits had an increased risk of delivering an infant with congenital syphilis as compared with mothers who had > 3 visits. This study suggests that targeted outreach efforts are necessary to control congenital syphilis and provides guidance for public health intervention activities.

Adult↗
PubMed1996

The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study.

Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult patients with trauma to state-approved trauma centers. If any one of the eight criteria are met, paramedics classify the patient as a "trauma alert" and transport to a state-approved trauma center. Widespread concern within the trauma care community that the scorecard was not providing an effective tool for adult trauma triage, particularly for older adults, was a motivating force for conducting an evaluation of the trauma scorecard's performance. Thus, the Florida Department of Health and Rehabilitative Services, Office of Emergency Medical Services initiated a research effort to assess the effectiveness of the state-adopted trauma triage criteria for adults, giving special attention to geriatric trauma. The results of the Florida Trauma Triage Study indicate that the eight triage criteria comprising the trauma scorecard produce unacceptable levels of undertriage in elderly patients (age 55 years or older) with life-threatening injuries.

Abbreviated Injury Scale↗
PubMed1999

Pediatricians' and social workers' knowledge and opinions of Florida's religious immunity laws.

BACKGROUND: Florida laws grant exemption from prosecution to parents who choose spiritual healing rather than conventional medical therapy for their children. Despite the American Academy of Pediatrics' policy statement supporting repeal of such laws, we believe pediatricians are not aware of existing statutes. METHODS: A survey to assess understanding of Florida's religious exemption laws was distributed to pediatric house staff, faculty, and clinical social workers at a large teaching hospital and to community pediatricians in private practice. RESULTS: Eighty-four percent of respondents were unaware of Florida statutes, and physicians were significantly less knowledgeable than social workers. Of those who understood the statutes, 92% believed physicians should overrule parents' decisions. Significantly more social workers than physicians believed that parents should be prosecuted for child abuse or neglect when medical treatment is withheld for religious reasons. CONCLUSIONS: Further education of pediatric health care workers is required before repeal of these laws will become a priority for legislators.

Adolescent↗
PubMed2003

Effects of physician supply on melanoma incidence and mortality in Florida.

BACKGROUND: Increasing supplies of dermatologists and family physicians have been associated with earlier detection of malignant melanoma. We investigated whether physician supply was similarly related to incidence and mortality rates of malignant melanoma. METHODS: Using the state tumor registry, we determined melanoma incidence and mortality rates for the years 1993 to 1995 for each Florida county. We measured physician supply for each Florida county using data from the 1994 American Medical Association Physician Masterfile. Multiple linear regression analysis was used to determine relationships between physician supply and melanoma incidence and mortality rates, controlling for other county-level characteristics. RESULTS: Among male patients, an increasing supply of family physicians was associated with higher melanoma incidence and lower melanoma mortality. Increasing supplies of dermatologists were associated with lower overall melanoma mortality rates, and increasing supplies of general internists were associated with higher overall melanoma mortality. CONCLUSION: We found that melanoma incidence and mortality rates varied substantially among Florida's 67 counties, and that differences in physician supply explained some of this variability. Further study is needed to confirm these findings and to elucidate possible mechanisms that would account for these associations.

Dermatology↗
PubMed1988

Equine Culicoides hypersensitivity in Florida: biting midges collected in light traps near horses.

Twenty-three species of Culicoides were trapped near pruritic horses during a 2-year survey in Florida. Nearly 99% of the biting midges collected were represented by Culicoides insignis Lutz, C. edeni Wirth and Blandon, C. stellifer (Coquillett), C. niger Root and Hoffman, C. haematopotus Malloch and C. venustus Hoffman. The relative contribution to the total catch by each of these species varied among collection sites. Seasonally, different species attain their largest population sizes at different times. Association of species collected in light traps with the seasonality of lesion development on the horses suggests that more than one species must be involved in causing Culicoides hypersensitivity in horses from Florida. Nulliparous females were present in most months that females of the same species were active; in some cases, species were trapped in each month of the year, particularly at the more southerly sites. The species of biting midge most likely to be involved in Culicoides hypersensitivity in horses in Florida are C. insignis, C. stellifer and C. venustus based upon their mammalophilic behaviour and seasonality.

Animals↗
PubMed2003

Evaluation of the Florida coordinated school health program pilot schools project.

The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a "case study" to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: "Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?" and "What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?" First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.

Adolescent↗
PubMed2005

Information technologies in Florida's rural hospitals: does system affiliation matter?

CONTEXT: The recent explosive growth of information technology in hospitals promises to improve hospital and patient outcomes. Financial barriers may cause rural hospitals to lag in adoption of information technology, however, formal studies that examine rural hospital adoption of information technology are lacking. PURPOSE: To determine the extent to which rural Florida hospitals utilize clinical and other information technology applications, to identify related information technology issues and barriers, and to explore differences between stand-alone and system-affiliated hospitals. METHODS: Chief information officers in rural Florida hospitals were surveyed from June 2003-October 2003. A comprehensive set of questions assessed hospital demographics, information technology priorities and barriers, clinical and other information technology systems, and staffing needs. FINDINGS: In rural Florida, current information technology priorities included upgrading security on information technology systems to meet Health Insurance Portability and Accountability Act requirements (53.6%), implementing technology to reduce medical errors and to promote patient safety (50.0%), and implementing wireless systems (46.4%). With respect to current information technology adoption, system-affiliated rural hospitals were statistically more likely than their stand-alone counterparts to have laboratory information systems (93% vs 39%), pharmacy (87% vs 46%), pharmacy dispensing (53% vs 8%), chart deficiency (60% vs 15%), and order communication results (60% vs 23%). Financial barriers to successful information technology implementation were noted by 69% of stand-alone and 20% of system-affiliated rural hospitals. CONCLUSIONS: Although top information technology priorities are similar for all rural hospitals examined, differences exist between system-affiliated and stand-alone hospitals in adoption of specific information technology applications and with barriers to information technology adoption.

Diffusion of Innovation↗
PubMed1993

Distribution of viral abundance in the reef environment of Key Largo, Florida.

The distribution of viral and microbial abundance in the Key Largo, Fla., reef environment was measured. Viral abundance was measured by transmission electron microscope direct counts and plaque titer on specific bacterial hosts in water and sediment samples from Florida Bay (Blackwater Sound) and along a transect from Key Largo to the outer edge of the reef tract in Key Largo Sanctuary. Water column viral direct counts were highest in Blackwater Sound of Florida Bay (1.2 x 10(7) viruses per ml), decreased to the shelf break (1.7 x 10(6) viruses per ml), and were inversely correlated with salinity (r = -0.97). Viral direct counts in sediment samples ranged from 1.35 x 10(8) to 5.3 x 10(8)/cm(3) of sediment and averaged nearly 2 orders of magnitude greater than counts in the water column. Viral direct counts (both sediment and water column measurements) exceeded plaque titers on marine bacterial hosts (Vibrio natriegens and others) by 7 to 8 orders of magnitude. Water column viral abundance did not correlate with bacterial direct counts or chlorophyll a measurements, and sediment viral parameters did not correlate with water column microbial, viral, or salinity data. Coliphage, which are indicators of fecal pollution, were detected in two water column samples and most sediment samples, yet their concentrations were relatively low (<2 to 15/liter for water column samples, and <2 to 108/cm(3) of sediment). Our findings indicate that viruses are abundant in the Key Largo environment, particularly on the Florida Bay side of Key Largo, and that processes governing their distribution in the water column (i.e., salinity and freshwater input) are independent of those governing their distribution in the sediment environment.

Animals↗
PubMed2004

Borrelia species in host-seeking ticks and small mammals in northern Florida.

The aim of this study was to improve understanding of several factors related to the ecology and environmental risk of Borrelia infection in northern Florida. Small mammals and host-seeking adult ticks were collected at several sites, and specimens were tested for the presence of Borrelia species, primarily by PCR amplification. Tissues from some vertebrates and ticks were initially cultured in BSK-H medium to isolate spirochetes, but none were recovered. However, comparison of partial flagellin (flaB), 66-kDa protein (p66), and outer surface protein A (ospA) gene sequences from DNAs amplified from small mammals and ticks confirmed the presence of several Borrelia species. Borrelia lonestari DNA was detected among lone star ticks (Amblyomma americanum) at four sites. Borrelia burgdorferi sensu stricto strains were detected in all small mammal species tested and in A. americanum, Ixodes affinis, and Ixodes scapularis ticks. Borrelia bissettii was found in a cotton mouse and cotton rats and in I. affinis ticks. The study findings extend the known geographic distributions of B. lonestari in A. americanum and of B. burgdorferi sensu lato in A. americanum, I. affinis, I. scapularis, and small mammals to new sites in Florida. The presence of B. burgdorferi sensu stricto strains in host-seeking lone star ticks at two sites in Florida suggests that A. americanum should still be considered a possible vector of B. burgdorferi sensu lato.

Animals↗
PubMed1999

Mortality in a cohort of licensed pesticide applicators in Florida.

OBJECTIVES: Although the primary hazard to humans associated with pesticide exposure is acute poisoning, there has been considerable concern surrounding the possibility of cancer and other chronic health effects in humans. Given the huge volume of pesticides now used throughout the world, as well as environmental and food residue contamination leading to chronic low level exposure, the study of possible chronic human health effects is important. METHODS: This was a retrospective cohort study, analysed by general standardised mortality ratio (SMR) of licensed pesticide applicators in Florida compared with the general population of Florida. A cohort of 33,658 (10% female) licensed pesticide applicators assembled through extensive data linkages yielded 1874 deaths with 320,250 person-years from 1 January 1975 to 31 December 1993. RESULTS: The pesticide applicators were consistently and significantly healthier than the general population of Florida. As with many occupational cohorts, the risks of cardiovascular disease and of diseases associated with alcohol and tobacco use were significantly lower, even in the subpopulations--for example, men, women, and licence subcategories. Among male applicators, prostate cancer mortality (SMR 2.38 (95% confidence interval (95% CI) 1.83 to 3.04) was significantly increased. No cases of soft tissue sarcoma were confirmed in this cohort, and non-Hodgkin's lymphoma was not increased. The number of female applicators was small, as were the numbers of deaths. Mortality from cervical cancer and breast cancer was not increased. Additional subcohort and exposure analyses were performed. CONCLUSIONS: Consistent with previous publications on farmers but at odds with current theories about the protective effects of vitamin D, prostate cancer was increased in these pesticide applicators. Female breast cancer was not increased despite theories linking risk of breast cancer with exposure to oestrogen disruptors--such as the organochlorines. The lack of cases of soft tissue sarcoma is at odds with previous publications associating the use of the phenoxy herbicides with an increased risk of these cancers.

Adult↗
PubMed1976

An analysis of a state hospital population subject to release under Florida law.

Section XI of the Florida Mental Health Act, or Baker Act, mandates the review of prior hospitalization orders for each resident patient. Those retained become voluntary patients, unless placed on involuntary status under procedures outlined in the act. As a result, many patients will probably be released. Staff from the Florida State University School of Social Work analyzed patients at Florida State Hospital from one catchment area and detailed their demographic characteristics, treatment needs, and interpersonal and financial resources. The researchers found that the area's one mental health center and four nursing homes would not be adequate community resources for meeting the patients' needs. They conclude that the release of many patients would create hardships both for the patient and for the service personnel in the community, and might be considered a violation of the intent of the act.

Activities of Daily Living↗