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PubMed2004

Personal digital assistant use in Florida obstetrics and gynecology residency programs.

OBJECTIVES: Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA) is a tool that has the potential to enhance residency education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology residency programs in the state of Florida. METHODS: The authors conducted a statewide survey addressing the general question: is the PDA useful in an obstetrics and gynecology residency training program? Specifically, the authors asked residents how much time was perceived to be saved weekly with the use of this tool, and in what aspect of their training use of this tool was most helpful. RESULTS: At the survey's close, five of seven programs had returned the survey for evaluation. These five institutions included both university- and community-based residency programs. Forty percent of obstetrics and gynecology residents at these programs responded to this questionnaire. Resident responses to the survey revealed that most of the perceived benefit was in maintaining procedural statistics logs, pharmacology reference manuals, and personal clinical protocols. Most responses revealed that only minimal time savings (<2 h/wk) were gained with using this tool. However, many residents felt they were not using this tool to its maximum potential. Nearly 90% of those who responded felt that the PDA should be available at residency programs and anticipated using it after completing residency. CONCLUSIONS: This study posed the question of PDA usefulness at obstetric and gynecology residency programs in the state of Florida. Although not all programs provided their residents with a PDA, 95% of the respondents revealed that they owned one of these tools. Experience at the authors' institution revealed high expectations for the potential uses of a PDA. Although many residents were not using this tool to its full potential, a PDA tutorial session could educate residents on the many applications available for PDAs, including applications to maintain on-call schedules and sign-out lists, statistics and procedure logs for credentialing and board certification, electronic billing, and electronic prescriptions.

Academic Medical Centers↗
PubMed2004

Florida health care providers' knowledge of folic acid for the prevention of neural tube defects.

OBJECTIVES: The purpose of this study was to determine the impact of an educational program on the knowledge and practice behavior of health care providers regarding folic acid use for the prevention of neural tube defects. METHODS: A survey was mailed to selected Florida health care providers to determine baseline knowledge and practice behavior. After a statewide educational program, another mail survey was sent to the same groups of providers to determine the effect of the campaign. RESULTS: Comparison between the two surveys showed a significant increase in knowledge and in the percentage of health care providers who recommended the periconceptional use of folic acid for the prevention of neural tube defects. Providers graduating in 1992 or later were more likely than those graduating before 1992 to have the appropriate knowledge about folic acid use but were less likely to recommend it to their patients. CONCLUSIONS: Significant gains were made in increasing knowledge and changing practice behavior among selected Florida health care providers. Regardless of the magnitude of these gains, our data show that some health care providers who have regular contact with women of childbearing age still do not know the recommended doses of folic acid or do not recommend its use. This points toward the need for continued education as well as efforts to modify provider behavior.

Adult↗
PubMed1999

Cancer incidence in a cohort of licensed pesticide applicators in Florida.

This study is a standardized incidence ratio (SIR) analysis of cancer incidence of licensed pesticide applicators in Florida, compared with that of Florida's general population. Through extensive data linkages, 33,658 applicators were assembled who had 1266 incident cancers and 279,397 person-years from January 1, 1975, to December 31, 1993. Disease risk from ethanol and tobacco use were significantly decreased. Among males, prostate cancer (SIR = 1.91; 95% confidence interval [CI], 1.72-2.13) and testicular cancer (SIR = 2.48; 95% CI, 1.57-3.72) were significantly elevated. No confirmed cases of soft tissue sarcoma (STS) were found, and the incidence of non-Hodgkin's lymphoma was not increased. There were few female applicators; nevertheless, cervical cancer incidence (SIR = 3.69; 95% CI, 1.84-6.61) was significantly increased, while the incidence of breast cancer was significantly decreased. Cancers that have been associated with estrogen disrupters were found in male, but not female, pesticide applicators. The lack of soft tissue sarcoma is at odds with prior literature associated with the use of phenoxy herbicides.

Adult↗
PubMed2000

Florida's "truth" campaign: a counter-marketing, anti-tobacco media campaign.

The "truth" campaign was created to change youth attitudes about tobacco and to reduce teen tobacco use throughout Florida by using youth-driven advertising, public relations, and advocacy. Results of the campaign include a 92 percent brand awareness rate among teens, a 15 percent rise in teens who agree with key attitudinal statements about smoking, a 19.4 percent decline in smoking among middle school students, and a 8.0 percent decline among high school students. States committed to results-oriented youth anti-tobacco campaigns should look to Florida's "truth" campaign as a model that effectively places youth at the helm of anti-tobacco efforts.

Adolescent↗
PubMed2001

National Public Health Performance Standards: workforce development and agency effectiveness in Florida.

The Florida Department of Health (FDOH) was the first state to pilot test both the Centers for Disease Control and Prevention (CDC) state agency and local Public Health System Performance Standards. The standards were found to be complementary and supportive of the FDOH quality performance improvement system, which had been in place for a decade, and the new Quality Management initiative. The pilot test found uneven performance across the state's county health departments and identified several areas, especially workforce development, that required additional efforts. The FDOH, in collaboration with the Center for Leadership in Public Health Practice at the College of Public Health in the University of South Florida, have collaborated and will continue to collaborate to design and deliver training in critical workforce development areas.

Efficiency, Organizational↗
PubMedDate not supplied

Hispanic health status in Orange County, Florida.

PURPOSE: To assess the health status of the Hispanic population of Orange County, Florida. METHODS: The methodology utilized secondary data for 66 ethnically identified indicators in a comparative framework applied for a 5-year period (1997-2001). FINDINGS: Orange County Hispanics are younger with lower per capita income than their Florida peers, less likely to be White, and much more likely to be of Puerto Rican origin. Relative to the Hispanic populations in the selected peer counties and statewide, Orange County Hispanics have higher age-adjusted death rates for a majority of disease categories and conditions, such as breast, lung, and prostate cancers; chronic liver disease and cirrhosis; diabetes mellitus; pneumonia and influenza; stroke; acquired immunodeficiency syndrome; motor vehicle accidents; and infant, neonatal, and child mortality. Orange County Hispanics did better in comparison to Orange non-Hispanics, with lower age-adjusted death rates for major causes of death such as heart disease, cancer, and stroke. However, for many indicators, the 5-year trends for Orange County Hispanics are moving in an unfavorable direction in contrast to the trends for non-Hispanics, which are either stable or improving. CONCLUSION: Comparative assessments of Hispanic populations using secondary data enable the development of a comprehensive health status profile. However, this approach is currently constrained by the limited number of ethnically identified indicators and, especially for Hispanics, problems in the accuracy and consistency of the assignment to racial categories and subsequent reporting.

Adolescent↗
PubMedDate not supplied

Implementation of an Internet-based geographic information system: the Florida experience.

Increasingly, Web-based data dissemination systems are being used to provide public health information. This article describes Florida's experience in augmenting a Web-based data query system, Florida CHARTS, with a geographic information system component. As with any systems development, users' needs guide the product. With a focus on community health assessment and improvement planning, several methods of data display have been established. A variety of issues are explored including the impact of small numbers of events on data display and data confidentiality, the selection of geographic units of analysis, and techniques for geographically coding data.

Florida↗
PubMed2003

Strategies for reaching retirement communities and aging social networks: HIV/AIDS prevention activities among seniors in South Florida.

Since 1993, the HIV/AIDS Program Office of the Broward County Health Department has recognized the importance of targeting the population of those aged 50 years and older. Close examination of epidemiological data for the south Florida area and requests from health care providers showed that targeted intervention had to address the needs of the seniors as well as the beliefs and perceptions of their health practitioners. Originally designed to provide community training, identify and train volunteer peer educators, and increase awareness and sensitivity among providers of health services, the senior initiative was officially expanded with funding from the Florida Department of Elder Affairs in 1997. The resulting Senior HIV Intervention Project (SHIP) is more comprehensive than the original senior training program, addressing the increased need for early intervention activities, HIV counseling, and testing. SHIP also links HIV-positive seniors to care and treatment services through a network of trained staff and volunteers. SHIP's considerable experience in serving the needs of older adults offers useful insight for others developing successful HIV/AIDS programming for people aged 50 years and older.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Office surgery safety and the Florida moratoria.

BACKGROUND: Office-based surgery has become an important method of healthcare delivery, but there is controversy about its safety. Since 2000, a series of articles were published in the lay media emphasizing the hazards of office surgery, leading to the Florida Board of Medicine restricting office procedures. OBJECTIVE: The objective of this study was to determine the nature and scope of deaths resulting from office surgery. METHODS: We reviewed the data on mandatory reporting by physicians to a central agency of all office surgical incidents that resulted in death, injury, or hospital transfer in the state of Florida from January 2000 to November 2004. E-mail, Internet, and telephone follow up were used to determine physician's board status, office accreditation, and hospital privileges. We reviewed data on medication interactions, anesthesia, and monitoring. RESULTS: A total of 36 deaths related to office procedures were reported. Only 18 of those were related to surgical procedures that are within the realm of plastic surgery, although surgeons of other specialties did 3 of these. When these 18 were reviewed by type of anesthesia, there were 12 who had general anesthesia, 10 with an anesthesiologist and 2 with a Certified Registered Nurse Anesthetist. Of those 18, 7 died before discharge. Although all 7 of them survived long enough to be transferred to a hospital, we classified them as office deaths. The other 11 died after appropriate discharge. Of the 7 office deaths, one developed bronchospasm during induction by an anesthesiologist. Five were during deep sedation (level III anesthesia) and 4 appeared to be related to excessive sedation and/or inadequate monitoring; the fifth was probably related to illicit drug use and the sixth from a fat embolism. Of the 11 postoperative deaths, 7 were said to be the result of thromboembolism and the others were from unknown causes. CONCLUSION: Although the total number of office operations during the study period is unknown, the fact that 7 deaths were reported would suggest that the location in which these procedures were done was not as much of a factor as the regulators have suggested. However, better patient screening, sedation management, deep vein thrombosis prophylaxis, and clinical judgment may have prevented some, if not most, of these deaths. The most frequent cause of death after discharge was thromboembolism, and some of these might have been prevented with better prophylaxis. More detailed findings and recommendations are presented.

Adult↗
PubMed2003

Invasive group A streptococcal infections in Florida.

BACKGROUND: Several previous studies of invasive Group A streptococcal (GAS) disease have been hindered by small sample sizes (< or = 100 patients) and limited generalizability. METHODS: We conducted a population-based study of invasive GAS disease. The objectives of the study were to describe the clinical features of individuals who were hospitalized for invasive GAS disease and to identify risk factors for hospital mortality. The cases were 257 patients who were hospitalized throughout Florida during a 4-year period and reported to the Florida Department of Health. Logistic regression was used to calculate adjusted odds ratios (OR) for mortality and 95% confidence intervals (CI). RESULTS: The overall mortality was 18% (41 of 228). Admission into an intensive care unit was a strong predictor of mortality (OR, 20.41; 95% CI, 6.41-64.96). Treatment with clindamycin reduced mortality in patients who had necrotizing fasciitis (OR, 0.11; 95% CI, 0.01-0.89) but not in patients who did not have necrotizing fasciitis (OR, 1.01; 95% CI, 0.31-3.33). CONCLUSION: Clindamycin reduces mortality in patients with invasive GAS disease who have necrotizing fasciitis.

Anti-Bacterial Agents↗
PubMed1990

Equine Culicoides hypersensitivity in Florida: biting midges aspirated from horses.

Nine species of Culicoides were aspirated from horses in Florida during the second phase of a study of equine Culicoides hypersensitivity (CHS). Approximately 90% of the 2933 midges were Culicoides insignis Lutz, 4% were C.stellifer (Coquillett), 3% were C.niger Root and Hoffman, 2% were C.alachua Jamnback and Wirth and the remaining 1% included C.venustus Hoffman, C.scanloni Wirth and Hubert, C.lahillei Iches (= C.debilipalpis Lutz), C.pusillus Lutz, and C.edeni Wirth and Blanton. Culicoides were sampled on seven farms located throughout Florida. The location and seasonality of lesion development on horses with CHS correlated with the Culicoides spp. collected directly from the horses as to their sites of attack, their seasonality and geographical distribution.

Animals↗
PubMed1991

The cliff swallow bug Oeciacus vicarius (Hemiptera: Cimicidae) in Florida: ectoparasite implications for hole-nesting birds.

In May 1988, ten juvenile birds, not yet ready to fledge, jumped to their death from a colony of the purple martin, Progne subis near Okeechobee City, Florida. The martin house and nestlings were found to be infested with ectoparasitic Oeciacus vicarius Horvath, the cliff swallow bug, not previously reported from Florida. This ectoparasite infestation apparently led to early abandonment of two houses by the adult martins. Oeciacus vicarius therefore represents a possible threat to all hole-nesting birds.

Animals↗
PubMed2004

Strong fungal specificity and selectivity for algal symbionts in Florida scrub Cladonia lichens.

Symbiosis is a major theme in the history of life and can be an important force driving evolution. However, across symbioses, it is difficult to tease apart the mechanisms that structure the interactions among potential partners. We used genetic similarity and frequency-based methods to qualitatively and quantitatively examine the patterns of association among several co-occurring Cladonia lichen fungi and their algal photobionts in six disjunct Florida scrub sites. The patterns of association were described by the degree of specificity, i.e. the phylogenetic range of associated partners, and of selectivity, i.e. the frequency of association among partners. Six fungal species associated with only one algal internal transcribed spacer clade, with the remaining two fungi being associated with two algal clades. In all cases, the fungi associated in unequal frequencies with the observed algal photobiont genotypes within those clades--suggesting that both specificity and selectivity were higher than expected. Fungal species can be grouped into three significantly different specificity classes: photobiont specialists, intermediates and generalists. In contrast to the pronounced specificity for photobionts among fungal species, the different Florida scrub sites do not harbour distinct photobiont pools, and differential photobiont availability cannot explain the patterning of lichen associations at this spatial scale. Therefore, we conclude that fungal specificity and selectivity for algal photobionts are major factors in determining the local composition of symbiotic partnerships.

Biological Evolution↗
PubMed2004

Determining personal care consumers' preferences for a consumer-directed cash and counseling option: survey results from Arkansas, Florida, New Jersey, and New York elders and adults with physical disabilities.

OBJECTIVE: To assess Medicaid consumers' interest in a consumer-directed cash option for personal care and other services, in lieu of agency-delivered services. DATA SOURCES/STUDY SETTING: Telephone survey data were collected from four states from April to November 1997. Postsurvey focus groups were conducted in four states in 1998. Early implementation experiences are drawn from three states from 1999 to 2002. STUDY DESIGN: Participants (N=2,140) were selected for a structured telephone survey interview from a probability-sampling frame of current Medicaid consumers in Arkansas, Florida, New Jersey, and New York. Key variables include interest in the cash option, demographic and background characteristics of consumers, as well as previous experience and training needed. Postsurvey focus groups were also conducted with current Medicaid consumers. DATA COLLECTION/EXTRACTION METHODS: Interviewers read the telephone survey from computer screens and entered responses directly into the database of the Macintosh Computer Assisted Telephone Interview software. Data were analyzed using SPSS 10.0 (http://www.spss.com) for Windows. PRINCIPAL FINDINGS: Cash option interest was positively associated with experience hiring and supervising workers, more severe levels of disability, having a live-in caregiver, living in Florida, and minority status. Age of the client was also a significant factor. CONCLUSIONS: There is significant interest in the cash option, although interest varies among subgroups of consumers. Future research should continue to evaluate interest in the cash option among different groups of consumers, as well as actual experience with the option when the Cash and Counseling Demonstration and Evaluation (CCDE) evaluation findings are completed.

Adult↗
PubMed1992

Cumulative sunlight exposure and the risk of developing skin cancer in Florida.

Epidemiologic evidence suggests that the risk of developing skin cancer is higher in certain geographic regions where sunlight is excessive. Even in such high risk regions, two distinct populations of long-term residents exist: people with, and people without skin cancer. We have compared the quantitative lifetime sunlight exposure between 11 nonmelanoma skin cancer patients who have lived in South Florida for 23.7 +/- 5.1 years and 9 age-matched normal, healthy individuals who have lived in South Florida for 23.4 +/- 4.1 years. An estimation of personal cumulative sunlight exposure was determined for each subject from data collected through detailed interviews. We found that there was no detectable, significant quantitative difference in cumulative sunlight exposure during life between these two groups. Because these individuals had previously been phenotyped for the effects of ultraviolet-B (UVB) radiation on induction of contact hypersensitivity, our results suggest that UVB-susceptibility may be a better indicator of skin cancer risk than cumulative lifetime sunlight exposure. Thus, although there is little doubt that sunlight exposure is an important factor in the development of skin cancer, our results emphasize the importance of host genetic factors in the pathogenesis of this disease.

Aged↗
PubMed2004

Patient injuries from surgical procedures performed in medical offices: three years of Florida data.

BACKGROUND: Many state medical boards and legislatures are in the process of developing regulations that restrict procedures in the office setting with the intention of enhancing patient safety. The highest quality data in existence on office procedure adverse incidents have been collected by the state of Florida. OBJECTIVE: The objective was to determine and analyze the nature of surgical incidents in office-based settings using 3 years of Florida data from March 2000 to March 2003. METHODS: An incidence study with prospective data collection was performed. Individual reports that resulted in death or a hospital transfer were further investigated by determining the reporting physician's board certification status, hospital privilege status (excluding procedure specific operating room privileges), and office accreditation status. RESULTS: In 3 years there were 13 procedure-related deaths and 43 procedure-related complications that resulted in a hospital transfer. Seven of the 13 deaths involved elective cosmetic procedures, 5 of which were performed under general anesthesia and 2 of which were performed with intravenous sedation anesthesia. Forty-two percent of the offices reporting deaths and 50% of the offices reporting procedural incidents that resulted in a hospital transfer were accredited by an independent accreditation agency. Ninety-six percent of physicians reporting surgical incidents were board-certified, and all had hospital privileges. CONCLUSIONS: Restrictions on office procedures for medically necessary procedures, such as requiring office accreditation, board certification, and hospital privileges, would have little effect on overall safety of surgical procedures. These data also show that the greatest danger to patients lies not with surgical procedures in office-based settings per se, but with cosmetic procedures that are performed in office-based settings, particularly when under general anesthesia. Our conclusions are dramatically different from those of a recent study, which claimed a 12-fold increased risk of death for procedures in the office setting.

Ambulatory Surgical Procedures↗
PubMed2006

Alligator attacks in southwest Florida.

The American alligator inhabits bodies of fresh water in Florida and other southeastern states. Although attacks on pets are frequent, alligator attacks on humans are relatively rare because of the animal's natural fear of man. Because of the rarity of attacks on humans, the pathologic findings and pathophysiology of death in such cases have not been well characterized in the literature. We report three cases of fatal alligator attacks that occurred in southwest Florida, each with different pathologic findings and mechanisms of death. Although the cause of death in each case was attributed to the alligator attack, the mechanisms of death differed and included exsanguination because of amputation of an extremity, overwhelming sepsis, and drowning. These cases illustrate the varied pathophysiologies associated with deaths due to alligator attacks on humans and the features that distinguish alligator bites from those of other aquatic predators.

Adult↗
PubMed1991

Reproducibility of attachment level measurements with two models of the Florida Probe.

Clinical assessment of the progression of periodontitis is based on the measurement of periodontal probing attachment levels over time. In calculating these changes, duplicate measurements from fixed reference points, including cemento-enamel junctions and acrylic stents, have been used to assist in detecting progressive disease. The Florida Probe has been previously shown to improve the reproducibility of these measurements when used with an acrylic stent. The objective of the present study was to evaluate the reproducibility of 2 models of the Florida Probe, the original stent model and the modified disk model, in measuring attachment level. The disk probe differs from the stent probe in that it uses the occlusal surface of the tooth as a static reference point in calculating changes in attachment level measurements. In 10 subjects, sites were probed 2 x by 2 examiners using both types of probe. Standard deviations and intra- and inter-examiner correlations were calculated. These results demonstrate that the new disk probe yields reproducible measurements similar to the stent probe and is therefore suitable for use in longitudinal clinical studies.

Equipment Design↗