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PubMedDate not supplied

Assessing the need for family nurse practitioners--the Florida experience.

This article presents results of a descriptive study designed to assess the need for Family Nurse Practitioners (FNPs) in Florida. The need for FNPs was examined within the context of the current crisis in access to health care in the United States and in Florida, where unique features of the state's population and economy combined to create inequities in the health care system. Data were also collected related to the number of primary care agencies already employing nurse practitioners, the educational preparation of these nurses, and the likelihood of agency nurses enrolling in an FNP program if such a program were available. A ten-item questionnaire was mailed to nursing service administrators at 330 health care agencies involved in the delivery of primary care. Ninety-seven questionnaires were returned. Results from the study indicated that the agencies will require increased numbers of primary care providers in the next 5 years. Further, a minority of nurse practitioners are prepared at the Master's level in the surveyed agencies, suggesting a need for increased educational opportunities for nurses if they are to enter advanced practice. The study represents one approach to establishing needs for FNPs that might be used in other states both to develop educational programs and to influence legislators regarding health and nurse practitioner issues affecting access to care.

Florida↗
PubMed1998

Sexual harassment policies in Florida school districts.

Until recently, little attention has focused on the sexual harassment that occurs in primary and secondary schools. Several school-related lawsuits and study results heightened awareness of the issue. This study investigated the extent to which Florida's school districts complied with the Florida Department of Education's (FDOE) recommendation and guidelines for addressing sexual harassment in schools. District equity coordinators were surveyed regarding policy development, implementation, promotion, education, and effects. Policies were collected for analysis. Most districts responded to the strong encouragement of the FDOE and approved a sexual harassment policy incorporating many of the suggested components. However, policies included only basic information when compared with suggestions from the literature. Results suggest problems with sexual harassment will continue due to lack of efforts in promoting awareness of the policy and education about the issue, which scholars insist are necessary for effectiveness.

Adolescent↗
PubMed2003

The rural physician workforce in Florida: a survey of US- and foreign-born primary care physicians.

CONTEXT: To meet the challenge of primary care needs in rural areas, continuing assessment of the demographics, training, and future work plans of practicing primary care physicians is needed. PURPOSE: This study's goal was to assess key characteristics of primary care physicians practicing in rural, suburban, and urban communities in Florida. METHODS: Surveys were mailed to all of Florida's rural primary care physicians (n = 399) and a 10% sampling (n = 1236) of urban and suburban primary care physicians. FINDINGS: Responses from 1000 physicians (272 rural, 385 urban, 343 suburban) showed that rural physicians were more likely to have been raised in a rural area, foreign-born and trained, a National Health Service Corps member, or a J-1 visa waiver program participant. Rural physicians were more likely to have been exposed to rural medical practice or living in a rural environment during their medical school and residency training. Factors such as rural upbringing and medical school training did not predict future rural practice with foreign-born physicians. Overall, future plans for practice did not seem to differ between rural, urban, and suburban physicians. CONCLUSIONS: Recruiting and retaining doctors in rural areas can be best supported through a mission-driven selection of medical students with subsequent training in medical school and residency in rural health issues. National programs such as the National Health Service Corps and the J-1 visa waiver program also play important roles in rural physician selection and should be taken into account when planning for future rural health care needs.

Age Distribution↗
PubMed2006

Physicians who treat the elderly in rural Florida: trends indicating concerns regarding access to care.

CONTEXT: Rural elderly patients are faced with numerous challenges in accessing care. Additional strains to access may be occurring given recent market pressures, which would have significant impact on this vulnerable population. PURPOSE: This study focused on the practice patterns and future plans of rural Florida physicians who routinely see elderly patients. Additionally, we examine those who provide services to a high volume of Medicare (HVM) patients. METHODS: A self-administered mailed survey was sent to rural physicians who identified themselves as practicing family medicine, internal medicine, psychiatry, general surgery, a surgical specialty, or a medical specialty. Questions examined changes in services offered by all rural physicians and among them, the HVM physicians. Impact of the professional liability insurance situation, satisfaction with current practice, and future practice plans on changes in service availability was also examined. RESULTS: Overall, 539 physicians responded for a participation rate of 42.7%. Two hundred eighty eight (54.9%) of all physicians in the study indicated a decrease or elimination of patient services in the last year. HVM physicians, compared to low volume of Medicare providers, were significantly more likely to decrease or eliminate services overall (66% vs 45%, P =.001). Mental health services (47% vs 18%, P =.001), vaccine administration (39% vs 16%, P =.008), and Pap smears (41% vs 13%, P =.008) were more likely to be eliminated among the HVM physicians. HVM physicians were also significantly more likely to be somewhat or very dissatisfied (40% vs 23%, P =.012) with their practice. CONCLUSIONS: Physicians in rural Florida report dissatisfaction with their practice and are decreasing or eliminating services that are important to the elderly. Given the aging population and increasing need for health care services, these trends raise concern about the ability for these patients to receive necessary care.

Adult↗
PubMed2003

Reliability of sound attenuation in Florida scrub habitat and behavioral implications.

Attenuation over distance in natural habitat is often difficult to predict when measured without respect to sound frequency. The physical-acoustic structure of Florida scrub habitat is described and both attenuation and reliability of attenuation are measured as a function of sound frequency, over several distances, speaker elevations, and microphone elevations. The spatial context of sound propagation in Florida scrub habitat is discussed and a model designed to describe contributions to overall attenuation from individual factors is presented. Sound frequencies below approximately 3.5 kHz attenuate more reliably than higher sound frequencies, suggesting that animals should pay greatest attention to relatively low sound frequencies when they assess attenuation or estimate sound-pressure level.

Animals↗
PubMed1992

Isolation of eastern equine encephalitis virus from Aedes albopictus in Florida.

Fourteen strains of eastern equine encephalitis (EEE) virus were isolated from Aedes albopictus mosquitoes collected in Polk County, Florida. These are the first isolations of an arbovirus of proven public health and veterinary importance from naturally infected Ae. albopictus in the United States since established populations of this introduced mosquito were first discovered in 1985. The widespread distribution of Ae. albopictus in Florida and in other areas of the United States where EEE is endemic raises concern that this species may become an epizootic and epidemic vector of EEE virus.

Aedes↗
PubMed1988

Transmission of HIV in Belle Glade, Florida: lessons for other communities in the United States.

The high cumulative incidence of AIDS and the large percentage of AIDS patients with no identified risks in Belle Glade, Florida, were evaluated through case interviews and neighborhood-based seroepidemiologic studies. It was found that of 93 AIDS patients reported between July 1982 and 1 August 1987, 34 could be directly linked to at least one other AIDS patient or to a person with AIDS-related complex by sexual contact, sharing of needles during intravenous drug abuse (or both), or perinatal exposure; of 877 randomly selected adults, 28 had antibodies to HIV; no person over age 60 and none of 138 children aged 2 to 10 years had antibodies to HIV; no clustering of infected persons within households occurred, except in sex partners; and HIV-seropositive adults were more likely than HIV-seronegative adults to be from Haiti, have a lower income, report sex with intravenous drug abusers, and have a history of previous treatment for sexually transmitted diseases. The presence of antibodies to five arboviruses prevalent in South Florida or the Caribbean did not correlate significantly with HIV infection. The high cumulative rate of AIDS in Belle Glade appears to be the result of HIV transmission through sexual contact and intravenous drug abuse; the evidence does not suggest transmission of HIV through insects.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Biological dinitrogen fixation (acetylene reduction) associated with Florida mangroves.

Biological dinitrogen fixation in mangrove communities of the Tampa Bay region of South Florida was investigated using the acetylene reduction technique. Low rates of acetylene reduction (0.01 to 1.84 nmol of C(2)H(4)/g [wet weight] per h) were associated with plant-free sediments, while plant-associated sediments gave rise to slightly higher rates. Activity in sediments increased greatly upon the addition of various carbon sources, indicating an energy limitation for nitrogenase (C(2)H(2)) activity. In situ determinations of dinitrogen fixation in sediments also indicated low rates and exhibited a similar response to glucose amendment. Litter from the green macroalga, Ulva spp., mangrove leaves, and sea grass also gave rise to significant rates of acetylene reduction. Higher rates of nitrogenase activity (15 to 53 nmol of C(2)H(4)/g [wet weight] per h were associated with washed excised roots of three Florida mangrove species [Rhizophora mangle L., Avicennia germinans (L) Stern, and Laguncularia racemosa Gaertn.] as well as with isolated root systems of intact plants (11 to 58 mug of N/g [dry weight] per h). Following a short lag period, root-associated activity was linear and did not exhibit a marked response to glucose amendment. It appears that dinitrogen-fixing bacteria in the mangrove rhizoplane are able to use root exudates and/or sloughed cell debris as energy sources for dinitrogen fixation.

Acetylene↗
PubMed1999

Detection of viral pathogens by reverse transcriptase PCR and of microbial indicators by standard methods in the canals of the Florida Keys.

In order to assess the microbial water quality in canal waters throughout the Florida Keys, a survey was conducted to determine the concentration of microbial fecal indicators and the presence of human pathogenic microorganisms. A total of 19 sites, including 17 canal sites and 2 nearshore water sites, were assayed for total coliforms, fecal coliforms, Escherichia coli, Clostridium perfringens, enterococci, coliphages, F-specific (F(+)) RNA coliphages, Giardia lamblia, Cryptosporidium parvum, and human enteric viruses (polioviruses, coxsackie A and B viruses, echoviruses, hepatitis A viruses, Norwalk viruses, and small round-structured viruses). Numbers of coliforms ranged from <1 to 1, 410, E. coli organisms from <1 to 130, Clostridium spp. from <1 to 520, and enterococci from <1 to 800 CFU/100 ml of sample. Two sites were positive for coliphages, but no F(+) phages were identified. The sites were ranked according to microbial water quality and compared to various water quality standards and guidelines. Seventy-nine percent of the sites were positive for the presence of enteroviruses by reverse transcriptase PCR (polioviruses, coxsackie A and B viruses, and echoviruses). Sixty-three percent of the sites were positive for the presence of hepatitis A viruses. Ten percent of the sites were positive for the presence of Norwalk viruses. Ninety-five percent of the sites were positive for at least one of the virus groups. These results indicate that the canals and nearshore waters throughout the Florida Keys are being impacted by human fecal material carrying human enteric viruses through current wastewater treatment strategies such as septic tanks. Exposure to canal waters through recreation and work may be contributing to human health risks.

Clostridium↗
PubMed2003

Children's bicycle helmet use and injuries in Hillsborough County, Florida before and after helmet legislation.

The purpose of this research was to explore the changes in children's bicycle helmet use and motor vehicle bicycle related injuries in Hillsborough County, Florida before and after passage of the Florida's bicycle helmet law for children under the age of 16. The results show a significant increase in bicycle helmet use among children, ages 5-13, in the post-law years compared with the pre-law years. Also, there has been a significant decline in the rates of bicycle related motor vehicle injuries among children in the post-law years compared with the pre-law years. Although there have been complementary educational and outreach activities in the county to support helmet use, it appears that the greatest increase in use occurred after the passage of the helmet law. It is recommended that educational efforts continue to sustain helmet use rates and decreases in injuries.

Accidents, Traffic↗
PubMed1998

Effect of the Asymptomatic Carotid Atherosclerosis Study on carotid endarterectomy in Florida.

BACKGROUND AND PURPOSE: The value of carotid endarterectomy (CEA) has been defined by several recent multicenter trials. The clinical effect of these trials remains undetermined since the Asymptomatic Carotid Atherosclerosis Study (ACAS) Clinical Advisory (dated September 28, 1994). METHODS: Patients undergoing CEA (ICD-9-CM 38.12) in nonfederal Florida hospitals were identified from the discharge database. Data were analyzed by federal fiscal year (FY, October 1 through September 30), comparing the years following the Advisory (FY95-FY96) to the preceding 3 years (FY92-FY94). RESULTS: There was a 68.3% increase in the number of CEAs during FY95-FY96 (mean FY92-FY94, 7,343; mean FY95-FY96, 12,356). This exceeded increases in total hospital discharges (4.5%), surgical discharges (2.2%), and the state's population (4.7%). The increase in CEAs spanned all patient demographic groups (gender, race, and age), although the magnitude was not consistent (range, 57.8% increase for 55 to 64 age group; 92.9% increase for > 84 age group). Concomitantly, there was a significant decrease in mortality (1.2% versus 0.8%), cardiac complication rate (ICD-9-CM 997.1, 4.1% versus 3.0%) and percentage of patients discharged > 7 days postoperatively (8.9% versus 4.9%). Mean length of stay declined 28% (5.8 versus 4.1 days), and mean adjusted charges declined 7% ($19,456 versus $18,055). Although the average case was less costly, the increased volume resulted in an estimated $56 million increase in annual hospital payments. CONCLUSIONS: The dramatic increase in the number of CEAs performed in the state of Florida after release of the ACAS Clinical Advisory suggests a causal relationship and mandates further cost-effectiveness analyses.

Adult↗
PubMed2005

Involuntary psychiatric examinations for danger to others in Florida after the attacks of September 11, 2001.

OBJECTIVE: Theories of perceived risk state that when people feel threatened, they will react more strongly than they would otherwise. This study tested the hypothesis that evaluations for involuntary psychiatric hospitalizations that were initiated by law enforcement personnel in Florida increased in the weeks after the attacks of September 11, 2001. METHODS: The authors applied interrupted time-series designs to determine whether there was a relationship between the number of involuntary psychiatric examinations initiated by law enforcement officials and the attacks of September 11, 2001. They examined the number of psychiatric evaluations of men and women who were considered to be mentally ill and harmful to others by law enforcement personnel in Florida during seven-day periods ("areal" weeks) that began with Tuesday, July 6, 1999, and ended with Monday, December 31, 2001 (because September 11, 2001, fell on a Tuesday). RESULTS: Over the 130 weeks of the study, law enforcement officials initiated examinations of an average of 25.96 men and 13.47 women per areal week. Law enforcement officials initiated examinations of approximately 14 more women than expected in the areal week that began with September 11, 2001. During the three areal weeks that began with September 18, 2001, a total of 34 more men than expected were presented for evaluation. These findings cannot be attributed to trends, seasonality, other cycles, or the tendency of the examination time series to remain elevated or depressed after high or low values in the series. CONCLUSIONS: Perceived general risk in a community may increase the likelihood that law enforcement personnel and the persons who summon them perceive persons with mental illness as imminently harmful. The public health response to any future terror attacks should include efforts to alert psychiatric service providers to the possibility of lower community tolerance for mental illness in the aftermath of an attack.

Dangerous Behavior↗
PubMedDate not supplied

Vaccine coverage levels after implementation of a middle school vaccination requirement, Florida, 1997-2000.

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.

Adolescent↗
PubMed1995

No-fault medical liability in Virginia and Florida. A preliminary evaluation.

State governments are experimenting with a variety of innovative approaches to the current tort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. States such as Virginia and Florida have already adopted a limited version of such a concept. This article examines the problems of the current tort system, different types of no-fault medical insurance alternatives and their advantages, and the experiences of the states of Virginia and Florida with their limited no-fault malpractice insurance systems. The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system.

Birth Injuries↗
PubMed1996

The limits of Medicaid reimbursement incentives. An evaluation of the Florida AIDS Nursing Home Admission Program.

Provider incentive payments in the Medicaid program have been in operation nationally since the early 1980s. Although initially indicating favorable results, recently the ability of such incentives to produce the desired action has been questioned. This study examined the Florida Medicaid AIDS Nursing Home Admission Incentive Program to determine the reasons behind the program's apparent inability to increase Medicaid-covered persons with AIDS (PWAs) admissions to nursing homes. A survey of 308 nursing homes in the 10 Florida counties with the highest cumulative AIDS cases in the state was conducted. The results reveal that (a) the level of incentive reimbursement received, (b) the financial classification of existing (non-AIDS) residents, and (c) the level of technological sophistication of the facility are all significantly related to the number of PWAs admitted. Based on these results, the author discusses implications for the future of Medicaid incentive programs for PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The impact of legislatively imposed practice guidelines on cesarean section rates: the Florida experience.

Florida legislation implemented in the fall of 1992, unique in the nation, mandated that practice guidelines regarding cesarean section deliveries be disseminated to obstetric physicians. The law also required that peer review boards at hospitals be established to review cesarean deliveries and that the exact dates of implementation of the guidelines be reported to a state agency. To determine the impact of the legislation, we conducted a retrospective analysis of 366,246 total live births occurring in Florida hospitals during 1992 and 1993, before and after formal hospital certification of the implementation of the guidelines. Changes in primary and repeat cesarean rates were analyzed for 108 independent groups of births, controlling for the mother's age, race, payment source, and the timing of the implementation of the guidelines at hospitals. The guideline certification program did not accelerate the consistent but gradual downward trend in cesarean births which had already been evident in the three prior years. The data do suggest that the guideline program may have affected repeat cesareans more than primary cesareans, especially in the first quarter of 1993, immediately after the hospital certification period. Reductions in repeat cesareans involved both Medicaid and commercially insured births, whereas reductions in primary cesareans were found almost exclusively within commercially insured mothers, where the existing rates are highest. Although births with a prior cesarean represent only 12.5% of all births, significant decreases in repeat cesareans were found in groups representing 72.6% of this population. By comparison, significant decreases in primary cesareans were found in groups representing only 36.5% of the births without a prior cesarean. The date of guideline implementation reported by hospitals was not related to any systematic change in observed cesarean section rates. We concluded that the mere dissemination of practice guidelines by a state agency may not achieve either the magnitude or the specificity of the results desired without an explicit and thorough guideline implementation program. Blunt legislative mandates may be ineffective when multiple initiatives are already achieving desired outcomes.

Adolescent↗
PubMed2001

Excellence in school nursing workshop: Florida's experience in standardizing school nursing orientation and education.

Specialty preparation is needed for safe, effective school nursing practice. The Excellence in School Nursing workshop was envisioned as a means to provide a statewide orientation and education program for school nurses in Florida. As a result of a needs assessment, the Florida Departments of Health and Education formed a curriculum development committee to address the educational needs of school nurses. A 3.5-day workshop was designed for school health nursing supervisors and school nurses employed by county health departments, school districts, and community agencies. The workshop was piloted and, based on evaluations and feedback, was revised and replicated nine times throughout the state. The workshop has proved to be an effective method of providing statewide orientation and education for school nurses. The purpose of this article is to describe the workshop curriculum, planning, implementation, and evaluation. Recommendations for adaptation and replication in other states are included.

Curriculum↗