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PubMed1983

Indoor radon progeny exposure in the Florida phosphate mining region: a review.

This paper reviews the data generated in studies of land radioactivity and indoor airborne radon progeny associated with mined and reclaimed phosphate lands in Florida. Highest indoor radon progeny levels are associated with the slab-on-grade type of construction. Concentrations exceeding 0.03 WL are associated with overburden soils, deposits and fill, while concentrations up to about 0.03 WL are associated with tailings. The lower limit for distinguishing increases above non-enhanced natural concentrations is on the order of 0.01-0.02 WL. Results of this study show that about 25% of the land produced by present methods of mining and reclamation practices would require restrictions on the type of construction or would require special construction methods. It is projected that with modification of mining and tailings disposal practices, virtually all of the land produced by mining and reclamation would be satisfactory for unrestricted construction use.

Background Radiation↗
PubMed1993

Modeling radon entry into Florida slab-on-grade houses.

Radon entry into a Florida house whose concrete slab is supported by a permeable concrete-block stem wall and a concrete footer is modeled. The slab rests on backfill material; the same material is used to fill the footer trench. A region of undisturbed soil is assumed to extend 10 m beyond and below the footer. The soil is assumed homogeneous and isotropic except for certain simulations in which soil layers of high permeability or radium content are introduced. Depressurization of the house induces a pressure field in the soil and backfill. The Laplace equation, resulting from Darcy's law and the continuity equation, is solved using a steady-state finite-difference model to determine this field. The mass-transport equation is then solved to obtain the diffusive and advective radon entry rates through the slab; the permeable stem wall; gaps at the intersections of the slab, stem wall, and footer; and gaps in the slab. These rates are determined for variable soil, backfill, and stem-wall permeability and radium content, slab-opening width and position, slab and stem-wall diffusivity, and water table depth. The variations in soil permeability and radium content include cases of horizontally stratified soil. We also consider the effect of a gap between the edge of the slab and the stem wall that restricts the passage of soil gas from the stem wall into the house. Calculations indicate that the total radon entry rate is relatively low unless the soil or backfill permeability or radium content is high. Variations in most of the factors, other than the soil permeability and radium content, have only a small effect on the total radon entry rate. However, for a fixed soil permeability, the total radon entry rate may be reduced by a factor of 2 or more by decreasing the backfill permeability, by making the stem wall impermeable and gap-free, (possibly by constructing a one-piece slab/stem-wall/footer), or by increasing the pressure in the interior of the stem wall (by ensuring that there is a large pressure drop across the slab/stem-wall gap), thereby reducing radon entry into the wall from the soil. Use of an impermeable stem wall and a low-permeability fill in combination is predicted to reduce the radon entry rate by 71%.

Air Pollution, Indoor↗
PubMed1994

Influence of ventilation strategies on indoor radon concentrations based on a semiempirical model for Florida-style houses.

Measurements in a full-scale experimental facility are used to benchmark a semiempirical model for predicting indoor radon concentrations for Florida-style houses built using slab-on-grade construction. The model is developed to provide time-averaged indoor radon concentrations from quantitative relationships between the time-dependent radon entry and elimination mechanisms that have been demonstrated to be important for this style of residential construction. The model successfully predicts indoor radon concentrations in the research structure for several pressure and ventilation conditions. Parametric studies using the model illustrate how different ventilation strategies affect indoor radon concentrations. It is demonstrated that increasing house ventilation rates by increasing the effective leakage area of the house shell does not reduce indoor radon concentrations as effectively as increasing house ventilation rates by controlled duct ventilation associated with the heating, ventilating, and air conditioning system. The latter strategy provides the potential to minimize indoor radon concentrations while providing positive control over the quality of infiltration air.

Air Pollution, Indoor↗
PubMed1995

Cluster of five children with acute encephalopathy associated with cat-scratch disease in south Florida.

Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.

Animals↗
PubMedDate not supplied

Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: evidence of core-group transmitters and the impact of illicit antibiotics.

In 1985, 2,455 cases of infection due to penicillinase-producing Neisseria gonorrhoeae were reported from Dade County, Florida. These cases represent the largest concentration of PPNG infections reported to date in the United States. A zip code-based geographic analysis of morbidity caused by gonorrhea and PPNG identified a core area where the percentage of all gonorrhea cases due to PPNG was 31-36%. This percentage decreased in a radial pattern outward from the central core. A prospective study of patients presenting to the Dade County central clinic with gonorrhea found that men infected with PPNG were more likely to have medicated themselves with illicit antibiotics than were patients infected with penicillin-sensitive N. gonorrhoeae (odds ratio, 3.6; 95% confidence interval, 1.9-6.8). Of all self-medicated patients, 42% obtained antibiotics via illicit over-the-counter purchase at pharmacies in the hyperendemic area. In contrast to previous reports, PPNG infection was not associated with either narcotic- or prostitution-related activities. The results show that PPNG is endemic in Dade County and is arrayed in a core distribution. Antibiotic abuse may have played an important role in the Miami epidemic and in the establishment of PPNG as an endemic strain.

Adolescent↗
PubMedDate not supplied

Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: phenotypic characterization of isolates from 1983, 1984, and 1986.

Penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) have been endemic in Miami, Florida, since 1981. Strains of PPNG isolated in Miami during 1983 (60 isolates), 1984 (41 isolates), and 1986 (107 isolates) were characterized by plasmid content, auxotype/serovar (A/S) class, and susceptibility to antimicrobial agents. In 1986, 95 isolates (89%) possessed the 3.2-Megadalton (MDa) beta-lactamase plasmid; 36 (34%) of these isolates also possessed the 24.5-MDa conjugative plasmid. These results contrast with those from 1984, when 37 PPNG isolates (90%) possessed the 4.4-MDa plasmid, and most possessed the 24.5-MDa conjugative plasmid. This in turn was a reversal of the pattern seen in 1983, when only 42 (69%) possessed the 3.2-MDa plasmid, and the conjugative plasmid was rare. In 1983 and 1986, isolates possessing the 4.4-MDa plasmid were more resistant to penicillin than were isolates containing the 3.2-MDa plasmid. All isolates were susceptible to spectinomycin and ceftriaxone. In early 1986, two A/S classes accounted for 66% of all isolates. Pro/IA-1,2 and Pro/IB-2 accounted for 31 (29%) and 40 (37%), respectively, and were isolated during every week in early 1986. In contrast, isolates belonging to 14 and six A/S classes possessing the 3.2- and 4.4-MDa beta-lactamase plasmid, respectively, were isolated sporadically. The composition of the PPNG strain population in Miami is dynamic, a factor that may have important implications for the use of traditional disease intervention strategies.

Disease Outbreaks↗
PubMed1976

A diphtheria outbreak in Dade County, Florida.

During a 16-week period in late 1969, 11 cases of diphtheria (three fatal) were reported from Miami, Dade County, Florida. For each of ten previous years, two cases at most had been reported. All patients resided in a predominantly black, low socioeconomic community within the 7-square-mile Model City area. Nine patients had positive cultures for toxigenic Corynebacterium diphtheriae, mitis strain. None of the 11 patients or 22 culture-positive household contacts had been vaccinated against diphtheria. During the outbreak, one dose of diphtheria-tetanus-pertussis vaccine or tetanus-diphtheria toxoid was given to more than 90,000 residents of Model City (95%) and to more than 200,000 residents of Dade County (16%). A state law was passed in June 1971 requiring all children to be vaccinated before entering school. No subsequent cases of diphtheria were reported in the ensuing five-year period. The Miami experience suggests that prompt mass vaccination will abort the spread of epidemic diphtheria and emphasizes the need for routine vaccination to minimize morbidity and mortality.

Adolescent↗
PubMed1981

Trends of lung cancer in northern Florida.

Although the entire state of Florida has experienced an increase in lung cancer mortality during the present decade, a differential rise among white men has been observed in Duval, a county in its northeastern region. This increase is not explained by population changes or migration of cases. It is hypothesized that an industrial exposure involving paper and pulp manufacturing, shipbuilding, or petroleum may account for these findings.

Age Factors↗
PubMed1989

Renal transplantation: a 20-year experience at the University of Florida.

Substantial gains have been made in both patient and graft survival during 20 years of transplanting kidneys at the University of Florida. The number of transplant recipients yearly has increased from six in 1966 to more than 100 in 1986. The use of immunosuppression reflects our evolving understanding of transplant immunology, with current morbidity and mortality rates considerably improved over those of the early years. This paper summarizes our transplantation experience over the past two decades.

Adolescent↗
PubMed1992

Thallium poisoning: an outbreak in Florida, 1988.

In October 1988, five of seven members of a Florida family were poisoned with thallium, constituting the largest outbreak of acute thallium poisoning in the United States since thallium was banned as a rodenticide in 1972. Three patients had an acute severe neuropathy with respiratory depression; one died. The other two had no symptoms. No cases were identified among nonhousehold relatives or friends, or in the community. Of the more than 100 environmental specimens collected at the family household and tested by atomic spectroscopy, three empty and four unopened glass soft drink bottles of the same lot number yielded thallium in a concentration fatal to humans. All family members who consumed the soft drink were poisoned (5/5) as compared with none of those who did not (0/2). Because poisoning was clustered to the family and police investigators provided evidence that the poisoning was deliberately targeted to the family, it was assumed that no other soft drink bottles contained thallium, and it was decided not to recall all soft drink bottles with the same lot number. A year later a neighbor of the family was arrested and convicted of the murder.

Adolescent↗
PubMed1998

Lifetime use of alternative therapy: a study of Florida residents.

BACKGROUND: Clinically relevant questions remain about who uses alternative medicine, which treatments they use and why. METHODS: The random digit dialing survey method was used to ask Florida residents about their lifetime use of 11 different alternative therapies. The response rate was 54% (n=1,012). RESULTS: Sixty-two percent of respondents had used one or more of these alternative therapies. Women, unmarried persons, those with regular physicians, and those with poor self-rated health were the highest users. Home remedies were used by 31% of the respondents, followed by special diets (24%), relaxation techniques (20%), and herbal medicines (18%). Acupuncture, biofeedback, energy healing, and hypnosis were used by less than 5% of the sample. CONCLUSIONS: Most respondents used an alternative therapy at some time. Ethnic diversity may be a useful marker for more diversity in alternative therapy. These results affirm the need for accelerated physician education in alternative medicine to help physicians respond appropriately to patients' inquiries about alternative therapy.

Acupuncture Therapy↗
PubMed1999

Squamous cell carcinoma of the glottic larynx: a review emphasizing the University of Florida philosophy.

BACKGROUND: Squamous cell carcinoma of the glottic larynx is strongly related to cigarette smoking and excessive ethanol intake. It is the most common head and neck cancer other than skin cancer. METHODS: We reviewed pertinent literature relative to etiology, epidemiology, and treatment results, with emphasis on the treatment philosophy at the University of Florida. RESULTS: The goals of treatment are cure and retention of a functional larynx. The probability of achieving both goals is high for patients with early disease. In contrast, a significant proportion of patients with advanced disease may be cured but must have a total laryngectomy as part of the treatment. CONCLUSIONS: Treatment options are influenced by the extent of disease and patient preference. Options include transoral laser resection, open partial laryngectomy, radiation therapy, and total laryngectomy. Adjuvant chemotherapy may have a role in advanced disease.

Adult↗
PubMed1999

South Florida survey on the relationship between academic medical centers and community physicians.

BACKGROUND: Little is known about the relationship between academic medical centers (AMCs) and community physicians (CPs). We examined this relationship for an individual specialty-dermatology. METHODS: South Florida dermatologists were queried regarding their practice and referral patterns, as well as the effect of managed care on these patterns. RESULTS: On average, the respondents see 7,342 patients annually. Ninety-eight percent refer one or more patients for aid in therapy (39%) and diagnosis (27%). Most were satisfied with the amount (63%) and quality (77%) of the service provided. Overall, only 0.2% of patients are referred. Sixty percent reported that managed care caused alterations in referral patterns. CONCLUSIONS: We found that, although community dermatologists diagnose and treat the vast majority of patients with skin disease seen by dermatologists, they also use and are satisfied with the AMC's services. Changes in referral patterns have occurred but have not negatively affected the relationship between the AMC and the CP.

Academic Medical Centers↗
PubMed1995

Clinical spectrum of HTLV-I in south Florida.

A total of 113 patients with infection due to human T-cell leukemia virus type 1 (HTLV-I) were evaluated at the University of Miami from January 1988 to March 1993. Forty patients were identified with adult T-cell leukemia/lymphoma (ATLL) and 63 with HTLV-I-associated myelopathy (HAM). Three had concomitant ATLL and HAM. Two HAM patients co-infected with human immunodeficiency virus type 1 (HIV-I) developed clonal lymphoproliferative disease during the study period. Patients with ATLL have a poor prognosis; multiple chemotherapy regimens including high-dose cytotoxic agents have been utilized with a small impact on survival. Most of our patients are currently treated with experimental regimens. Rheumatologic or autoimmune illnesses were identified, mostly in HAM patients, and a small number developed immunodeficiencies in the absence of other definable etiologic factors. Most of the patients were immigrants from areas of endemicity in the Caribbean basin, although many Americans were also recognized. HTLV-I/II infection was diagnosed serologically and typed as HTLV-I by polymerase chain reaction (PCR) or a modified Western blot when a DNA sample was not available. In 24 of 40 patients with ATLL, Southern blot hybridization performed on DNA extracted from peripheral blood lymphocytes or tumor tissue demonstrated clonal HTLV-I integration. In South Florida, ATLL and HAM are now seen frequently. Since HTLV-I infection is associated with a 4% lifetime risk of developing ATLL and an additional 0.25% lifetime risk for developing HAM, a large pool of asymptomatically infected individuals must exist here.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Reevaluation of the effectiveness of environmental designs to reduce robbery risk in Florida convenience stores.

Prevention of intentional injuries to convenience store workers has focused on prevention of robbery. Data from a cross-sectional study of the effectiveness of environmental designs to deter robbery in Florida convenience stores were reanalyzed in order to determine the effect of confounding from local crime risk factors and other environmental designs on robbery rate. Results of this reanalysis were applied to a review of the literature. Of 14 store design factors and 5 local crime risk factors considered, concealed access/escape routes, cash register located at the back or the side of the store, high county crime rate, and high county population size were significantly associated with increased robbery rate. Poor cash handling policy was significantly related to a decreased robbery rate. Results also indicated that local crime factors and some environmental designs confound the relationship between other environmental designs and robbery rate. Conclusions from this reanalysis indicated that studies of the effectiveness of environmental designs to deter robbery must adjust for confounding. Although environmental design tends to be an effective robbery deterrent strategy, results from studies have been inconsistent as to the effectiveness of specific design factors. This inconsistency is partially explained by lack of adjustment for confounding from local crime risk factors and multiple environmental design factors. Areas for further research are discussed.

Crime↗
PubMed2000

Profiles in courage: evolution of Florida's quality improvement and performance measurement system.

As public health begins to embrace performance standards, it is important to critically examine state and local health department quality improvement and performance measurement systems. In this article, Florida's decade-long evolution of quality improvement and performance measurement as well as their integration are described. Lessons for other states are discussed along with implications for implementing performance standards for state and local health departments.

Adolescent↗
PubMed2002

Predicting death from HIV/AIDS: a case-control study from Florida public HIV/AIDS clinics.

BACKGROUND: After markedly decreasing for 3 years, HIV/AIDS mortality declined only slightly in 1999. METHODS: The authors conducted a case-control study in four Florida urban public health HIV clinics to evaluate modifiable factors associated with HIV/AIDS mortality in a non-research setting. Structured chart review was conducted for 120 case-patients who died in 1999 and for 240 randomly selected control-patients. Risk factors associated with death in univariate analysis were entered into three conceptually related, matched logistic regression models. RESULTS: In the final multivariate model, homelessness (adjusted odds ratio [AOR], 9.98; 95% confidence interval [CI], 2.34-42.5), Medicaid insurance (AOR, 3.10; 95% CI, 1.43-6.74), having a documented adherence problem (AOR, 3.50; 95% CI, 1.64-7.47), injection drug use (AOR, 2.46; 95% CI, 1.11-5.43), non-specific liver failure (AOR, 76.9; 95% CI, 6.79-870.9), interrupted highly active antiretroviral therapy (HAART) secondary to side effects (AOR, 4.00; 95% CI, 1.46-10.9), and not receiving HAART (AOR, 2.62; 95% CI, 1.03-6.68) were independent predictors of mortality. CONCLUSIONS: In addition to medical and clinical indicators, several sociobehavioral-demographic factors remained important throughout the multivariate analysis. Improvement in care should include a focus on social circumstances of infected people. Special attention to the homeless, those with adherence problems, and those with liver disease is clearly indicated.

Acquired Immunodeficiency Syndrome↗
PubMed2003

HIV infection and associated risks among young men who have sex with men in a Florida resort community.

OBJECTIVE: Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men (MSM). Most of these studies used samples of convenience. The authors obtained population-based data on young MSM living in South Beach (Miami Beach, Florida), a resort community where some of the highest AIDS rates in the United States have been reported. METHODS: A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM living in South Beach. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing. RESULTS: From the 2,622 screened residential units, 100 mostly white and Hispanic MSM (92.6% of eligible participants) were enrolled in the study. Fifteen percent of the sample tested positive for antibodies to HIV. White and Hispanic MSM had similar rates. Forty-five percent of the sample reported engaging in unprotected anal intercourse (UAI) in the prior 12 months, and 31% reported UAI with a nonprimary partner. The estimated annual incidence of HIV infection was 6.3%. CONCLUSION: The high prevalences of UAI and HIV infection in South Beach attest to a previously undocumented public health concern. The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas.

Adult↗