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PubMed2002

Recruitment feasibility and HIV prevention intervention acceptability among rural north Florida blacks.

PROBLEM: There has been limited HIV prevention intervention among Southeastern rural Blacks residing in Florida. The prevalence of HIV/AIDS among this population increasingly supports the need for HIV prevention intervention. METHODS: The primary focus of this article is the process and outcome evaluations of the feasibility of recruiting rural Blacks to accept and participate in HIV prevention intervention and HIV testing and return for their test results. The interventions were conducted over a 5-month period. FINDINGS: One hundred rural residents participated in the HIV prevention intervention, which was well received except for completing the preintervention and postintervention surveys. Thirty-nine percent of the adult participants consented to OraSure HIV testing, and 75% of those tested returned for their results. CONCLUSION: Community-based HIV prevention intervention, including condom demonstration, can successfully be conducted with rural populations. Rural Blacks will participate in HIV testing using OraSure.

Adolescent↗
PubMed2002

Community-based education and problem solving: the Community Health Scholars Program at the University of Florida.

BACKGROUND: Although many medical schools understand and support the need for community service as part of educational training, this goal has been difficult to operationalize. DESCRIPTION: The Community Health Scholars program, a joint effort between the Area Health Education Center and the University of Florida, places 1st-year medical students in clinical settings with underserved populations, both rural and urban. The stated goal of the experience is to solve a problem identified by the communities as well as provide exposure to community practice and environment. EVALUATION: The program provided notable services to many communities. More than 80% of participating students believed it was a good or excellent learning experience; more than 90% believed that the program affected their career choice; and 100% believed that the program should be continued. Although this is a 1st-year program, students were not surveyed until their last year, suggesting that the program may have a lasting effect. CONCLUSIONS: This collaborative program successfully provided a service-learning experience for students while promoting solutions to problems in underserved communities.

Community Health Planning↗
PubMed2005

Vitamin d deficiency and seasonal variation in an adult South Florida population.

Hypovitaminosis D is associated with impaired neuromuscular function, bone loss, and fractures. If a person is not taking a vitamin supplement, sun exposure is often the greatest source of vitamin D. Thus, vitamin D deficiency is not uncommon in the winter, particularly in northern latitudes. Our goal was to establish the prevalence of vitamin D deficiency in south Florida (U.S.), a region of year-round sunny weather. At the end of the winter, 212 men and women attending an internal medicine clinic at a local county hospital were enrolled for measurements of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D, and PTH; 99 participants returned at the end of summer. The mean (+/-sd) winter 25(OH)D concentration was 24.9 +/- 8.7 ng/ml (62.3 +/- 21.8 nmol/liter) in men and 22.4 +/- 8.2 ng/ml (56.0 +/- 20.5 nmol/liter) in women. In winter, the prevalence of hypovitaminosis D, defined as 25(OH)D less than 20 ng/ml (50 nmol/liter), was 38% and 40% in men and women, respectively. In the 99 subjects who returned for the end of summer visit, the mean 25(OH)D concentration was 31.0 +/- 11.0 ng/ml (77.5 +/- 27.5 nmol/liter) in men and 25.0 +/- 9.4 ng/ml (62.5 +/- 23.5 nmol/liter) in women. Seasonal variation represented a 14% summer increase in 25(OH)D concentrations in men and a 13% increase in women, both of which were statistically significant. The prevalence of hypovitaminosis D is considerable even in southern latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis.

Adolescent↗
PubMed2005

Antitumour activity of 3-chlorodeoxylapachol, a naphthoquinone from Avicennia germinans collected from an experimental plot in southern Florida.

As part of an ongoing collaborative effort to discover new anticancer agents from plants, an extract obtained from the leaves and twigs of Avicennia germinans, collected in a coastal area of southern Florida, was identified as possessing cytotoxic activity in a panel of human cancer cell lines. Fractionation of the petroleum ether partition, using cytotoxicity to guide the fractionation, led to the isolation of 3-chlorodeoxylapachol. The antitumour potential of 3-chlorodeoxylapachol was demonstrated with the in-vivo hollow fibre assay, a model of antitumour activity using human cancer cell-filled fibres implanted into mice. The possibility that this compound is an artefact of the isolation procedure was ruled out by liquid chromatography-mass spectrometry analysis of extracts prepared without the use of chlorinated solvent. In conclusion, 3-chlordeoxylapachol, a secondary metabolite obtained from the chloroform-soluble extract of a mangrove tree, was cytotoxic in a panel of human cancer cells, and active against KB human cancer cells in the murine hollow fibre antitumour model, with selectivity in KB cells for the intravenous site at lower doses, indicating possible metabolic activation.

Antineoplastic Agents↗
PubMed1989

The Florida Health Care Access Act: a blended regulatory/competitive approach to the indigent health care problem.

The problem of indigent health care has received much attention from governmental officials, health care providers, health policy analysts, and others. A majority of states have generated legislative proposals to deal with the problem, although their strategies differ in terms of method and scope. This article discusses Florida's approach to the problem as contained in the Health Care Access Act of 1984 and subsequent legislation. The article will provide background on the reasons a hospital assessment strategy was chosen as the funding mechanism and will examine the problems that occurred during the implementation phase of the legislation.

Advisory Committees↗
PubMed1995

Neurosurgery at the University of Florida.

The significant factors in the development of the neurosurgery program at the University of Florida have been the funding for 10 endowed chairs and a Brain Institute, the achievement of departmental status in the College of Medicine, the collaborative research with a strong Department of Neuroscience, and the strong commitment by the faculty to subspecialty neurosurgery and to service in the national neurosurgical organizations.

Curriculum↗
PubMed2005

Radiosurgery in the treatment of malignant gliomas: the University of Florida experience.

OBJECTIVE: To review a single-institution's 12-year experience of treating malignant gliomas with linear accelerator-based radiosurgery. METHODS: One hundred patients were treated for malignant gliomas at the University of Florida between May 1, 1989, and June 12, 2002. Patient variables were entered into a radiosurgery database in a prospective manner. The endpoint of the study was length of survival from the time of diagnosis. The minimum length of follow-up was 18 months or until death. In an attempt to control for selection bias, we used the Radiation Oncology Therapy Group's (RTOG) recursive partitioning categories to compare survival in our group of radiosurgically boosted patients with the RTOG historical database. RESULTS: Recursive partitioning analysis classification was significantly associated with survival. Compared with historical controls, this cohort of patients demonstrated a decreased survival for recursive partitioning analysis Class I and II patients, similar survival for Class III and IV patients, and increased median survival for Class V patients. Other variables demonstrating a statistically significant impact on survival were eloquent location and recurrent disease. CONCLUSION: The results of this study and those of RTOG 93-05 suggest that the reported benefit of upfront radiosurgical boost for malignant gliomas is the result of selection bias. The possibility remains that radiosurgical boost is of benefit in recurrent tumors, especially those in RTOG Class V.

Adult↗
PubMed2003

Neurobehavioral performance and work experience in Florida farmworkers.

Farmworkers experience many work-related hazards, including exposure to neurotoxicants. We compared neurobehavioral performance of 288 farmworkers in central Florida who had done farm work for at least 1 month with 51 controls who had not. Most of the farmworkers had worked in one or more of three types of agriculture: ornamental ferns, nurseries, or citrus fruit. We collected information on farm work history in a structured interview and evaluated neurobehavioral performance using a battery of eight tests. Analyses were adjusted for established confounders including age, sex, education, and acculturation. Ever having done farm work was associated with poor performance on four tests--digit span [odds ratio (OR) = 1.90; 95% confidence interval (CI), 1.02-3.53], tapping (coefficient = 4.13; 95% CI, 0.00-8.27), Santa Ana test (coefficient = 1.34; 95% CI, 0.29-2.39), and postural sway (coefficient = 4.74; 95% CI, -2.20 to 11.7)--but had little effect on four others: symbol digit latency, vibrotactile threshold, visual contrast sensitivity, and grip strength. Associations with farm work were similar in magnitude to associations with personal characteristics such as age and sex. Longer duration of farm work was associated with worse performance. Associations with fern work were more consistent than associations with nursery or citrus work. Deficits related to the duration of work experience were seen in former as well as current farmworkers, and decreased performance was related to chronic exposure even in the absence of a history of pesticide poisoning. We conclude that long-term experience of farm work is associated with measurable deficits in cognitive and psychomotor function.

Adult↗
PubMed2004

Abnormal bone composition in female juvenile American alligators from a pesticide-polluted lake (Lake Apopka, Florida).

Reproductive disorders have been found in pesticide-exposed alligators living in Lake Apopka, Florida (USA). These disorders have been hypothesized to be caused by exposure to endocrine- disruptive estrogen-like contaminants. The aim of this study was to expand our analysis beyond previous studies by investigating whether bone tissue, known to be affected by sex steroid hormones, is a potential target of endocrine disruptors. Long bones from 16 juvenile female alligators from Lake Apopka (pesticide-contaminated lake) and Lake Woodruff (control lake) were evaluated by peripheral quantitative computed tomography. We observed significant differences in bone composition, with female alligators from the contaminated lake having greater trabecular bone mineral density (BMD), total BMD, and trabecular mineral content compared with females from the control lake (p < 0.05). Increased trabecular and total BMD measurements suggest that juvenile female alligators from Lake Apopka were exposed to contaminants that created an internal environment more estrogenic than that normally observed. This estrogenic environment could be caused by both natural and anthropogenic compounds. Effects on BMD indicate interference with bone homeostasis. We hypothesize that contaminants present in the lake inhibit the natural and continuous resorption of bone tissue, resulting in increased bone mass. Although this is the only study performed to date examining effects of environmental estrogenic compounds on alligator bones, it supports previous laboratory-based studies in rodents. Further, this study is important in demonstrating that the alterations in morphology and physiology induced in free-ranging individuals living in environments contaminated with endocrine-active compounds are not limited to a few systems or tissues; rather, effects can be observed in many tissues affected by these hormones.

Alligators and Crocodiles↗
PubMed2006

Water quality influences reproduction in female mosquitofish (Gambusia holbrooki) from eight Florida springs.

Contamination of freshwater ecosystems with nitrate is a growing global concern. Although nitrate pollution is recognized as a cause of aquatic eutrophication, few studies have examined the possible physiological impacts of nitrate exposure. In this study, we surveyed several reproductive variables of viviparous female Gambusia holbrooki (Poeciliidae) captured from eight springs in Florida. The eight springs represent a gradient of nitrate contamination (1-5 mg/L nitrate-nitrogen). We had two objectives in this study: to describe reproductive biology of female mosquitofish in the springs and to understand reproductive variation in the context of water quality, particularly the nitrate concentration. Our data show a significant negative association between nitrate and both dry weight of developing embryos and rate of reproductive activity among mature females. In addition, variation in Gambusia condition index and embryo number and dry weight was related to temperature variation, and hepatic weight was negatively related to dissolved oxygen concentration. Finally, we observed that many of the measured reproductive variables were interrelated and changeable, depending on gestational stage. Specifically, we provide evidence that maternal support of the embryo occurs at least during the first two thirds of gestation and that female fecundity is affected by an apparent tradeoff between embryo size and embryo number.

Animals↗
PubMed1997

Reproductive toxins and alligator abnormalities at Lake Apopka, Florida.

The alligator population at Lake Apopka in central Florida declined dramatically between 1980 and 1987. Endocrine-disrupting chemicals and specifically DDT metabolites have been implicated in the alligators' reproductive failure. The DDT metabolite hypothesis is based largely on the observation of elevated concentrations of p,p-DDE and p,p-DDD in alligator eggs obtained from Lake Apopka in 1984 and 1985. In the following commentary, we draw attention to two nematocides that are established reproductive toxins in humans, dibromochloropropane (DBCP) and ethylene dibromide (EDB), which could also have played a role in the reproductive failure observed in alligators from Lake Apopka in the early 1980s.

Alligators and Crocodiles↗
PubMed1999

A comparison of the reproductive physiology of largemouth bass, Micropterus salmoides, collected from the Escambia and Blackwater Rivers in Florida.

Largemouth bass (LMB), Micropterus salmoides, were taken from the Escambia River (contaminated site) and the Blackwater River (reference site) near Pensacola, Florida. The Escambia River collection occurred downstream of the effluent from two identified point sources of pollution. These point sources included a coal-fired electric power plant and a chemical company. Conversely, the Blackwater River's headwaters and most of its length flow within a state park. Although there is some development on the lower part of the Blackwater River, fish were collected in the more pristine upper regions. Fish were captured by electroshocking and were maintained in aerated coolers. Physical measurements were obtained, blood was taken, and liver and gonads were removed. LMB plasma was assayed for the concentration of 17ss-estradiol (E2) and testosterone using validated radioimmunoassays. The presence of vitellogenin was determined by gel electrophoresis (SDS-PAGE) and Western blotting using a monoclonal antibody validated for largemouth bass vitellogenin. No differences in plasma concentrations of E2 or testosterone were observed in females from the two sites. Similarly, males exhibited no difference in plasma E2. However, plasma testosterone was lower in the males from the contaminated site, as compared to the reference site. Vitellogenic males occurred only at the contaminated site. Additionally, liver mass was proportionately higher in males from the contaminated site, as compared to males from the reference site. These data suggest that reproductive steroid levels may have been altered by increased hepatic enzyme activity, and the presence of vitellogenic males indicates that an exogenous source of estrogen was present in the Escambia River.

Analysis of Variance↗
PubMed1996

Gender and ethnic differences in the prevalence of alcohol, cigarette, and illicit drug use over time in a cohort of young Hispanic adolescents in south Florida.

The purpose of this study was to describe patterns of substance use among young Hispanic adolescents of Cuban and Central/South American heritage, many of whom are recent immigrants to the U.S. At present there are very little epidemiologic data on these Hispanic ethnic subgroups, particularly for girls. A cohort of 848 middle school boys and girls in Miami, Florida completed questionnaires in 7th, 8th, and 9th grades concerning their use of alcohol, cigarettes, marijuana, and other illicit drugs. African Americans and White non-Hispanics were used as comparison groups. In general, White non-Hispanics and U.S.-born Hispanics had the highest lifetime and past year prevalence rates of substance use. While no statistically significant gender differences were found for any of the racial/ethnic groups, the use of substances among Hispanic girls often exceeded that of their male counterparts. A progressive increase in use of alcohol, cigarettes, marijuana, and other illicit drugs was evident over the two and one-half year duration of the study for both gender groups.

Adolescent↗
PubMed2000

Balancing resources and risk: selecting home care clients in Florida's CARES program.

Selecting home care patients who would otherwise go into a nursing home always involves error: serving too many or two few. To clarify the choices program and case managers must make, we propose a risk-based alternative to current selection methods that involves scientifically-derived variable weighting and conscious choice of cut-off score for bestowing home care eligibility. We illustrate our proposal with data from Florida's Comprehensive Assessment and Review of Long-term Care Services (CARES) program. Using logistic regression we identify characteristics that distinguish clients recommended for nursing home placement from those referred to the community and use these results to estimate the risk of nursing home recommendation for each client. An approach to using these risk scores to determine eligibility is demonstrated along with assessment of the impact of alternative risk score cut-offs on denying care to as many as half or as few as 5% of clients served.

Activities of Daily Living↗
PubMed1996

Race and gender differences in the distribution of home and community-based services in Florida.

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.

Aged↗
PubMed2001

Women on welfare: a study of the Florida WAGES population.

Using the ASI, a multi-dimensional survey instrument, data were collected on women in Florida's welfare program (WAGES). The women manifested serious problems in terms of physical and mental health, employment skills and childcare needs. Length of time on welfare was strongly associated with the severity of recipients' problems. Women with 2 + years on welfare were significantly more likely to have problems. However, substance use was lower than anticipated which may be because substance abusers are dropping out of welfare. This possibility raises concerns that, rather than going into the workfore, women may be returning to the streets. If so, instead of reducing the welfare costs, we are shifting those costs to local health, social service and criminal justice systems.

Data Collection↗
PubMed2004

Tobacco Use Prevention Education (TUPE) Programs in the State of Florida: correlates and predictors of teachers' perceptions of program effectiveness.

In Florida, data from telephone surveys were used to identify correlates and predictors of teachers' perceptions of the effectiveness of tobacco use prevention education (TUPE) prior to the implementation of the Tobacco Pilot Project (TPP). A 40% random sample of public middle and high schools yielded 296 middle school teachers (MST) and 282 high school teachers (HST). Higher perceived program effectiveness ratings were associated with: using peer leaders, frequent evaluations, parental involvement, few barriers, high student interest, and low tolerance norms for tobacco use. The importance of program features and implementation contexts to teachers' perceived program effectiveness ratings is highlighted.

Adolescent↗
PubMed2004

Nutrition risk and associated factors in congregate meal participants in northern Florida: role of Elder Care Services (ECS).

Nutrition is a key for extending quality of life of the elderly. Factors associated with nutritional risk in elders were identified with a modified nutrition screen initiative checklist. High, moderate and low nutritional risk was seen in 31, 46 and 23%, respectively, of 324 elders in six congregate meal sites in northern Florida. High nutritional risk was associated with urban residency, females, being African American, self-reported poor health and irregular visits to medical/health professionals. African American females living in urban areas with limited access to health care are most vulnerable.

Aged↗