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PubMed2001

Physician practice volume and alternative surgical treatment for breast cancer in Florida.

OBJECTIVE: To determine whether surgeon procedure volume is related to the selection of a surgical option (mastectomy versus breast-conserving surgery) for breast cancer treatment . STUDY SETTING/STUDY DESIGN: Secondary data sources were used to study surgical procedures performed for female breast cancer in Florida during the years 1997-98 in a retrospective population-based analysis. DATA EXTRACTION: Surgical procedures for female breast cancer in Florida were identified during 1997 and 1998 (N = 28,380) by combining data from the Florida Acute Hospital and Short-term Psychiatric Inpatient Data Collection and the Ambulatory Outpatient Data Collection. A total of 1,320 physicians who provided breast surgical procedures in Florida during the two-year study period were identified. PRINCIPAL FINDINGS: After controlling for selected patient and physician characteristics, the lowest volume surgeons were nearly twice as likely to perform mastectomies rather th an breast-conserving surgery compared with the highest volume group. Patients with Medicaid as an insurer were also nearly twice as likely to receive mastectomies. Patient demographic factors such as age, while statistically significant, were shown to be far less predictive of procedure choice. Forty-two percent of the physicians performed fewer than two surgeries on average per year. CONCLUSIONS: Patients treated by lower volume physicians have a greater likelihood of receiving mastectomies than do those patients treated by higher volume physicians.

Age Factors↗

PubMed2006

Mortality associated with Hurricane Katrina--Florida and Alabama, August-October 2005.

On August 25, 2005, Hurricane Katrina made landfall between Hallandale Beach and Aventura, Florida, as a Category 1 hurricane, with sustained winds of 80 mph. Storm effects, primarily rain, flooding, and high winds, were substantial; certain areas reported nearly 12 inches of rainfall. After crossing southern Florida and entering the Gulf of Mexico, the hurricane strengthened and made landfall in southeastern Louisiana on August 29 as a Category 3 hurricane, with sustained winds of 125 mph. Katrina was one of the strongest hurricanes to strike the United States during the past 100 years and was likely the nation's costliest natural disaster to date. This report summarizes findings and recommendations from a review of mortality records of Florida's Medical Examiners Commission (FMEC) and the Alabama Department of Forensic Science (ADFS). CDC was invited by the Florida Department of Health (FDOH) and the Alabama Department of Public Health (ADPH) to assess the mortality related to Hurricane Katrina. The mortality review was intended to provide county-based information that would be used to 1) define the impact of the hurricane, 2) describe the etiology of deaths, and 3) identify strategies to prevent or reduce future hurricane-related mortality. Combined, both agencies identified five, 23, and 10 deaths, respectively, that were directly, indirectly, or possibly related to Hurricane Katrina. Information from the characterization of these deaths will be used to reduce hurricane-related mortality through early community awareness of hurricane-related risk, prevention measures, and effective communication of a coordinated hurricane response plan.

Alabama↗

PubMed2006

Rapid needs assessment of two rural communities after Hurricane Wilma--Hendry County, Florida, November 1-2, 2005.

On October 24, 2005, Hurricane Wilma, the most intense hurricane (882 mb) ever recorded in the Atlantic Basin, made landfall on the southern tip of Florida. By landfall, Wilma had been downgraded from a Category 5 (i.e., winds of > or =156 mph) to a Category 3 hurricane but still contained winds of >110 mph. The storm moved slowly over the Florida Keys and south Florida, causing extensive wind and flood damage to homes and businesses. Approximately 3 million households were left without power, and thousands of residents were displaced to temporary shelters; 10 deaths were storm related. On October 27, the Florida Department of Health (FDOH) asked CDC and the North Carolina Division of Public Health (NCDPH) for assistance in performing a rapid needs assessment of communities most affected by the storm. On the basis of information from local public health officials, field assessment teams, and electric power companies, FDOH identified Hendry County, a rural county with a 2000 population of 36,210, as the most severely affected area. Two Hendry County communities, Montura Ranch Estates and Pioneer Plantation in the town of Clewiston (pop. 6,460), were of particular concern. According to the 2000 census, nearly 20% of Clewiston residents lived below the poverty level. The assessment determined that approximately one third of households also had been affected by at least one other hurricane that preceded Wilma during 2004 and 2005. More than half of the households surveyed lived in homes that were damaged but still habitable, and 10% of households in Montura Ranch Estates reported their homes as uninhabitable; approximately 73% of households had not received information about how to remain safe during clean-up activities. Results of the assessment were immediately provided to the Hendry County Emergency Operations Center, Hendry County Health Department, and FDOH for allocation of resources to help these communities recover from the hurricane.

Disasters↗

PubMed1991

Epidemiology of AIDS in Florida.

Florida is third in the nation in the cumulative number of AIDS cases. The epidemic in the state has grown steadily since 1981, clustering initially in metropolitan South Florida but dispersing to other urban and nonurban areas. Heterosexually transmitted AIDS is fast increasing and is more than twice as common in Florida than the United States; however, homosexual/bisexual men and intravenous drug-using men and women continue to represent the majority of new cases. Special serologic studies of the prevalence of HIV infection provide a timely view of the dynamics and characteristics of the epidemic in various segments of the state's population. Data from a large, ongoing serosurvey suggest that about one in every 220 childbearing women is HIV-infected, a finding consistent with Florida's rank of second nationally in the number of pediatric AIDS cases.

Acquired Immunodeficiency Syndrome↗

PubMed1990

The Pew National Dental Education Program at the University of Florida College of Dentistry.

The University of Florida College of Dentistry is located in a dynamic environment. Socially, economically, and demographically, the state of Florida manifests changes reflective of the entire nation, i.e., increasing numbers of elderly and minorities, a fluctuating, diversified economy, and altered cultural values. The explosive growth unique to this state has both positive and negative implications for all aspects of its culture and economy. The college resides in a maturing, research-oriented university facing vigorous competition from other major universities in the state. Within the Health Science Center, the college was occupied during the first decade of its existence with development of an innovative curriculum, and now it must turn its attention to a new emphasis on research and service. A process of strategic planning was conducted at the University of Florida College of Dentistry from January 1986 through June 1987. Four consultant groups representing the college, the university, organized dentistry in Florida, and outside consultants, were guided by a steering committee in a thorough evaluation of the external and internal environment of the institution.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Dental↗

PubMed1985

Serological observations on the epidemiology of bluetongue virus infections in the Caribbean and Florida.

Serological surveys of cattle, sheep and goats have confirmed that infection with bluetongue virus (BTV) is common in Florida, Puerto Rico and St. Croix in the USA, in the Caribbean countries of Jamaica, St. Kitts/Nevis, Antigua, St. Lucia, Barbados, Grenada, Trinidad and Tobago, and the Bahamas, and in the South American countries of Guyana and Suriname. In most countries, over 50% of ruminant livestock have antibody to BTV as assessed by the bluetongue immunodiffusion (BTID) test. A sentinel animal system operating in Florida and 4 islands in the Caribbean has established that the transmission of BTV is seasonal, with most animals becoming infected in late summer and fall. In Florida, it appears that there may be some years when little virus transmission occurs among cattle. Examination of sera from yearling animals and sentinels in the region for antibody to the range of serotypes of BTV recognized worldwide, has resulted in a) the isolation of BTV type 2 from cattle in Florida - the 1st time this virus has been identified in the Western Hemisphere - and b) the recognition that the range of serotypes of BTV present in the Caribbean may be different from those in the USA. No clinical disease has been associated with BTV during the period of these studies (1979-83).

Animals↗

PubMed1988

Helminths of the Florida manatee, Trichechus manatus latirostris, with a discussion and summary of the parasites of sirenians.

We examined 215 Florida manatees (Trichechus manatus latirostris) at necropsy to determine the helminth fauna. Six species were identified: Heterocheilus tunicatus (Nematoda: Ascaridoidea); Anoplocephala sp. (Cestoda: Cyclophyllidea); and 4 species of trematodes, Cochleotrema cochleotrema (Digenea: Opisthotrematidae), Chiorchis fabaceus (Digenea: Paramphistomatidae), Nudacotyle undicola (Digenea: Nudacotylidae), and Moniligerum blairi (Digenea: Opisthotrematidae). Seventy-three percent of the manatees examined were infected with at least 1 species of helminth. The mean number of species of helminths per infected manatee was 1.9 with a range of 1-4. Fifty-nine manatees were helminth-free; 30 of these were calves. No associations were found between the intensity of helminth infections and host sex, age class, season, and geographic location of recovery, or cause of death. Differences in parasite prevalence between age classes were highly significant for Chiorchis, Cochleotrema, and Heterocheilus, due to a low number of infected calves. A higher prevalence of Cochleotrema was found in manatees recovered from eastern Florida, and Heterocheilus was evident in significantly more manatees from western and souther Florida. Comparisons in the parasite fauna are made among Florida manatees and other sirenian populations, and a brief review of sirenian parasites is included.

Animals↗

PubMed1995

Translocation of coyote rabies--Florida, 1994.

Translocation of a rabies variant from one area to another has been identified increasingly in the United States. During November and December 1994, rabies was diagnosed in five dogs from two associated kennels in Florida; in addition, two other dogs being kept at one of the kennels died with suspected, but unconfirmed, rabies. Rabies virus recovered from the five dogs was identified as a variant not previously found in Florida but endemic in coyotes (Canis latrans) in south Texas. The suspected source of infection was translocation of infected coyotes from Texas to Florida. This report summarizes the findings of an investigation of these cases by the Alachua County Public Health Unit, the Florida Department of Health and Rehabilitative Services, and CDC.

Animals↗

PubMed1994

Eye care for patients with diabetes in the state of Florida: status in 1988.

BACKGROUND: More than 14 million Americans are suspected of having diabetes with fewer than half of those currently diagnosed. Diabetes is the number one cause of new cases of blindness in persons 20-74 years of age. METHODS: This study was performed in the state of Florida to determine both the accessibility of eye care as well as the similarities and differences in the practice behavior patterns of optometrists and ophthalmologists for patients with diabetes. RESULTS: The results of two surveys sent to both the Florida Society of Ophthalmology and the Florida Optometric Association by the Florida Diabetes Retinopathy Task Force (FDRTF) were analyzed. The results indicated better accessibility for diabetics to optometrists (81 percent of counties) than ophthalmologists (55 percent of counties). In addition, the results demonstrated strong similarities in practice patterns between the two professions. The results also indicate that primary care medical doctors do not routinely take advantage of the practicing optometrist for the examination of the diabetic patients in their practices. CONCLUSIONS: The poor utilization of the primary care optometrist creates a gap in the health care delivery for the patient with diabetes. This gap may contribute to the increase in the complication of diabetic retinopathy.

Diabetic Retinopathy↗

PubMed1994

Pregnancy care liability misperceptions among medical students in Florida.

BACKGROUND: Previous studies have demonstrated a professional liability insurance (PLI) fee misperception among medical students that had a direct influence on their subsequent decision making concerning the provision of pregnancy care (PC) in family practice (FP). In Florida, the paucity of family physicians providing PC and prenatal services led to the present study, which was designed to survey those senior medical students in Florida who were interested in FP to determine their opinions regarding pregnancy care-related liability issues. METHODS: All fourth-year medical students in the three allopathic medical schools in Florida who were members of a family practice interest group (FPIG) were mailed a short questionnaire by an independent researcher. The questionnaire asked students about a) whether they planned to deliver babies in practice, b) the cost of first-year liability insurance, and c) the risk of being sued if they provided PC in family practice. RESULTS: Fifty-one medical students (64% of the FPIG members in Florida) provided responses to the mail survey. Of the 51 respondents, 57% plan to enter FP residencies, and 31% were either somewhat likely or very likely to provide PC in FP. Those unlikely to do PC listed PLI cost and risk as their primary concerns. A comparison of medical students planning to provide PC with those not planning to provide PC services revealed average estimates of PLI premiums that were discordant by $5,000 per year. Furthermore, estimates in both groups exceeded the actual first-year rates of PLI insurance by more than $20,000 per year. Ninety percent of the students estimated that the actual risk of being sued for malpractice while providing PC was "high." Students' perceptions of PC PLI cost, and risk of being sued, were learned primarily from sources outside of the medical school. CONCLUSIONS: This study suggests a problem in the medical education of FP-bound students that allows students to develop misperceptions about the liability cost and risk of providing PC in FP.

Adult↗

PubMed1993

Survey of Florida physicians. Characteristics and satisfaction.

Data from a 1991 physician survey jointly sponsored by the Florida Medical Association and the Florida Physicians Association are used to assess characteristics and satisfaction of Florida physicians in the current environment of increased managed care initiatives. Significant predictors of HMO affiliation include an urban practice location, a low proportion of Medicare patients, and Hispanic ethnicity. Income is negatively associated with HMO-affiliation, although not significantly. Physicians affiliated with HMOs are less satisfied than their counterparts with respect to current and future earnings, skills enhancement opportunities, time with patients, patient appreciation, specialty referral systems, overall quality of practice, opportunity to practice in desired manner, and overall satisfaction. Other results showed that Florida's primary care physicians are less satisfied than other physicians across some components of their practices. Also, HMO-affiliated physicians who participate in managerial decision-making are significantly more satisfied than other physicians.

Adult↗

PubMed1994

Cancer among Hispanic males in south Florida. Nine years of incidence data.

BACKGROUND: Dade County (Florida) is the largest county in the United States in which a majority of the population is Hispanic. To describe and compare cancer incidence among white and black Hispanic and non-Hispanic males in South Florida and to identify those sites showing important racial-ethnic differences between sub-groups, incidence rates were determined from 9 years of prospective population-based cancer surveillance data. METHODS: All incident cancer cases diagnosed among male residents of Dade County for the period January 1, 1981, through December 31, 1989, were obtained from the statewide tumor registry for Florida, the Florida Cancer Data System. Race- and ethnic-specific age-standardized incidence rates and standardized rate ratios to compare rates among racial-ethnic subgroups for each site are presented. RESULTS: Compared with white non-Hispanics, white Hispanic males had significantly higher rates of cancers of the liver, gallbladder, nasal cavity, penis, and thyroid; acute lymphocytic leukemia; and Kaposi's sarcoma. Significantly lower rates were found for cancers of the esophagus, stomach, colon, rectum, pancreas, lung, testes, bladder, and kidney, and for mesothelioma, melanoma, non-Hodgkin's lymphoma, and chronic lymphocytic leukemia. Black Hispanics had significantly lower rates only of cancers of the esophagus, lung, and prostate than did black non-Hispanics. CONCLUSION: Differences were found in incidence rates by race-ethnicity; while incidence rates for most sites among white Hispanic males were lower than among white non-Hispanics, higher rates for several sites are of particular concern and merit further investigation to determine differences in risk factors and exposures.

Black or African American↗

PubMed1996

Florida tobacco prevention and control program: building capacity through collaboration.

Florida has an aggressive program of tobacco prevention and control. The Tobacco-Free Florida Coalition has been a leading force; however, numerous other partners have also participated in this effort. The development of various programs, strategies and activities has occurred because several key agencies in the state were willing to collaborate on agreed upon goals and reduce the traditional barriers of turf and territory in working with each other. As a result a comprehensive tobacco prevention and control effort has been established in Florida, and several large federal and private grants have been secured to support this initiative. This effort was accomplished in about four years in the absence of a dedicated tobacco tax increase which has benefitted at least two states in the country, California and Massachusetts. The infrastructure is now in place for a great deal of future success with this initiative. Continual assessment will be needed to ensure that the objectives of this program are achieved as the Tobacco-Free Florida Coalition moves ahead with its action plans over the next few years.

Adolescent↗

PubMed2003

Biomass and exopolysaccharide production in submerged cultures of Pleurotus ostreatoroseus Sing. and Pleurotus ostreatus "florida" (Jack.: Fr.) Kummer.

The species of the genus Pleurotus produce large amounts of biomass and exopolysaccharide (EPS) in submerged cultures, which may be used for biotechnological purposes. In the present work two Brazilian autochthonous strains of edible Pleurotus (P. ostratoroseus Sing. and P. ostreatus "florida") were used. The fungi grown in liquid Potato Dextrose medium (PD) were used as inocula to cultivate those microorganisms in the POL culture medium. After a 9-day incubation, the optimal growth time for biomass production, P. ostreatus "florida" presented higher biomass production (22.8 g d.w./l) than P. ostreatoroseus (16.8 g d.w./l). After a 7-day incubation, the optimal growth time for EPS production, P. ostreatoroseus produced higher amounts of crude EPS (5.8 g d.w./l) than P. ostreatus "florida" (1.4 g d.w./l). Relative carbohydrate composition for P. ostreatoroseus and P. ostreatus "florida" EPS were: glucose (95.5-87.7), galactose (traces - 4.9), mannose (traces - 3.1), xylose (1.3-2.5), and arabinose (3.2-1.8). Lower ammonium sulfate concentration in the POL culture medium increased the exopolysaccharides production by P. ostreatoroseus.

Ammonium Sulfate↗

PubMed2005

Anthocyanins in Cornus alternifolia, Cornus controversa, Cornus kousa and Cornus florida fruits with health benefits.

The anthocyanins in native Cornus alternifolia, Cornus controversa, Cornus kousa and Cornus florida were quantified by HPLC and characterized by spectroscopic methods. The analyses of C. alternifolia and C. controversa revealed that both contained , and , respectively. Similarly, C. florida and C. kousa showed identical anthocyanin profiles with major anthocyanins as and cyanidin 3-O-glucoside (6), respectively. The amount of anthocyanins , and in C. alternifolia and C. controversa were 8.21, 8.44 and 0.02 mg; and 7.74, 5.92, and 0.02 mg/g of fresh fruits, respectively. The anthocyanins and in C. kousa and C. florida were 0.02 and 0.16 mg; and 0.62 and 0.03 mg/g fresh fruits, respectively. Anthocyanins and were not studied earlier for their inhibition of lipid peroxidation, cyclooxygenase enzymes (COX-1 and COX-2), and tumor cell proliferation. At 50 microg/mL, anthocyanins and inhibited lipid peroxidation by 71% and 68%, respectively. Similarly, they inhibited COX-1 enzymes by 39% and 49% and COX-2 enzyme by 54% and 48%, respectively, at 100 microg/mL. Anthocyanin displayed 50% growth inhibition (IC(50)) at 21, 25, 50, 60, and 75 microg/mL, against HCT-116 (colon), MCF-7 (breast), NCI-H460 (lung), SF-268 (central nervous system CNS), and AGS (stomach) human tumor cell lines, respectively. Similarly, IC(50) values for anthocyanin were 38, 30, 76, 100, and 100 microg/mL against HCT-116, MCF-7, NCI H460, SF-268, and AGS, respectively. This is the first report of the quantification and biological activities of anthocyanins in C. alternifolia, C. kousa and C. florida in addition to the anthocyanins not previously quantified in C. controversa.

Anthocyanins↗

PubMed1992

Conversion from external appliance wearing or internal urinary diversion to a continent urinary reservoir (Florida pouch I and II): surgical technique, indications and complications.

A total of 20 patients with diversion requiring an external appliance or internal urinary diversion underwent conversion to a continent urinary reservoir (Florida pouch I or II). All patients subsequently reported an improvement in the quality of life and expressed satisfaction with the new urinary diversion procedure. Of the patients 15 (75%) previously had an ileal conduit, while 1 (5%) had undergone ureterosigmoidostomy, 1 (5%) had cutaneous ureterostomy, 1 (5%) had a suprapubic tube, 1 (5%) had a sigmoid conduit and 1 (5%) had a cecal conduit. After the original diversion 3 patients (15%) had recurrent urinary infections, 3 had complications related to the stoma and external appliance (stenosis and skin dermatitis) and 5 (25%) had ureteral obstruction in 7 ureters. A total of 17 patients with conduits (85%) underwent conversion via different surgical technical aspects depending on the status of the intestinal segment from the conduit and the function of the ureteral reimplantation: in 14 the conduit was discarded or was used only to patch the newly created Florida I colonic pouch, while in 6 the conduit was preserved and 9 ureterointestinal reimplantations were left undisturbed (Florida pouch II). Among 7 ureters preoperatively obstructed (original diversion), reimplanting them into the pouch failed to prevent further renal damage in 5 (71%). Three renal units required nephrectomy, 2 kidneys deteriorated and 2 recovered renal function after percutaneous balloon dilation and stenting. Among 31 preoperatively nonobstructed renoureteral units (original diversion), 22 were reimplanted into the colonic reservoir. One of these units (4.2%) became obstructed postoperatively and 3 (13.5%) presently have reflux. The 10 reimplantations left undisturbed in the detubularized conduit drain satisfactorily without postoperative obstruction and in 6 reflux has not been demonstrated. Renal function (serum creatinine) is preserved in all patients but 15 (75%) have hyperchloremia of mild degree. Two patients (10%) have acidosis and 1 (5%) of these had low red blood cell folic acid. Conversion of an external or internal diversion to a continent colonic urinary reservoir (Florida pouch I or II) can be successful and improve the quality of life of the patient. The functioning renal units that were preoperatively obstructed were associated with a high failure rate (71%) after reimplantation. Metabolic alterations will require long-term followup, and are particularly worrisome in children and young adults.

Adolescent↗

PubMed2003

Ancestral polymorphisms in genetic markers obscure detection of evolutionarily distinct populations in the endangered Florida grasshopper sparrow (Ammodramus savannarum floridanus).

Genetic analyses of bird subspecies designated as conservation units can address whether they represent units with independent evolutionary histories and provide insights into the evolutionary processes that determine the degree to which they are genetically distinct. Here we use mitochondrial DNA control region sequence and six microsatellite DNA loci to examine phylogeographical structure and genetic differentiation among five North American grasshopper sparrow (Ammodramus savannarum) populations representing three subspecies, including a population of the endangered Florida subspecies (A. s. floridanus). This federally listed taxon is of particular interest because it differs phenotypically from other subspecies in plumage and behaviour and has also undergone a drastic decline in population size over the past century. Despite this designation, we observed no phylogeographical structure among populations in either marker: mtDNA haplotypes and microsatellite genotypes from floridanus samples did not form clades that were phylogenetically distinct from variants found in other subspecies. However, there was low but significant differentiation between Florida and all other populations combined in both mtDNA (FST = 0.069) and in one measure of microsatellite differentiation (theta = 0.016), while the non-Florida populations were not different from each other. Based on analyses of mtDNA variation using a coalescent-based model, the effective sizes of these populations are large (approximately 80,000 females) and they have only recently diverged from each other (< 26,000 ybp). These populations are probably far from genetic equilibrium and therefore the lack of phylogenetic distinctiveness of the floridanus subspecies and minimal genetic differentiation is due most probably to retained ancestral polymorphism. Finally, levels of variation in Florida were similar to other populations supporting the idea that the drastic reduction in population size which has occurred within the last 100 years has not yet had an impact on levels of variation in floridanus. We argue that despite the lack of phylogenetic distinctiveness of floridanus genotypes the observed genetic differentiation and previously documented phenotypic differences justify continued designation of this subspecies as a protected population segment.

Animals↗

PubMed2000

Breast Disease-Related Educational Outcomes at the University of Florida.

The purpose of this study was to assess resident knowledge related to breast disease at the University of Florida. In addition, we surveyed graduates of our surgery program regarding the importance of breast disease in their surgical practice and we determined if the completion of postgraduate courses on breast disease influenced patient outcome measures. In the decade of the 1990s, we compared the American Board of Surgery In-Service Training Examination (ABSITE) scores of residents rotating on the breast service in the 6 months immediately prior to examination (June-January) with those residents who had not rotated on the breast service within the 6 months leading up to the ABSITE examination. We also compared ABSITE scores of surgery residents at the University of Florida at Gainesville (breast service) to surgery residents at the University of Florida at Jacksonville (no breast service). Finally, we surveyed graduates of the general surgery program at the University of Florida at Gainesville (1980-1998) to determine the importance of breast disease in their practices and if the completion of postgraduate courses on breast disease influenced rates of breast conservation and immediate breast reconstruction. Residents who rotated on the breast service in the 6 months prior to the ABSITE had significantly fewer incorrect breast-related ABSITE questions than residents who had not rotated on the breast service. Those graduates who had taken postgraduate courses in breast disease responded that they were more likely to perform breast-conserving surgery. There was also a trend for graduates who had completed postgraduate courses on breast disease to respond that they were more likely to perform immediate breast reconstruction following mastectomy. Limiting breast surgery to a single service does not appear to improve resident accumulation and retention of breast disease-related knowledge. Graduates who complete postgraduate courses related to breast disease are more likely to perform breast-conserving surgery and immediate reconstruction following mastectomy. Since the management of breast disease comprises a significant part of general surgical practice, surgical educators must ensure adequate resident education and evaluation with respect to breast disease.

Journal Article↗